Subcortical vascular dementia: amyloid burden predicts longitudinal cognitive decline

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Takeaway

  • In subcortical vascular dementia, amyloid burden, independently or interactively with small vessel disease, contributed to longitudinal cognitive decline, and amyloid deposition was the strongest poor prognostic factor.

 

Study design/methods

  • This longitudinal cohort study enrolled 61 patients with subcortical vascular dementia from 2 tertiary referral centers.
  • Patients had baseline MRI and 11C-Pittsburgh compound B (PiB) PET (to detect amyloid) and annual neuropsychological testing for 3 years.
  • Generalized estimation equations allowed controlling for age, sex, education, APOE4, and follow-up interval.

 

Key Results

  • PiB positivity predicted faster decline in attention, visuospatial, visual memory, and global cognition function.
  • More white matter hyperintensities predicted faster cognitive decline in attention, visuospatial, visual recognition memory, and language function.
  • Lacunes and microbleeds were not predictors.
  • Only PiB positivity was associated with faster decline on global dementia rating.

 

Limitations

  • Findings might not apply to patients seen in other settings.

 

Why this matters

  • PET amyloid burden predicts cognitive decline in subcortical vascular dementia better than MRI small vessel disease.