The Impact of Strategic White Matter Hyperintensity Lesion Location on Language

S Hilal, JM Biesbroek, Henri Vrooman, E Chong, HJ Kuijf, N Venketasubramanian, CY (Ching-Yu) Cheng, TY Wong, GJ Biessels, C Chen

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Abstract

Objective: The impact of white matter hyperintensities (WMH) on language possibly depends on lesion location through disturbance of strategic white matter tracts. We examined the impact of WMH location on language in elderly Asians. Design: Cross-sectional. Setting: Population-based. Participants: Eight-hundred nineteen residents of Singapore, ages (≥65 years). Measurements: Clinical, cognitive and 3T magnetic resonance imaging assessments were performed on all participants. Language was assessed using the Modified Boston Naming Test (MBNT) and Verbal Fluency (VF). Hypothesis-free region-of-interest-based (ROI) analyses based on major white matter tracts were used to determine the association between WMH location and language. Conditional dependencies between the regional WMH volumes and language were examined using Bayesian-network analysis. Results: ROI-based analyses showed that WMH located within the anterior thalamic radiation (mean difference: −0.12, 95% confidence interval [CI]: −0.22; −0.02, p = 0.019) and uncinate fasciculus (mean difference: −0.09, 95% CI: −0.18; −0.01, p = 0.022) in the left hemisphere were significantly associated with worse VF but did not survive multiple testing. Conversely, WMH volume in the left cingulum of cingulate gyrus was significantly associated with MBNT performance (mean difference: −0.09, 95% CI: −0.17; −0.02, p = 0.016). Bayesian-network analyses confirmed the left cingulum of cingulate gyrus as a direct determinant of MBNT performance. Conclusion: Our findings identify the left cingulum of cingulate gyrus as a strategic white matter tract for MBNT, suggesting that language – is sensitive to subcortical ischemic damage. Future studies on the role of sporadic ischemic lesions and vascular cognitive impairment should not only focus on total WMH volume but should also take WMH lesion location into account when addressing language.

Original languageEnglish
Pages (from-to)156-165
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Volume29
Issue number2
DOIs
Publication statusPublished - Feb 2021

Bibliographical note

Funding Information:
EDIS is supported by the National Medical Research Council (NMRC), Singapore (NMRC/CG/NUHS/2010 [Grant no: R-184-006-184-511 ]) and (NMRC/CSA/038/2013). Dr. Biessels is supported by Vici Grant 918.16.616 from ZonMw, The Netherlands. This work is additionally supported by bright focus foundation (reference no. A2018165F) [Grant no: R-608-000-248-597] awarded to Dr. Hilal.

Funding Information:
Dr. Hilal received travel grant from Internationale Stichting Alzheimer Onderzoek (ISAO), the Netherlands. For the remaining authors none were declared.

Funding Information:
EDIS is supported by the National Medical Research Council (NMRC), Singapore (NMRC/CG/NUHS/2010 [Grant no: R-184-006-184-511]) and (NMRC/CSA/038/2013). Dr. Biessels is supported by Vici Grant 918.16.616 from ZonMw, The Netherlands. This work is additionally supported by bright focus foundation (reference no. A2018165F) [Grant no: R-608-000-248-597] awarded to Dr. Hilal. Dr. Hilal received travel grant from Internationale Stichting Alzheimer Onderzoek (ISAO), the Netherlands. For the remaining authors none were declared. Previous presentation: The International Society of Vascular Behavioral and Cognitive Disorder, Hong Kong, 14–17 November 2018.

Publisher Copyright:
© 2020 American Association for Geriatric Psychiatry

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