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Swardfager W, Cogo-Moreira H, Masellis M, Ramirez J, Herrmann N, Edwards JD, Saleem M, Chan P, Yu D, Nestor SM, Scott CJM, Holmes MF, Sahlas DJ, Kiss A, Oh PI, Strother SC, Gao F, Stefanovic B, Keith J, Symons S, Swartz RH, Lanctôt KL, Stuss DT, Black SE. The effect of white matter hyperintensities on verbal memory: Mediation by temporal lobe atrophy. Neurology 2018; 90:e673-e682. [PMID: 29374101 DOI: 10.1212/wnl.0000000000004983] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/27/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the relationship between white matter hyperintensities (WMH) presumed to indicate disease of the cerebral small vessels, temporal lobe atrophy, and verbal memory deficits in Alzheimer disease (AD) and other dementias. METHODS We recruited groups of participants with and without AD, including strata with extensive WMH and minimal WMH, into a cross-sectional proof-of-principle study (n = 118). A consecutive case series from a memory clinic was used as an independent validation sample (n = 702; Sunnybrook Dementia Study; NCT01800214). We assessed WMH volume and left temporal lobe atrophy (measured as the brain parenchymal fraction) using structural MRI and verbal memory using the California Verbal Learning Test. Using path modeling with an inferential bootstrapping procedure, we tested an indirect effect of WMH on verbal recall that depends sequentially on temporal lobe atrophy and verbal learning. RESULTS In both samples, WMH predicted poorer verbal recall, specifically due to temporal lobe atrophy and poorer verbal learning (proof-of-principle -1.53, 95% bootstrap confidence interval [CI] -2.45 to -0.88; and confirmation -0.66, 95% CI [-0.95 to -0.41] words). This pathway was significant in subgroups with (-0.20, 95% CI [-0.38 to -0.07] words, n = 363) and without (-0.71, 95% CI [-1.12 to -0.37] words, n = 339) AD. Via the identical pathway, WMH contributed to deficits in recognition memory (-1.82%, 95% CI [-2.64% to -1.11%]), a sensitive and specific sign of AD. CONCLUSIONS Across dementia syndromes, WMH contribute indirectly to verbal memory deficits considered pathognomonic of Alzheimer disease, specifically by contributing to temporal lobe atrophy.
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Affiliation(s)
- Walter Swardfager
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada.
| | - Hugo Cogo-Moreira
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Mario Masellis
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Joel Ramirez
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Nathan Herrmann
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Jodi D Edwards
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Mahwesh Saleem
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Parco Chan
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Di Yu
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sean M Nestor
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Christopher J M Scott
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Melissa F Holmes
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Demetrios J Sahlas
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Alexander Kiss
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Paul I Oh
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Stephen C Strother
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Fuqiang Gao
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Bojana Stefanovic
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Julia Keith
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sean Symons
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Richard H Swartz
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Krista L Lanctôt
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Donald T Stuss
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
| | - Sandra E Black
- From Sunnybrook Research Institute (W.S., M.M., J.R., N.H., J.D.E., M.S., P.C., D.Y., S.M.N., C.J.M.S., M.F.H., A.K., P.I.O., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.), Toronto; University of Toronto (W.S., M.M., N.H., M.S., P.C., D.Y., S.M.N., A.K., P.I.O., S.C.S., F.G., B.S., J.K., S.S., R.H.S., K.L.L., D.T.S., S.E.B.); University Health Network Toronto Rehabilitation Institute (W.S., P.I.O., K.L.L.), Canada; Universidade Federal de São Paulo (H.C.-M.), Brazil; McMaster University (D.J.S., S.C.S.), Hamilton; and Rotman Research Institute (D.T.S.), Baycrest, Toronto, Canada
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