Early- vs late-onset subcortical vascular cognitive impairment
Young Kyoung Jang, MD, Hunki Kwon, MS, Yeo Jin Kim, MD, Na Yeon Jung, MD, Jin SanLee, MD, Juyoun Lee, MD, Juhee Chin, PhD, Kiho Im, PhD, Seun Jeon, PhD, Jong Min Lee, PhD, Joon-Kyoung Seong, PhD, Jeong Hun Kim, MS, Seonwoo Kim, PhD, Yearn Seong Choe, PhD, Kyung-Han Lee, MD, PhD, Sung Tae Kim, MD, PhD, Jae Seung Kim, MD, PhD, Jae Hong Lee, MD, PhD, Duk L. Na, MD, PhD, Sang Won Seo, MD, PhD and Hee Jin Kim, MD
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Correspondence to Dr. Kim: evekhj@gmail.com
ABSTRACT
Objective: To evaluate the differences between early-onset subcortical vascular cognitive impairment (EO-SVCI) and late-onset subcortical vascular cognitive impairment (LO-SVCI) with regard to pathologic burden, structural changes, and cognitive function.
Methods: We prospectively recruited 142 patients from a single referral center. Patients were divided into EO-SVCI (n = 30, age at onset <65 years) and LO-SVCI (n = 112, age at onset ≥65 years) groups. All patients underwent neuropsychological tests, 3T brain MRI, and [11C] Pittsburgh compound B (PiB)–PET. We compared pathologic burden such as small vessel disease and amyloid burden; structural changes such as structural network, cortical thickness, and hippocampal volume; and cognitive function between EO-SVCI and LO-SVCI.
Results: EO-SVCI patients had more lacunes, while LO-SVCI patients had higher PiB standardized uptake value ratios. EO-SVCI patients exhibited more severe structural network disruptions in the frontal area, while LO-SVCI patients exhibited more severe cortical and hippocampal atrophy. Although disease severity did not differ between the 2 groups, frontal-executive dysfunction was more severe in EO-SVCI patients.
Conclusions: EO-SVCI patients showed more vascular related factors, while LO-SVCI patients exhibited more Alzheimer disease–related characteristics. The greater number of lacunes in EO-SVCI might account for the more severe frontal network disruption and frontal-executive dysfunction, while the greater amyloid burden in LO-SVCI might account for the more severe cortical and hippocampal atrophy. Our findings suggest that the age at onset is a crucial factor that determines distinct features in SVCI patients, such as pathologic burden, structural changes, and cognitive function.
