Memory Aging and Cognition Center, National University Health System (SH, EC, CC), Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore (SH, CC), Singapore; Saw Swee Hock School of Public Health, National University of Singapore (SH), Singapore.
Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht (JMB, GJB), the Netherlands.
Am J Geriatr Psychiatry. 2021 Feb;29(2):156-165. doi: 10.1016/j.jagp.2020.06.009. Epub 2020 Jun 17.
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.
Cross-sectional.
Population-based.
Eight-hundred nineteen residents of Singapore, ages (≥65 years).
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.
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.
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.
脑白质高信号（WMH）对语言的影响可能取决于病变位置，通过对战略白质束的干扰。我们研究了老年人中 WMH 位置对语言的影响。
横断面研究。
基于人群。
819 名新加坡居民，年龄（≥65 岁）。
对所有参与者进行临床、认知和 3T 磁共振成像评估。使用改良波士顿命名测试（MBNT）和言语流畅性（VF）评估语言。使用基于主要白质束的无假设的感兴趣区（ROI）分析来确定 WMH 位置与语言之间的关联。使用贝叶斯网络分析检查区域 WMH 体积与语言之间的条件依赖性。
基于 ROI 的分析表明，左半球的前丘脑辐射（平均差异：-0.12，95%置信区间[CI]：-0.22；-0.02，p=0.019）和钩束（平均差异：-0.09，95%CI：-0.18；-0.01，p=0.022）内的 WMH 与 VF 较差显著相关，但未通过多次检验。相反，左扣带束的左扣带束的 WMH 体积与 MBNT 表现显著相关（平均差异：-0.09，95%CI：-0.17；-0.02，p=0.016）。贝叶斯网络分析证实左扣带束是 MBNT 表现的直接决定因素。
我们的研究结果确定左扣带束是 MBNT 的战略白质束，表明语言对皮质下缺血性损伤敏感。未来关于散发性缺血性病变和血管性认知障碍作用的研究不仅应关注总 WMH 体积，还应在解决语言问题时考虑 WMH 病变位置。
