Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging: The rotterdam study

Background and Purpose Ventricular enlargement and white matter lesions are frequent findings on cerebral mag­netic resonance imaging scans of elderly subjects. In demented subjects they seem related to the severity of the dementia, but in nondemented subjects their clinical significance is less clear. We investigated the relation of size of the lateral ventricles and white matter lesions with cognitive function in a population-based random sample of nondemented elderly persons. Methods The study population consisted of 90 subjects, aged 65 to 84 years, who were randomly selected from the cohort of the Rotterdam Study, and who were not demented. The presence of white matter lesions and the ventricle-to-brain ratio were assessed on magnetic resonance scans. Par­ticipants were tested with a neuropsychological battery that covered a broad range of cognitive functions. Results Ventricular enlargement and white matter lesions were both and independently associated with poorer perfor­mance on all tests. After adjustment for age and sex, ventricular enlargement was significantly associated with worse scores on tests assessing global cognitive function (Mini-Mental State Examination, P=.02; Groninger Intelligence Test, P=.01), memory (Word List Learning delayed recall, P=.03), and executive control functions (Stroop part II, P=.02; Trail Making Test B, P<.01); for white matter lesions the differ­ences were significant for tests measuring executive control functions and mental speed (Trail Making Test A and B, P=.01 and P<.01, respectively; verbal fluency, P=.01), and memory (Word List Learning delayed recall, P=.04). Conclusions This study suggests that white matter lesions are primarily related to impairment of subcorticofrontal func­tions, whereas enlargement of the lateral ventricles is associ­ated with disturbances of cortical functions as well.