Dysexecutive syndrome and cerebrovascular disease in non-amnestic mild cognitive impairment: a systematic review of the literature

Sudo, Felipe Kenji; Alves, Carlos Eduardo Oliveira; Alves, Gilberto Sousa; Ericeira-Valente, Letice; Tiel, Chan; Moreira, Denise Madeira; Laks, Jerson; Engelhardt, Eliasz

doi:10.1590/S1980-57642012DN06030006

ABSTRACT

Objective:

Non-amnestic dysexecutive Vascular Mild Cognitive Impairment (VaMCI) may represent preclinical Vascular Dementia (VaD). The aim of this study was to summarize the clinical, neuropsychological and neuroimaging aspects of VaMCI; and to assess its patterns of progression to dementia.

Methods:

Searches were made in the ISI Web of Knowledge, PubMed and Lilacs databases, using the terms "mild cognitive impairment" and "executive function". Altogether, 944 articles were retrieved.

Results:

VaMCI cases had poorer performances on fronto-executive tasks, a higher prevalence of stroke, presence of periventricular and profound white matter hyperintensities on MRI images, as well as more extrapyramidal signs and behavioral symptoms. Executive dysfunction might be associated with disconnection of fronto-parietal-subcortical circuits. Progression to dementia was associated with baseline deficits in executive function, in simple sustained attention and language, and large periventricular WMH.

Discussion:

VaMCI develops with impairment in non-memory domains and subcortical white matter changes on MRI images, which are consistent with clinical and neuroimaging findings in VaD.

Key words:
mild cognitive impairment; vascular dementia; executive function; neuropsychology; neuroimaging; cerebrovascular disease

RESUMO

Objetivo:

Comprometimento Cognitivo Leve Vascular (CCLV) não-amnésico disexecutivo pode representar a fase pré-clínica da Demência Vascular (DV). Este estudo tem por objetivo descrever os aspectos clínicos, cognitivos e de neuroimagem do CCLV, além de avaliar padrões de progressão para demência.

Métodos:

Foram realizadas buscas nas bases de dados ISI Web of Knowledge, PubMed e Lilacs, usando os termos "comprometimento cognitivo leve" e "função executiva". Ao todo, 944 artigos foram obtidos.

Resultados:

Pacientes com CCLV apresentaram piores desempenhos em tarefas fronto-executivas, histórico de acidentes vasculares encefálicos, presença de hiperintensidades da substância branca periventriculares e profundas, e mais, sinais extrapiramidais e sintomas comportamentais. A disfunção executiva parece se relacionar à desconexão de circuitos fronto-parieto-subcorticais. A progressão para demência relacionou-se a déficits em linguagem, função executiva e atenção sustentada à primeira avaliação, e a hiperintensidades na substância branca periventricular extensas.

Discussão:

O CCLV cursa com comprometimento cognitivo em domínios não-memória e alterações da substância branca subcortical à imagem por RM alinhadas com os achados característicos da DV.

Palavras-chave:
comprometimento cognitivo leve; demência vascular; função executiva; neuropsicologia; neuroimagem; doença cerebrovascular.

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REFERENCES

Morris JC, Price JL. Pathologic correlates of nondemented aging, mild cognitive impairment, and early-stage Alzheimer's disease. J Mol Neurosc 2001;17:101-118.
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
Busse A, Hensel A, Gühne U, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: Longterm course of four clinical subtypes. Neurology 2006;67:2176-2185.
Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B. Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord 2006;22:312-319.
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194.
Delano-Wood L, Bondi MW, Sacco J, et al. Heterogeneity in mild cognitive impairment: differences in neuropsychological profile and associated white matter lesion pathology. J Int Neuropsychol Soc 2009;15:906-914.
Libon DJ, Bondi MW, Price CC, et al. Verbal serial list learning in mild cognitive impairment: A profile analysis of interference, forgetting, and errors. J Int Neuropsychol Soc 2011;17:905-914.
American Psychiatric Association. DSM-5 Development. Available at Available at http://www.dsm5.org Accessed March 25, 2012.
» http://www.dsm5.org
Palmer K, Backman L, Winblad B, Fratiglioni L. Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. Am J Geriatr Psychiatry 2008;16:603-611.
Pa J, Boxer A, Chao LL, et al. Clinical-Neuroimaging Characteristics of Dysexecutive Mild Cognitive Impairment. Ann Neurol. 2009;65:414-423.
Eppig J, Wambach D, Nieves C, et al. Dysexecutive functioning in mild cognitive impairment: derailment in temporal gradient. J Int Neuropsychol Soc 2012;18:20-28.
Johnson JK, Pa J, Boxer AL, et al. Baseline preditors of clinical progression among patients with Dysexecutive Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2010;30:344-351.
Sudo FK, Alves CEO, Alves GS, et al. Dysexecutive mild cognitive impairment: clinical, cognitive and neuroimaging aspects. VIII Reunião dos Pesquisadores em Doença de Alzheimer - Brazilian Meeting on Alzheimer´s Disease and Related Disorders. 2011;5:36.
Frisoni GB, Galluzi S, Bresciani L, et al. Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome. J Neurol 2002;249:1423-32.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Plos Medicine. 2009;6:1-28.
Chao L, Pa J, Duarte A, et al. Patterns of cerebral hypoperfusion in amnestic and dysexecutive MCI. Alzheimer Dis Assoc Disord. 2009;23: 245-252.
Zhou A, Jia J. Different cognitive profiles between mild cognitive impairment due to cerebral small vessel disease and mild cognitive impairment of Alzheimer's disease origin. J Int Neuropsychol Soc 2009;15:898-905.
Galluzzi S, Sheud CF, Zanetti O, et al. Distinctive clinical features of mild cognitive impairment with subcortical cerebrovascular disease. Dement Geriatr Cogn Disord 2005;19:196-203.
Gainotti G, Ferraccioli M, Vita MG, et al. Patterns of neuropsychological impairment in MCI patients with small subcortical infarcts or hippocampal atrophy. J Int Neuropsychol Soc 2008;14:611-619.
Knopman DS, Roberts RO, Geda YE, et al. Association of prior stroke with cognitive function and cognitive impairment: a population-based study. Arch Neurol 2009;66:614-619.
Sudo FK, Alves GS, Alves CE, et al. Impaired abstract thinking may discriminate between normal aging and mild cognitive impairment. Arq Neuropsiquiatr 2010;68:179-184.
Brandt J, Aretouli E, Neijstrom E, et al. Selectivity of executive function deficits in Mild Cognitive Impairment. Neuropsychology 2009;23:607-618.
Halfelt JJ, Wuu J, Sollinger AB, et al. An exploration of subgroups of mild cognitive impairment based on cognitive, neuropsychiatric and functional features: analyses of data from the National Alzheimer's Coordinating Center. Am J Geriatr Psychiatr. 2011;19:940-950.
Ambron E, McIntosh RD, Finotto S, et al. Closing-in behavior in mild cognitive impairment: an executive deficit. J Int Neuropsychol Soc 2012;18:269-276.
Teng E, Becker BW, Woo E, et al. Subtle deficits in instrumental activities of daily living in subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord .2010;30:189-197.
Zanetti M, Ballabio C, Abbate C, et al. Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study. J Am Geriatr Soc. 2006;54:580-586.
Bombois S, Debette S, Delbeuck X, et al. Prevalence of subcortical vascular lesions and association with executive function in mild cognitive impairment subtypes. Stroke 2007;38:2595-2597.
Jacobs HI, Visser PJ, Van Boxtel MPJ, et al. The association between white matter hyperintensities and executive decline in mild cognitive impairment in network dependent. Neurobiol Aging 2012;33:201.e1-201.e8.
Shim YS, Yoon B, Shon YM, et al. Difference of the hippocampal and white matter microalterations in MCI patients according to the severity of subcortical vascular changes: neuropsychological correlates of diffusion tensor imaging. Clin Neurol Neurosug 2008;110:552-561.
Grambaite R, Selnes P, Reinvang I, et al. Executive dysfunction in mild cognitive impairment is associated with changes in frontal and cingulate white-matter tracts. J Alzheimer's Disease 2011;27:453-462.
Sachdev PS, Chen X, Brodaty H, et al. The determinants and longitudinal course of post-stroke mild cognitive impairment. J Int Neuropsychol. 2009;15:915-923.
Debette S, Bombois S, Bruandet A, et al. Subcortical hyperintensities are associated with cognitive decline in patients with mild cognitive impairment. Stroke 2007;38:2924-2930.
Saunders NL, Summers MJ. Longitudinal deficits in attention, executive and working memory in subtypes of mild cognitive impairment. Neuropsychology 2011;25:237-248.
Engelhardt E, Moreira DM, Alves GS, et al. Binswanger's disease: quantitative fractional anisotropy. Arq Neuropsiquiatr 2009;67:179-184.
Engelhardt E, Moreira DM, Alves GS, et al. The corpus callosum in Binswanger's disease - A quantitative fractional anisotropy analysis. Dement Neuropsychol 2008;2:278-283.
Tullberg M, Fletcher E, DeCarli C, et al. White-matter lesions impair frontal lobe function regardless of their location. Neurology 2004;63:246-253.
Royall DR, Lauterbach EC, Cummings JL, et al. Executive control function: A review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Associations. J Neuropsych Clin Neurosc 2002;14:377-405.
Miyake A, Friedman NP, Emerson MJ, Witzki AH Howerter ,. Contributions to complex "frontal lobe" tasks: a latent variable analysis. Cognitive Psychology 2000;41:49-100.
Robinson A, Heaton R, Leahman R, Stilson D. The utility of Wisconsin Card Sorting test in detecting and localizing frontal lobe lesions. J Consult Clin Psychology 1980;48:605-614.
Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-62.
Bechara A, Damasio AR, Damasio H, Anderson S. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994;50:7-15.
Royall DR, Mahurin RK, Gray K. Bedside assessment of executive impairment: the Executive Interview (EXIT). J Am Geriatr Soc 1992; 40:1221-1226.
Royall DR, Cordes JA, Polk M. CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:588-594.
Rosen WG. Verbal fluency in aging and dementia. J Clin Exp Neuropsychol 1980;2:135-146.
Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271-276.
Porteus SD. New applications of the Porteus Maze tests. Percept Mot Skills 1968;26:787-798.
Wentzel C., Rockwood K, MacKnight C, et al. Progression of impairment in patients with vascular cognitive impairment without dementia. Neurology 2001;57:714-716.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
20 May 2012
Accepted
20 July 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Morris JC, Price JL. Pathologic correlates of nondemented aging, mild cognitive impairment, and early-stage Alzheimer's disease. J Mol Neurosc 2001;17:101-118.

[2] Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[3] Busse A, Hensel A, Gühne U, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: Longterm course of four clinical subtypes. Neurology 2006;67:2176-2185.

[4] Yaffe K, Petersen RC, Lindquist K, Kramer J, Miller B. Subtype of mild cognitive impairment and progression to dementia and death. Dement Geriatr Cogn Disord 2006;22:312-319.

[5] Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.

[6] Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194.

[7] Delano-Wood L, Bondi MW, Sacco J, et al. Heterogeneity in mild cognitive impairment: differences in neuropsychological profile and associated white matter lesion pathology. J Int Neuropsychol Soc 2009;15:906-914.

[8] Libon DJ, Bondi MW, Price CC, et al. Verbal serial list learning in mild cognitive impairment: A profile analysis of interference, forgetting, and errors. J Int Neuropsychol Soc 2011;17:905-914.

[9] American Psychiatric Association. DSM-5 Development. Available at Available at http://www.dsm5.org Accessed March 25, 2012.
» http://www.dsm5.org

[10] Palmer K, Backman L, Winblad B, Fratiglioni L. Mild cognitive impairment in the general population: occurrence and progression to Alzheimer disease. Am J Geriatr Psychiatry 2008;16:603-611.

[11] Pa J, Boxer A, Chao LL, et al. Clinical-Neuroimaging Characteristics of Dysexecutive Mild Cognitive Impairment. Ann Neurol. 2009;65:414-423.

[12] Eppig J, Wambach D, Nieves C, et al. Dysexecutive functioning in mild cognitive impairment: derailment in temporal gradient. J Int Neuropsychol Soc 2012;18:20-28.

[13] Johnson JK, Pa J, Boxer AL, et al. Baseline preditors of clinical progression among patients with Dysexecutive Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2010;30:344-351.

[14] Sudo FK, Alves CEO, Alves GS, et al. Dysexecutive mild cognitive impairment: clinical, cognitive and neuroimaging aspects. VIII Reunião dos Pesquisadores em Doença de Alzheimer - Brazilian Meeting on Alzheimer´s Disease and Related Disorders. 2011;5:36.

[15] Frisoni GB, Galluzi S, Bresciani L, et al. Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome. J Neurol 2002;249:1423-32.

[16] Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Plos Medicine. 2009;6:1-28.

[17] Chao L, Pa J, Duarte A, et al. Patterns of cerebral hypoperfusion in amnestic and dysexecutive MCI. Alzheimer Dis Assoc Disord. 2009;23: 245-252.

[18] Zhou A, Jia J. Different cognitive profiles between mild cognitive impairment due to cerebral small vessel disease and mild cognitive impairment of Alzheimer's disease origin. J Int Neuropsychol Soc 2009;15:898-905.

[19] Galluzzi S, Sheud CF, Zanetti O, et al. Distinctive clinical features of mild cognitive impairment with subcortical cerebrovascular disease. Dement Geriatr Cogn Disord 2005;19:196-203.

[20] Gainotti G, Ferraccioli M, Vita MG, et al. Patterns of neuropsychological impairment in MCI patients with small subcortical infarcts or hippocampal atrophy. J Int Neuropsychol Soc 2008;14:611-619.

[21] Knopman DS, Roberts RO, Geda YE, et al. Association of prior stroke with cognitive function and cognitive impairment: a population-based study. Arch Neurol 2009;66:614-619.

[22] Sudo FK, Alves GS, Alves CE, et al. Impaired abstract thinking may discriminate between normal aging and mild cognitive impairment. Arq Neuropsiquiatr 2010;68:179-184.

[23] Brandt J, Aretouli E, Neijstrom E, et al. Selectivity of executive function deficits in Mild Cognitive Impairment. Neuropsychology 2009;23:607-618.

[24] Halfelt JJ, Wuu J, Sollinger AB, et al. An exploration of subgroups of mild cognitive impairment based on cognitive, neuropsychiatric and functional features: analyses of data from the National Alzheimer's Coordinating Center. Am J Geriatr Psychiatr. 2011;19:940-950.

[25] Ambron E, McIntosh RD, Finotto S, et al. Closing-in behavior in mild cognitive impairment: an executive deficit. J Int Neuropsychol Soc 2012;18:269-276.

[26] Teng E, Becker BW, Woo E, et al. Subtle deficits in instrumental activities of daily living in subtypes of mild cognitive impairment. Dement Geriatr Cogn Disord .2010;30:189-197.

[27] Zanetti M, Ballabio C, Abbate C, et al. Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study. J Am Geriatr Soc. 2006;54:580-586.

[28] Bombois S, Debette S, Delbeuck X, et al. Prevalence of subcortical vascular lesions and association with executive function in mild cognitive impairment subtypes. Stroke 2007;38:2595-2597.

[29] Jacobs HI, Visser PJ, Van Boxtel MPJ, et al. The association between white matter hyperintensities and executive decline in mild cognitive impairment in network dependent. Neurobiol Aging 2012;33:201.e1-201.e8.

[30] Shim YS, Yoon B, Shon YM, et al. Difference of the hippocampal and white matter microalterations in MCI patients according to the severity of subcortical vascular changes: neuropsychological correlates of diffusion tensor imaging. Clin Neurol Neurosug 2008;110:552-561.

[31] Grambaite R, Selnes P, Reinvang I, et al. Executive dysfunction in mild cognitive impairment is associated with changes in frontal and cingulate white-matter tracts. J Alzheimer's Disease 2011;27:453-462.

[32] Sachdev PS, Chen X, Brodaty H, et al. The determinants and longitudinal course of post-stroke mild cognitive impairment. J Int Neuropsychol. 2009;15:915-923.

[33] Debette S, Bombois S, Bruandet A, et al. Subcortical hyperintensities are associated with cognitive decline in patients with mild cognitive impairment. Stroke 2007;38:2924-2930.

[34] Saunders NL, Summers MJ. Longitudinal deficits in attention, executive and working memory in subtypes of mild cognitive impairment. Neuropsychology 2011;25:237-248.

[35] Engelhardt E, Moreira DM, Alves GS, et al. Binswanger's disease: quantitative fractional anisotropy. Arq Neuropsiquiatr 2009;67:179-184.

[36] Engelhardt E, Moreira DM, Alves GS, et al. The corpus callosum in Binswanger's disease - A quantitative fractional anisotropy analysis. Dement Neuropsychol 2008;2:278-283.

[37] Tullberg M, Fletcher E, DeCarli C, et al. White-matter lesions impair frontal lobe function regardless of their location. Neurology 2004;63:246-253.

[38] Royall DR, Lauterbach EC, Cummings JL, et al. Executive control function: A review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Associations. J Neuropsych Clin Neurosc 2002;14:377-405.

[39] Miyake A, Friedman NP, Emerson MJ, Witzki AH Howerter ,. Contributions to complex "frontal lobe" tasks: a latent variable analysis. Cognitive Psychology 2000;41:49-100.

[40] Robinson A, Heaton R, Leahman R, Stilson D. The utility of Wisconsin Card Sorting test in detecting and localizing frontal lobe lesions. J Consult Clin Psychology 1980;48:605-614.

[41] Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-62.

[42] Bechara A, Damasio AR, Damasio H, Anderson S. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994;50:7-15.

[43] Royall DR, Mahurin RK, Gray K. Bedside assessment of executive impairment: the Executive Interview (EXIT). J Am Geriatr Soc 1992; 40:1221-1226.

[44] Royall DR, Cordes JA, Polk M. CLOX: an executive clock drawing task. J Neurol Neurosurg Psychiatry 1998;64:588-594.

[45] Rosen WG. Verbal fluency in aging and dementia. J Clin Exp Neuropsychol 1980;2:135-146.

[46] Reitan RM. Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 1958;8:271-276.

[47] Porteus SD. New applications of the Porteus Maze tests. Percept Mot Skills 1968;26:787-798.

[48] Wentzel C., Rockwood K, MacKnight C, et al. Progression of impairment in patients with vascular cognitive impairment without dementia. Neurology 2001;57:714-716.

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