WSO - January 2023 - 67

Ohlmeier et al.
67
Figure 1. Z-score plot of BMET scores divided by controls
and all lacunar patients and by controls and stroke subtype.
Total OM: sub-score orientation and memory; total EF-PS:
sub-score executive functioning and processing speed;
orientation: sub-task orientation; repetition: sub-task fiveitem
repetition; matching: sub-task letter-number matching;
motor: sub-task motor sequencing; Lseq: sub-task letter
sequencing; NLSeq: sub-task number-letter sequencing;
recall: sub-task five-item recall; recognition: sub-task fiveitem
recognition memory.
The size of our cohort allowed us to examine associations
between cardiovascular risk factors and VCI. Diabetes
mellitus, increased depressive symptoms, and higher BMI
were associated with increased risk of VCI, while years of
full-time education with lower risk. An association between
cognitive performance and diabetes has been identified in
previous research studies,15 suggesting that diabetic control
may be important in preventing VCI. Previous smaller
studies have shown associations between VCI and hyperlipidemia,
alcohol consumption, and smoking, but we were
unable to replicate these findings.4
We found a positive association with the GDS depression
score and VCI. Depression has been found to be a risk
factor for Alzheimer's disease16 and our findings are consistent
with a similar relationship for VCI. This is in alignment
with previous findings that show that depressive
symptoms and late
life depression are associated with
greater severity of WMH.17,18 We did not find an independent
association with the apathy score and VCI. This is in
contrast to previous studies that found that apathy but not
depression was associated with cognition, white matter
ultrastructural damage and dementia risk in SVD.6
Although both lacunar infarct count and WMH were
associated with VCI after controlling for age and sex, when
both were entered into the model only WMH remained significant.
This suggests that diffuse white matter damage is
the major pathology underlying VCI and dementia in this
population. This is consistent with the hypothesis that diffuse
white matter damage results in white matter tract disruption
and disconnection of complex distributed networks
relying on white matter integrity and underlying cognitive
functions, such as executive functioning.19 There has been
considerable debate as to whether WMH in different locations
have different associations with cognitive impairment.20
We found that DWM-WMH was associated with
Table 4. Logistic regression for the association between lacune count, WMH and VCI in lacunar patients.
Wald
Lacune count
WMH score
Sex (female)
Age in years
Time between BMET and stroke (days)
FTH education (years)
1.880
19.906
4.959
1.777
1.761
6.525
Sig.
0.170
0.000
0.026
0.183
0.185
0.011
OR
1.054
1.458
0.716
0.992
0.999
0.912
95% CI: for Exp (B)
Lower
0.978
1.235
0.534
0.979
0.998
0.849
Upper
1.137
1.720
0.961
1.004
1.000
0.979
WMH: white matter hyperintensity; VCI: vascular cognitive impairment; OR: odds ratio; CI: confidence interval; BMET: Brief Memory and Executive
Test; and FTH: full-time higher.
International Journal of Stroke, 18(1)

WSO - January 2023

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