Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease
Background Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrum...
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| Veröffentlicht in: | European journal of neurology 2022-01, Vol.29 (1), p.158-167 |
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| creator | Jokinen, Hanna Laakso, Hanna M. Ahlström, Matti Arola, Anne Lempiäinen, Juha Pitkänen, Johanna Paajanen, Teemu Sikkes, Sietske A. M. Koikkalainen, Juha Lötjönen, Jyrki Korvenoja, Antti Erkinjuntti, Timo Melkas, Susanna |
| description | Background
Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH).
Methods
Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation.
Results
Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single‐leg stance, timed up‐and‐go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up‐and‐go performance.
Conclusion
The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
Domain‐specific cognitive and motor functions had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and gray matter volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of gray matter volume with IADL was mediated by global cognition and timed up‐and‐go performance. |
| doi_str_mv | 10.1111/ene.15108 |
| format | Article |
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Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH).
Methods
Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation.
Results
Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single‐leg stance, timed up‐and‐go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up‐and‐go performance.
Conclusion
The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
Domain‐specific cognitive and motor functions had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and gray matter volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of gray matter volume with IADL was mediated by global cognition and timed up‐and‐go performance.</description><identifier>ISSN: 1351-5101</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.15108</identifier><identifier>PMID: 34528346</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Activities of daily living ; Atrophy ; Cognition ; Cognition & reasoning ; Cognitive ability ; Gait ; instrumental activities of daily living ; Magnetic resonance imaging ; motor functions ; neuropsychology ; Quality of life ; Segmentation ; small vessel disease ; Substantia alba ; Substantia grisea ; Synergism ; vascular cognitive impairment ; vascular dementia ; Vascular diseases</subject><ispartof>European journal of neurology, 2022-01, Vol.29 (1), p.158-167</ispartof><rights>2021 The Authors. published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-a87f9f3096b84c0a2dc08689a5e6e6fccb41684e9b84d5fddec36d3ee2d6a7af3</citedby><cites>FETCH-LOGICAL-c3888-a87f9f3096b84c0a2dc08689a5e6e6fccb41684e9b84d5fddec36d3ee2d6a7af3</cites><orcidid>0000-0002-8257-4037 ; 0000-0001-7889-1120 ; 0000-0003-4348-0449 ; 0000-0003-0564-9637 ; 0000-0002-5914-6202 ; 0000-0002-0161-3656 ; 0000-0002-9495-7692 ; 0000-0002-5402-787X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.15108$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.15108$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34528346$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jokinen, Hanna</creatorcontrib><creatorcontrib>Laakso, Hanna M.</creatorcontrib><creatorcontrib>Ahlström, Matti</creatorcontrib><creatorcontrib>Arola, Anne</creatorcontrib><creatorcontrib>Lempiäinen, Juha</creatorcontrib><creatorcontrib>Pitkänen, Johanna</creatorcontrib><creatorcontrib>Paajanen, Teemu</creatorcontrib><creatorcontrib>Sikkes, Sietske A. M.</creatorcontrib><creatorcontrib>Koikkalainen, Juha</creatorcontrib><creatorcontrib>Lötjönen, Jyrki</creatorcontrib><creatorcontrib>Korvenoja, Antti</creatorcontrib><creatorcontrib>Erkinjuntti, Timo</creatorcontrib><creatorcontrib>Melkas, Susanna</creatorcontrib><title>Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background
Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH).
Methods
Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation.
Results
Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single‐leg stance, timed up‐and‐go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up‐and‐go performance.
Conclusion
The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
Domain‐specific cognitive and motor functions had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and gray matter volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of gray matter volume with IADL was mediated by global cognition and timed up‐and‐go performance.</description><subject>Activities of daily living</subject><subject>Atrophy</subject><subject>Cognition</subject><subject>Cognition & reasoning</subject><subject>Cognitive ability</subject><subject>Gait</subject><subject>instrumental activities of daily living</subject><subject>Magnetic resonance imaging</subject><subject>motor functions</subject><subject>neuropsychology</subject><subject>Quality of life</subject><subject>Segmentation</subject><subject>small vessel disease</subject><subject>Substantia alba</subject><subject>Substantia grisea</subject><subject>Synergism</subject><subject>vascular cognitive impairment</subject><subject>vascular dementia</subject><subject>Vascular diseases</subject><issn>1351-5101</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp1kUFv1DAQhS0EoqXtgT-ALHEph7R27DjOEVULRarKoeUcee1xcZXYi8fZasWfr8u2HJCYy4zmffOk0SPkPWdnvNY5RDjjHWf6FTnkUumGC8Ff11l0vKl7fkDeId4zxtq-ZW_JgZBdq4VUh-T3zS5CvgtYgqUGMdlgSkgRafLUprsYStgCNdHROZWUaZg3JuQZYkH6EMpP6pdony7MRNNSbJqBhlhPt5ALtZBhnauEs5kmugVEmKgLCAbhmLzxZkI4ee5H5MeX1e3FZXP1_eu3i89XjRVa68bo3g9esEGttbTMtM4yrfRgOlCgvLVryZWWMFTZdd45sEI5AdA6ZXrjxRE53ftucvq1AJZxDmhhmkyEtODYdr2Qkveqr-jHf9D7tOT6W6UU6zsphp5V6tOesjkhZvDjJofZ5N3I2fiUyFgTGf8kUtkPz47Legb3l3yJoALne-AhTLD7v9O4ul7tLR8BpN6YFA</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Jokinen, Hanna</creator><creator>Laakso, Hanna M.</creator><creator>Ahlström, Matti</creator><creator>Arola, Anne</creator><creator>Lempiäinen, Juha</creator><creator>Pitkänen, Johanna</creator><creator>Paajanen, Teemu</creator><creator>Sikkes, Sietske A. M.</creator><creator>Koikkalainen, Juha</creator><creator>Lötjönen, Jyrki</creator><creator>Korvenoja, Antti</creator><creator>Erkinjuntti, Timo</creator><creator>Melkas, Susanna</creator><general>John Wiley & Sons, Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8257-4037</orcidid><orcidid>https://orcid.org/0000-0001-7889-1120</orcidid><orcidid>https://orcid.org/0000-0003-4348-0449</orcidid><orcidid>https://orcid.org/0000-0003-0564-9637</orcidid><orcidid>https://orcid.org/0000-0002-5914-6202</orcidid><orcidid>https://orcid.org/0000-0002-0161-3656</orcidid><orcidid>https://orcid.org/0000-0002-9495-7692</orcidid><orcidid>https://orcid.org/0000-0002-5402-787X</orcidid></search><sort><creationdate>202201</creationdate><title>Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease</title><author>Jokinen, Hanna ; Laakso, Hanna M. ; Ahlström, Matti ; Arola, Anne ; Lempiäinen, Juha ; Pitkänen, Johanna ; Paajanen, Teemu ; Sikkes, Sietske A. M. ; Koikkalainen, Juha ; Lötjönen, Jyrki ; Korvenoja, Antti ; Erkinjuntti, Timo ; Melkas, Susanna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-a87f9f3096b84c0a2dc08689a5e6e6fccb41684e9b84d5fddec36d3ee2d6a7af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Activities of daily living</topic><topic>Atrophy</topic><topic>Cognition</topic><topic>Cognition & reasoning</topic><topic>Cognitive ability</topic><topic>Gait</topic><topic>instrumental activities of daily living</topic><topic>Magnetic resonance imaging</topic><topic>motor functions</topic><topic>neuropsychology</topic><topic>Quality of life</topic><topic>Segmentation</topic><topic>small vessel disease</topic><topic>Substantia alba</topic><topic>Substantia grisea</topic><topic>Synergism</topic><topic>vascular cognitive impairment</topic><topic>vascular dementia</topic><topic>Vascular diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jokinen, Hanna</creatorcontrib><creatorcontrib>Laakso, Hanna M.</creatorcontrib><creatorcontrib>Ahlström, Matti</creatorcontrib><creatorcontrib>Arola, Anne</creatorcontrib><creatorcontrib>Lempiäinen, Juha</creatorcontrib><creatorcontrib>Pitkänen, Johanna</creatorcontrib><creatorcontrib>Paajanen, Teemu</creatorcontrib><creatorcontrib>Sikkes, Sietske A. M.</creatorcontrib><creatorcontrib>Koikkalainen, Juha</creatorcontrib><creatorcontrib>Lötjönen, Jyrki</creatorcontrib><creatorcontrib>Korvenoja, Antti</creatorcontrib><creatorcontrib>Erkinjuntti, Timo</creatorcontrib><creatorcontrib>Melkas, Susanna</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jokinen, Hanna</au><au>Laakso, Hanna M.</au><au>Ahlström, Matti</au><au>Arola, Anne</au><au>Lempiäinen, Juha</au><au>Pitkänen, Johanna</au><au>Paajanen, Teemu</au><au>Sikkes, Sietske A. M.</au><au>Koikkalainen, Juha</au><au>Lötjönen, Jyrki</au><au>Korvenoja, Antti</au><au>Erkinjuntti, Timo</au><au>Melkas, Susanna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2022-01</date><risdate>2022</risdate><volume>29</volume><issue>1</issue><spage>158</spage><epage>167</epage><pages>158-167</pages><issn>1351-5101</issn><eissn>1468-1331</eissn><abstract>Background
Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH).
Methods
Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation.
Results
Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single‐leg stance, timed up‐and‐go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up‐and‐go performance.
Conclusion
The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
Domain‐specific cognitive and motor functions had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and gray matter volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant‐evaluated IADL, but not on self‐evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of gray matter volume with IADL was mediated by global cognition and timed up‐and‐go performance.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>34528346</pmid><doi>10.1111/ene.15108</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0002-8257-4037</orcidid><orcidid>https://orcid.org/0000-0001-7889-1120</orcidid><orcidid>https://orcid.org/0000-0003-4348-0449</orcidid><orcidid>https://orcid.org/0000-0003-0564-9637</orcidid><orcidid>https://orcid.org/0000-0002-5914-6202</orcidid><orcidid>https://orcid.org/0000-0002-0161-3656</orcidid><orcidid>https://orcid.org/0000-0002-9495-7692</orcidid><orcidid>https://orcid.org/0000-0002-5402-787X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Activities of daily living Atrophy Cognition Cognition & reasoning Cognitive ability Gait instrumental activities of daily living Magnetic resonance imaging motor functions neuropsychology Quality of life Segmentation small vessel disease Substantia alba Substantia grisea Synergism vascular cognitive impairment vascular dementia Vascular diseases |
| title | Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease |
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