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Occurrence of Impaired Physical Performance in Memory Clinic Patients With Cerebral Small Vessel Disease

Verwer, Jurre H., MSc*; Biessels, Geert-Jan, MD, PhD*; Heinen, Rutger, MD*; Exalto, Lieza G., MD, PhD*; Emmelot-Vonk, Marielle H., MD, PhD; Koek, Huiberdina L., MD, PhD on behalf of the Utrecht Vascular Cognitive Impairment (VCI) study group

Alzheimer Disease & Associated Disorders: July-September 2018 - Volume 32 - Issue 3 - p 214–219
doi: 10.1097/WAD.0000000000000233
Original Articles

Cerebral small vessel disease (CSVD) occurs often in memory clinic patients. Apart from cognitive deficits, these patients can express physical decline, which predicts adverse health outcomes. In this study, we investigated the cooccurrence of clinically relevant impairments in physical performance and CSVD in memory clinic patients. We included 131 patients with vascular brain injury, mild cognitive impairment or Alzheimer disease with available 3T MRI and physical performance scores. CSVD was visually rated according to 3 subtypes and as a total burden score, composed of the presence of white matter hyperintensities (WMH), lacunar infarcts (LI), and cerebral microbleeds (MB). Physical performance was assessed with the Short Physical Performance Battery (SPPB), covering gait speed, balance, and chair stand performance. CSVD markers and impaired physical performance both occurred often. High total CSVD burdens cooccurred with impaired chair stand performances [odds ratio (OR) 2.67; 95% confidence interval (CI) (1.12-6.34)]. WMH cooccurred with impaired SPPB scores (OR, 3.76; 95% CI, 1.68-8.44), impaired gait speeds (OR, 4.11; 95% CI, 1.81-9.31) and impaired chair stand performances (OR, 5.62; 95% CI, 2.29-13.80). In memory clinic patients, high burdens of CSVD, particularly WMH, often cooccur with impairments in physical performance. The presence of WMH should alert clinicians to the presence of these, clinically relevant, physical impairments.

*Department of Neurology, Brain Center Rudolf Magnus

Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands

J.H.V.: conceptualization and design, data collection, data analysis, data interpretation, drafting manuscript; G.J.B.: conceptualization and design, data interpretation, critical revision of manuscript; R.H.: data collection, critical revision of manuscript; L.G.E.: data collection, critical revision of manuscript; M.H.E.-V.: critical revision of the manuscript; H.L.K.: conceptualization and design, data analysis, data interpretation, critical revision of manuscript.

Members of the Utrecht Vascular Cognitive Impairment (VCI) Study group involved in the present study (in alphabetical order by department): University Medical Center Utrecht, The Netherlands, Department of Neurology: G.J.B., L.G.E., O.N.G., R.H., S.M.H., N.K., J.H.V.; Department of Radiology/Image Sciences Institute: J. de Bresser; Department of Geriatrics: M.H.E.-V., H.L.K., J.E. de Wit; Julius Center for Health Sciences and Primary Care: K. Blom; Hospital Diakonessenhuis Zeist, The Netherlands: M. Hamaker, R. Faaij, M. Pleizier, M. Prins, E. Vriens.

Supported by funding for the “Dutch Parelsnoer collaboration” and grants from ZonMw (Vidi), The Netherlands Organization for Health Research and Development [91711384], and The Netherlands Heart Foundation [2010 T073] to G.J.B.

The authors declare no conflicts of interest.

Reprints: Jurre H. Verwer, MSc, Department of Neurology & Neurosurgery, Room number G03.232 University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA Utrecht, The Netherlands (e-mail:

Received July 12, 2017

Accepted November 12, 2017

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