Executive functions and processing speed in covert cerebral small vessel disease

Hanna Jokinen; Hanna M Laakso; Anne Arola; Teemu I Paajanen; Jussi Virkkala; Teppo Särkämö; Tommi Makkonen; Iiris Kyläheiko; Heidi Heinonen; Johanna Pitkänen; Antti Korvenoja; Susanna Melkas

doi:10.1111/ene.16533

Executive functions and processing speed in covert cerebral small vessel disease

Eur J Neurol. 2024 Oct 30:e16533. doi: 10.1111/ene.16533. Online ahead of print.

Authors

Hanna Jokinen^{1

2}, Hanna M Laakso², Anne Arola², Teemu I Paajanen³, Jussi Virkkala⁴, Teppo Särkämö⁵, Tommi Makkonen^{2

5}, Iiris Kyläheiko², Heidi Heinonen¹, Johanna Pitkänen⁶, Antti Korvenoja⁷, Susanna Melkas⁶

Affiliations

¹ Division of Neuropsychology, Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
² Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
³ Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Helsinki, Finland.
⁴ Department of Neurophysiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁵ Cognitive Brain Research Unit, Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
⁶ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁷ Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

PMID: 39475227
DOI: 10.1111/ene.16533

Abstract

Background and purpose: Executive dysfunction and slowed processing speed are central cognitive impairments in cerebral small vessel disease (cSVD). It is unclear whether the subcomponents of executive functions become equally affected and whether computerized tests are more sensitive in detecting early cognitive changes over traditional tests. The associations of specific executive abilities (cognitive flexibility, inhibitory control, working memory) and processing speed with white matter hyperintensities (WMHs) and Instrumental Activities of Daily Living (IADL) were examined.

Methods: In the Helsinki Small Vessel Disease Study, 152 older individuals without stroke or dementia were assessed with brain magnetic resonance imaging and comprehensive neuropsychological evaluation. WMH volumes were obtained with automated segmentation. Executive functions and processing speed measures included established paper-and-pencil tests and the computer-based Flexible Attention Test (FAT), Simon task and Sustained Attention to Response Task.

Results: White matter hyperintensity volume and IADL were associated with multiple cognitive measures across subdomains independently of demographic factors. The highest effect sizes were observed for FAT numbers and number-letter tasks (tablet modifications from the Trail Making Test), FAT visuospatial span, Simon task and semantic verbal fluency. Some of the widely used tests such as Stroop inhibition, phonemic fluency and digit span were not significantly associated with either WMHs or IADL.

Conclusion: Processing speed and executive function subcomponents are broadly related to functional abilities and WMH severity in covert cSVD, but the strength of associations within subdomains is heavily dependent on the assessment method. Digital tests providing precise measures of reaction times and response accuracy seem to outperform many of the conventional paper-and-pencil tests.

Keywords: cerebral small vessel disease; cognition disorders; executive function; neuropsychological tests; processing speed.

Abstract

Grants and funding