Cognitive dysfunction associated with silent brain lesions in community-dwelling elderly subjects: the Sefuri study

Abstract

We investigated the cognitive dysfunction associated with silent brain lesions in community-dwelling elderly subjects. Subclinical brain infarction (SBI) and chronic kidney disease conferred a risk of vascular cognitive impairment (VCI) or executive dysfunction. The physical inactivity is a major public health problem; however, the causative factors for the physical inactivity per se are poorly understood. We showed that the deep white matter lesions are one of the major factors that cause apathetic behavior, and that apathy or vascular depression has significant negative effects on the leisure-time physical activity in community-dwelling elderly subjects. Furthermore, the physical inactivity is one of the modifiable risk factors for hippocampal atrophy and Alzheimer disease. Path analysis based on structural equation modeling (SEM) indicated that the direct paths from the leisure-time activity to hippocampal atrophy and from hippocampal atrophy to memory dysfunction were significant. We are unable to infer a causal or temporal association among VCI, physical inactivity, and hippocampal atrophy from the present observational study. Nonetheless, based on the SEM scheme with acceptable model fit indices, we propose a hypothesis that vascular factors (i.e., VCI and vascular depression) would facilitate hippocampal atrophy or Alzheimer disease as a result of the physical inactivity.