[Purpose] We use MR diffusion tensor imaging (DTI) to measure the fractional anisotropy(FA), which is an index of anisotropic diffusion in the cerebral white matter tracts, and to evaluate subjective cognitive impairment (SCI) and mild cognitive impairment (MCI).This study revealed the possibility of diagnosing cognitive dysfunction at an early stage.

[Cases and Methods] These cases were patients who were found to have decreased memory ability during a forgetfulness outpatient visit. Classification was based on the clinical dementia scale CDR. DTI was taken in all cases, and the FA value was measured. They were measured by setting regions of interest at five locations in the cerebral white matter fiber tracts (left and right uncinate fasciculus, left and right posterior cingulate fasciculus, and splenium of the corpus callosum) on DTI color map.

[Results] This time, 19 patients were assigned to SCI group, 45 patients to MCI group, 37 patients to AD group, and 14 patients to healthy group as controls. Compared with healthy group, there was a significant decrease in the FA value of the left uncinate fasciculus in SCI group, and in the right uncinate fasciculus in MCI group.

[Conclusion] In SCI and MCI groups, we observed a decrease in the FA value of uncinate fasciculus, that is, structural changes in nerve fibers in the cerebral white matter, compared to healthy group. By quantifying changes in the cerebral white matter by anisotropic diffusion of DTI, it has been suggested that the FA value is an indicator that can quantitatively and objectively evaluate cognitive dysfunction from an early stage, similar to changes in the cerebral cortex.

Olfactory groove meningiomas (OGMs) may grow large before symptomatic manifestations. We present the case of a 48-year-old woman with a history of worsening olfactory disturbance, visual impairment, and cognitive dysfunction. Magnetic resonance imaging (MRI) revealed a huge OGM with peritumoral edema. The patient underwent microsurgical resection for total gross tumor removal, and cognitive function improved postoperatively. Progressive cognitive and olfactory dysfunctions and decreased spontaneity in olfactory meningiomas are similar to the early symptoms of Alzheimer's disease and should be considered for differential diagnosis. The problem of patients' refusal to seek medical attention owing to the effects of dementia has been noted. Although symptoms of dementia also appeared in the present case, the patient was eventually taken to the hospital owing to difficulties in caring for her. Refusal to seek medical care delays appropriate medical intervention and may result in missed treatment opportunities. Particularly, OGM removal is expected to improve symptoms. Therefore, making a differential diagnosis and early treatment are crucial.

Introduction: Dural arteriovenous fistula (DAVF), also known as dural arteriovenous malformation, accounts for 10% to 15% of intracranial vascular anomalies. DAVF causes diverse symptoms based on the location of the shunt and hemodynamics, occasionally manifesting as cognitive impairment. The incidence of cognitive symptoms in patients with DAVF reportedly ranges from 1.6% to 12.0%. In this report, we describe a DAVF case that presented with cognitive symptoms and improved through endovascular therapy.

Case: A 73-year-old woman sought medical attention at our institution because of episodic vertigo and gradual progression of cognitive decline. DAVF was identified in the transverse and sigmoid sinuses and was accompanied by severe venous stasis. After two sessions of endovascular treatment, a marked reduction in shunt flow was observed, leading to improvements in the patient’s cognitive function and activities of daily living.

Discussion: DAVF is an important etiology of cognitive impairment. Notably, DAVF can also cause cerebral hemorrhage with life-threatening consequences. Early diagnosis and therapeutic intervention are crucial to ameliorate cognitive symptoms through appropriate management.