Altered functional MR imaging language activation in elderly individuals with cerebral leukoaraiosis

To test the hypothesis that leukoaraiosis alters functional activation during a semantic decision language task. Materials and Methods: With institutional review board approval and written informed consent, 18 right-handed, cognitively healthy elderly participants with an aggregate leukoaraiosis lesion volume of more than 25 cm³ and 18 age-matched control participants with less than 5 cm³ of leukoaraiosis underwent functional MR imaging to allow comparison of activation during semantic decisions with that during visual perceptual decisions. Brain statistical maps were derived from the general linear model. Spatially normalized group t maps were created from individual contrast images. A cluster extent threshold of 215 voxels was used to correct for multiple comparisons. Intergroup random effects analysis was performed. Language laterality indexes were calculated for each participant. Results: In control participants, semantic decisions activated the bilateral visual cortex, left posteroinferior temporal lobe, left posterior cingulate gyrus, left frontal lobe expressive language regions, and left basal ganglia. Visual perceptual decisions activated the right parietal and posterior temporal lobes. Participants with leukoaraiosis showed reduced activation in all regions associated with semantic decisions; however, activation associated with visual perceptual decisions increased in extent. Intergroup analysis showed significant activation decreases in the left anterior occipital lobe (P = .016), right posterior temporal lobe (P = .048), and right basal ganglia (P = .009) in particpants with leukoariosis. Individual participant laterality indexes showed a strong trend (P = .059) toward greater left lateralization in the leukoaraiosis group. Conclusion: Moderate leukoaraiosis is associated with atypical functional activation during semantic decision tasks. Consequently, leukoaraiosis is an important confounding variable in functional MR imaging studies of elderly individuals.