Home › Research › Brain scans and imaging
Strategic subcortical hyperintensities in cholinergic pathways and executive function decline in treated Alzheimer patients
Behl P, Bocti C, Swartz RH, Gao F, Sahlas DJ, Lanctot KL, Streiner DL, Black SE.. Archives of neurology, 2007-02-01
Topic: Amyloid, tau and blood-test diagnosis
Objective To investigate changes in cognition, function, and behavior after 1 year in patients with Alzheimer disease being treated with cholinesterase inhibitors, in relation to the presence or absence of subcortical hyperintensities involving the cholinergic pathways. Design One-year prospective cohort study. Setting Memory Clinic, Sunnybrook Health Sciences Centre, University of Toronto. Patients Ninety patients with possible/probable Alzheimer disease who were being treated with cholinesterase inhibitors at baseline. Interventions Yearly standardized neuropsychological testing and brain magnetic resonance imaging (MRI). The Cholinergic Pathways Hyperintensities Scale (CHIPS) was applied to baseline MRIs to rate the severity of subcortical hyperintensities in cholinergic pathways. The consensus-derived Age-Related White Matter Changes (ARWMC) Rating Scale was used as a general measure of white matter disease burden. Main outcome measures Tests of global cognition, function, and behavior and specific cognitive and functional domains. Results Patients in the low CHIPS group were equivalent to those in the high CHIPS group with regard to baseline demographic characteristics, cognitive severity, and vascular risk factors. After covarying age and education, no differences were found after 1 year in overall cognition, function, and behavior or on memory, language, and visuospatial tasks. Patients in the high CHIPS group showed improvement on executive function and working memory tasks compared with those in the low CHIPS group. For the ARWMC scale, groups with and without white matter abnormalities were equivalent on baseline demographics and in cognitive, functional, and behavioral outcomes. Conclusion Cerebrovascular compromise of the cholinergic pathways may be a factor that contributes more selectively than does total white matter lesion burden to response to cholinergic therapy in Alzheimer disease, particularly on frontal/executive tasks.
Key findings
- Results Patients in the low CHIPS group were equivalent to those in the high CHIPS group with regard to baseline demographic characteristics, cognitive severity, and vascular risk factors.
- After covarying age and education, no differences were found after 1 year in overall cognition, function, and behavior or on memory, language, and visuospatial tasks.
- Patients in the high CHIPS group showed improvement on executive function and working memory tasks compared with those in the low CHIPS group.
Why it matters
In Alzheimer's patients taking cholinesterase inhibitors, having more white matter changes in cholinergic pathways did not lead to worse overall thinking, function, or behavior after one year. In fact, those with more such changes improved on executive function and working memory tasks compared with those with fewer changes.
New to this subject? Start with our plain-English guide: Brain scans & tests →
Study details
- Study designcohort study
- Evidence strengthModerate
How this study scored 55/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of neurology) |
| Journal's citation record | 3 / 4 | Archives of Neurology: journal h-index 353 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2007 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (pubmed indexes it as a clinical or observational study) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 85 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.0 citations a year over 21 year(s) since 2007 |
| Impact for its field and year | 3 / 6 | Cited 4.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 1 / 4 | Cited 5 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Sandra E. Black: h-index 132 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Toronto: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 17296844) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Behl, P., Bocti, C., Swartz, R. H., Gao, F., Sahlas, D. J., Lanctot, K. L., et al. (2007). Strategic subcortical hyperintensities in cholinergic pathways and executive function decline in treated Alzheimer patients. Archives of neurology. https://doi.org/10.1001/archneur.64.2.266
Vancouver
Behl P, Bocti C, Swartz RH, Gao F, Sahlas DJ, Lanctot KL, et al. Strategic subcortical hyperintensities in cholinergic pathways and executive function decline in treated Alzheimer patients. Archives of neurology. 2007. doi:10.1001/archneur.64.2.266. PMID: 17296844.
BibTeX
@article{behl2007-17296844,
author = {Behl, P. and Bocti, C. and Swartz, R. H. and Gao, F. and Sahlas, D. J. and Lanctot, K. L. and Streiner, D. L. and Black, S. E.},
title = {{Strategic subcortical hyperintensities in cholinergic pathways and executive function decline in treated Alzheimer patients}},
journal = {Archives of neurology},
year = {2007},
doi = {10.1001/archneur.64.2.266},
pmid = {17296844},
url = {https://doi.org/10.1001/archneur.64.2.266}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Later studies that cite this one
4 studies in the alzhub library list this one in their references.
Related studies in Brain scans and imaging
Also tagged “cognitive-function”
1,118 studies in the library carry the topic tag “cognitive-function”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 1,118 tagged studies.