Cognition

Cognition can be considered generally to be those mental capacities such as attention, memory, language, visuospatial skills, and reasoning that are commonly referred to as "thinking." Whereas these abilities clearly cannot proceed normally without a functioning cerebral cortex, white matter also makes an important contribution to normal cognition by joining cortical and subcortical areas into unified neural networks that subserve neurobehavioral capacities. Therefore, white matter lesions interrupt normal behavior by disconnecting components of these networks, even though these components may themselves be intact. One of the most common neurobehavioral deficits in patients with white matter disorders is cognitive dysfunction, and in many patients this loss of intellectual ability reaches a level that meets criteria for dementia. This syndrome is due to widespread white matter involvement that disrupts many cognitive domains simultaneously. Evidence indicates that a specific neurobehavioral pattern may characterize this syndrome; this ''white matter dementia'' may involve deficits in sustained attention, memory retrieval, visuospatial skills, frontal lobe function, and psychiatric status, with relative preservation of language, procedural memory, and extrapyramidal function. This profile of deficits and strengths is consistent with that which would be expected from the higher concentration of white matter in the frontal lobes and the right hemisphere. In other cases, in which there is more focal white matter involvement, specific neurobehavioral syndromes have been convincingly described, including amnesia, aphasia, alexia, apraxia, agnosia, executive dysfunction, and callosal disconnection. Thus, depending on its location, cerebral white matter disease may interfere with cognition as a whole or with selected cognitive domains.

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