Diagonal Earlobe Crease is a Visible Sign for Cerebral Small Vessel Disease and Amyloid-β.
Jin San Lee, Seongbeom Park, Hee Jin Kim, Yeshin Kim, Hyemin Jang, Ko Woon Kim, Hak Young Rhee, Sung Sang Yoon, Kyoung Jin Hwang, Key-Chung Park, Seung Hwan Moon, Sung Tae Kim, Samuel N Lockhart, Duk L Na, Sang Won Seo
Author Information
Jin San Lee: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Seongbeom Park: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Hee Jin Kim: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Yeshin Kim: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Hyemin Jang: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea. ORCID
Ko Woon Kim: Department of Neurology, Chonbuk National University Hospital, Jeonju, Korea.
Hak Young Rhee: Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Sung Sang Yoon: Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
Kyoung Jin Hwang: Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
Key-Chung Park: Department of Neurology, Kyung Hee University Hospital, Seoul, Korea.
Seung Hwan Moon: Departments of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Sung Tae Kim: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Samuel N Lockhart: Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, 94720, USA. ORCID
Duk L Na: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea.
Sang Won Seo: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, Korea. sangwonseo@empal.com.
We investigated the frequency and clinical significance of diagonal earlobe crease (DELC) in cognitively impaired patients using imaging biomarkers, such as white matter hyperintensities (WMH) on MRI and amyloid-β (Aβ) PET. A total of 471 cognitively impaired patients and 243 cognitively normal (CN) individuals were included in this study. Compared with CN individuals, cognitively impaired patients had a greater frequency of DELC (OR 1.6, 95% CI 1.1-2.2, P = 0.007). This relationship was more prominent in patients with dementia (OR 1.8, 95% CI 1.2-2.7, P = 0.002) and subcortical vascular cognitive impairment (OR 2.4, 95% CI 1.6-3.6, P < 0.001). Compared with Aβ-negative cognitively impaired patients with minimal WMH, Aβ-positive patients with moderate to severe WMH were significantly more likely to exhibit DELC (OR 7.3, 95% CI 3.4-16.0, P < 0.001). We suggest that DELC can serve as a useful supportive sign, not only for the presence of cognitive impairment, but also for cerebral small vessel disease (CSVD) and Aβ-positivity. The relationship between DELC and Aβ-positivity might be explained by the causative role of CSVD in Aβ accumulation.
