Diagonal Earlobe Crease is a Visible Sign for Cerebral Small Vessel Disease and Amyloid-beta

Abstract

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-beta (A beta) 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 A beta-negative cognitively impaired patients with minimal WMH, A beta-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 A beta-positivity. The relationship between DELC and A beta-positivity might be explained by the causative role of CSVD in A beta accumulation.