{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T22:00:12Z","timestamp":1785708012869,"version":"3.56.0"},"reference-count":49,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the correlation between verbal and visual memory function and correlation with brain metabolites (lactate and N\u2010Acetylaspartate, NAA) in individuals with mitochondrial encephalomyopathy, lactic acidosis, and stroke\u2010like episodes (MELAS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Memory performance and brain metabolites (ventricular lactate, occipital lactate, and occipital NAA) were examined in 18 MELAS, 58\u2009m.3243A\u2009&gt;\u2009G carriers, and 20 familial controls. Measures included the Selective Reminding Test (verbal memory), Benton Visuospatial Retention Test (visual memory), and MR Spectroscopy (NAA, Lactate). ANOVA, chi\u2010squared\/Fisher\u2019s exact tests, paired <jats:italic>t<\/jats:italic>\u2010tests, Pearson correlations, and Spearman correlations were used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>When compared to carriers and controls, MELAS patients had the: (1) most impaired memory functions (Visual: <jats:italic>p<\/jats:italic>\u2009=\u20090.0003; Verbal: <jats:italic>p<\/jats:italic>\u2009=\u20090.02), (2) greatest visual than verbal memory impairment, (3) highest brain lactate levels (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), and (4) lowest brain NAA levels (<jats:italic>p<\/jats:italic>\u2009=\u20090.0003). Occipital and ventricular lactate to NAA ratios correlated significantly with visual memory performance (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.001). Higher lactate levels (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.01) and lower NAA levels (<jats:italic>p<\/jats:italic>\u2009=\u20090.0009) correlated specifically with greater visual memory dysfunction in MELAS. There was little or no correlation with verbal memory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Individuals with MELAS are at increased risk for impaired memory. Although verbal and visual memory are both affected, visual memory is preferentially affected and more clearly associated with brain metabolite levels. Preferential involvement of posterior brain regions is a distinctive clinical signature of MELAS. We now report a distinctive cognitive phenotype that targets visual memory more prominently and earlier than verbal memory. We speculate that this finding in carriers presages a conversion to the MELAS phenotype.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51564","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T13:25:29Z","timestamp":1651843529000},"page":"841-852","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Visual memory failure presages conversion to <scp>MELAS<\/scp> phenotype"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3776-9959","authenticated-orcid":false,"given":"Emily B.","family":"Leaffer","sequence":"first","affiliation":[{"name":"Sergievsky Center &amp; Department of Neurology Columbia University  New York City New York USA"},{"name":"Department of Psychology, Queens College &amp; The Graduate Center City University of New York  New York City New York USA"},{"name":"Northeast Cognitive Assessment  Rye Brook New York 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