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. 2009 Jul 14;73(2):120-5.
doi: 10.1212/WNL.0b013e3181ad53fd.

Cognitive impairment risk: white matter hyperintensity progression matters

Lisa C Silbert  1 , Diane B Howieson, Hiroko Dodge, Jeffrey A Kaye
Affiliations

Cognitive impairment risk: white matter hyperintensity progression matters

Lisa C Silbert et al. Neurology. .

Abstract

Objective: To determine whether white matter hyperintensity (WMH) progression rate is a better predictor of cognitive impairment risk than baseline WMH volume in healthy elderly individuals.

Method: Ninety-eight cognitively intact elderly subjects were followed in the Oregon Brain Aging Study. Forty-nine had at least 3 brain MRIs and annual cognitive and neurologic assessments until diagnosed with persistent cognitive impairment (PCI). Brain, ventricular CSF (vCSF), intracranial volume (ICV), hippocampus, total WMH, periventricular (PV) WMH, and subcortical WMH volumes were measured. Cox proportional hazards survival analyses were used to assess cognitive impairment risk.

Results: After adjusting for age, apolipoprotein E4 status, incident hypertension, ICV, entry Mini-Mental State Examination, baseline hippocampus, and both baseline vCSF volume and rate of vCSF volume change, increased progression of total WMH volume (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.3-2.7, p = 0.0007) and PV WMH volume (HR 1.94, 95% CI 1.3-3.1, p = 0.001) conferred higher risk of PCI, whereas baseline WMH volumes did not. Every 1 mL/y increase in PV WMH volume was associated with a 94% increased risk of PCI.

Conclusion: Progression of total and periventricular (PV) white matter hyperintensity (WMH) volumes are better predictors of persistent cognitive impairment (PCI) than baseline WMH burden. Greater PV WMH burden progression is associated with the development of PCI, a potential precursor to Alzheimer or vascular dementia. Identification of factors that decrease WMH accumulation over time is needed to maintain cognitive health in our growing elderly population.

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References

    1. Yue NC, Arnold AM, Longstreth WT Jr, et al. Sulcal, ventricular, and white matter changes at MR imaging in the aging brain: data from the cardiovascular health study. Radiology 1997;202:33–39. - PubMed
    1. Baum KA, Schulte C, Girke W, Reischies FM, Felix R. Incidental white-matter foci on MRI in “healthy” subjects: evidence of subtle cognitive dysfunction. Neuroradiology 1996;38:755–760. - PubMed
    1. DeCarli C, Murphy DG, Tranh M, et al. The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults. Neurology 1995;45:2077–2084. - PubMed
    1. Longstreth WT Jr, Manolio TA, Arnold A, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 1996;27:1274–1282. - PubMed
    1. Adak S, Illouz K, Gorman W, et al. Predicting the rate of cognitive decline in aging and early Alzheimer disease. Neurology 2004;63:108–114. - PubMed

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