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The natural course of MRI white matter hyperintensities
Reinhold Schmidt1, Helena Schmidt, Peter Kapeller
1Department of Neurology, Karl-Franzens University, Auenbruggerplatz 22, A-8036, Graz, Austria. reinhold.schmidt@kfunigraz.ac.at
Abstract:
The rate and extent of progression of white matter hyperintensities (WMH) over time in elderly subjects is yet unclear. These abnormalities may represent an early form of subcortical vascular dementia. As to whether such changes could be used, as a surrogate marker for this subtype of vascular dementia remains to be determined. So far there exists only a very limited number of studies determining the rate, clinical predictors and cognitive consequences of WMH evolution. There is evidence that these changes do progress over time, however the results of the different studies cannot be compared due to methodological differences. The Austrian Stroke Prevention Study reported that 17.9% of normal individuals show progression over time. The only published quantitative data demonstrated an absolute increase of 1.1 cm(3) over an observational period of 4 years in healthy subjects. Diastolic blood pressure, early confluent or confluent WMH at baseline and genetic variants in the angiotensinogen gene are so far the only known predictors of WMH progression. The Austrian Stroke Prevention Study did not find an association between the evolution of WMH and cognitive functioning but the statistical power of this analysis was small and the relationship needs to be further explored.
Insights
White matter hyperintensities (WMH) progress over time in elderly individuals, potentially indicating early vascular dementia. Further research is needed to understand WMH evolution and its cognitive impacts.
Area of Science:
- Neurology
- Neuroimaging
- Geriatrics
Background:
- White matter hyperintensities (WMH) are common in the elderly and may signify early subcortical vascular dementia.
- The progression rate and clinical significance of WMH evolution are not well-established.
- Limited studies exist on WMH progression, with methodological differences hindering comparisons.
Purpose of the Study:
- To investigate the rate and extent of white matter hyperintensity (WMH) progression in elderly subjects.
- To explore potential clinical predictors and cognitive consequences associated with WMH evolution.
- To determine if WMH changes can serve as a surrogate marker for vascular dementia.
Main Methods:
- Observational study design analyzing WMH progression over time.
- Utilized data from the Austrian Stroke Prevention Study.
- Identified predictors including baseline WMH, diastolic blood pressure, and angiotensinogen gene variants.
Main Results:
- 17.9% of individuals showed WMH progression over time.
- An average absolute increase of 1.1 cm³ in WMH volume was observed over 4 years in healthy subjects.
- Diastolic blood pressure, baseline WMH, and angiotensinogen gene variants were identified as predictors of progression.
Conclusions:
- WMH progression occurs in elderly individuals.
- Certain factors predict WMH progression, but its role as a vascular dementia surrogate requires further investigation.
- The association between WMH evolution and cognitive function needs more exploration due to limited statistical power in current analyses.