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Updated: Jul 10, 2026

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Paradoxical embolisation and cerebral white matter lesions in dementia

N Purandare1, R C Oude Voshaar, C McCollum

  • 1University of Manchester, Division of Psychiatry, Education and Research Centre, Wythenshawe Hospital, Wythenshawe, Manchester M23 9LT, UK.

The British Journal of Radiology
|November 14, 2007
PubMed

Insights

Patent foramen ovale (PFO) is linked to white matter hyperintensities in Alzheimer's disease. Spontaneous cerebral emboli show a negative correlation with white matter changes in vascular dementia, suggesting different underlying mechanisms.

Area of Science:

  • Neurology
  • Neuroimaging
  • Cerebrovascular Disease

Background:

  • Alzheimer's disease (AD) and vascular dementia (VaD) are major causes of cognitive decline.
  • White matter hyperintensities (WMH) are common findings on cerebral MRI in dementia patients.
  • The role of patent foramen ovale (PFO) and spontaneous cerebral emboli (SCE) in dementia pathogenesis is under investigation.

Purpose of the Study:

  • To investigate the association between SCE, PFO, and WMH in patients with AD and VaD.
  • To explore the potential contribution of PFO and SCE to the development of WMH in different dementia subtypes.

Main Methods:

  • SCE detection using transcranial Doppler of the middle cerebral artery.
  • PFO identification via ultrasound contrast agent and assessment of venous-to-arterial circulation shunt (v-aCS).
  • WMH (DWMH and PVH) quantification using Schelten's scale on cerebral MRI.

Main Results:

  • In AD, both deep white matter hyperintensities (DWMH) and periventricular hyperintensities (PVH) were significantly associated with PFO after adjusting for cardiovascular risk factors.
  • No significant relationship between SCE and WMH was observed in AD.
  • In VaD, a significant negative correlation was found between the severity of DWMH and SCE.

Conclusions:

  • A significant venous-to-arterial shunt (PFO) is associated with more severe DWMH in Alzheimer's disease, potentially contributing to its etiology.
  • The negative correlation between SCE and DWMH in vascular dementia supports the hypothesis that VaD may result from predominantly embolic ischemic injury.

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