Predictors for cognitive decline in patients with confluent white matter hyperintensities

Area of Science:

• Neurology
• Gerontology
• Neuroimaging

Background:

• Confluent white matter hyperintensities (WMH) increase cognitive decline risk in stroke patients, but individual outcomes vary.
• Identifying predictors of cognitive decline is crucial for targeted interventions.

Purpose of the Study:

• To investigate predictors of cognitive decline in stroke patients with confluent WMH.
• To explore associations between clinical, genetic, imaging, and biochemical factors and cognitive changes.

Main Methods:

• Followed 100 stroke patients with confluent WMH for 2 years.
• Assessed clinical features, apolipoprotein E status, imaging measures (WMH, cortical gray matter [cGM], ventricles, hippocampi), and B vitamins.
• Evaluated cognitive changes using Clinical Dementia Rating scale, Mini-Mental State Examination, and Mattis Dementia Rating scale.
• Performed Pittsburgh compound B imaging in dementia converters.

Main Results:

• Cortical gray matter (cGM) atrophy and absence of hyperlipidemia predicted increased Clinical Dementia Rating scale grade.
• cGM atrophy and absence of hyperlipidemia also correlated with poorer Mini-Mental State Examination and Mattis Dementia Rating scale scores.
• Alzheimer's-like Pittsburgh compound B retention was infrequent; incident stroke and B vitamins did not predict cognitive decline.

Conclusions:

• Cortical gray matter (cGM) atrophy and absence of hyperlipidemia are key predictors of cognitive decline in stroke patients with confluent WMH.
• Significant cognitive decline can manifest independently of new strokes or underlying Alzheimer's disease pathology.