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Neuropathologic basis of white matter hyperintensity accumulation with advanced age
Deniz Erten-Lyons1, Randall Woltjer, Jeffrey Kaye
1From the Department of Neurology (D.E.-L., J.K., L.C.S.), Veterans Affairs Medical Center, Portland, OR; and Departments of Neurology (D.E.-L., J.K., N.M., H.H.D., D.B.H., K.W., L.C.S.) and Pathology (R.W., S.G., H.T.), Oregon Health & Science University, Portland.
Small vessel ischemic disease drives white matter hyperintensity (WMH) accumulation in aging. Alzheimer disease (AD) pathology also correlates with WMH, suggesting shared mechanisms like ischemia impact brain health.
Area of Science:
- Neuropathology
- Neuroimaging
- Vascular Biology
Background:
- White matter hyperintensities (WMH) are common in aging and linked to cognitive decline.
- Understanding the underlying pathologies driving WMH is crucial for developing targeted interventions.
Purpose of the Study:
- To identify the specific vascular pathology measure most strongly associated with longitudinal WMH accumulation.
- To investigate the correlation between Alzheimer disease (AD) neuropathology and WMH progression.
Main Methods:
- Longitudinal analysis of 66 older adults with autopsy and multiple MRI scans.
- Mixed-effects models assessed associations between WMH and various neuropathologic measures (e.g., arteriolosclerosis, myelin pallor, Braak score).
- Models were adjusted for age at death and follow-up duration.
Main Results:
- Arteriolosclerosis, myelin pallor, and Braak score were significantly associated with increased WMH accumulation.
- Higher Braak scores correlated with increased presence of atherosclerosis.
- WMH accumulation in advanced age is linked to small-vessel ischemic disease.
Conclusions:
- Small-vessel ischemic disease is a primary driver of white matter changes in aging.
- A link exists between AD pathology and disrupted white matter integrity, potentially via shared mechanisms like ischemia.
- Findings suggest shared pathways may contribute to both vascular brain injury and AD neurodegeneration.
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