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Association between white matter hyperintensity and medial temporal atrophy at various stages of Alzheimer's disease

N Kandiah1, R J Chander, A Ng

  • 1Department of Neurology, National Neuroscience Institute, Singapore; Duke - NUS Graduate Medical School Singapore, Singapore.

European Journal of Neurology
|August 22, 2014
PubMed
Abstract

Insights

White matter hyperintensity (WMH) burden significantly increases with Alzheimer's disease (AD) progression. This WMH burden strongly associates with medial temporal atrophy (MTA) in mild cognitive impairment and mild AD stages.

Area of Science:

  • Neurology
  • Neuroimaging
  • Cerebrovascular Disease

Background:

  • Small vessel cerebrovascular disease is implicated in Alzheimer's disease (AD) pathogenesis.
  • The precise contribution of cerebrovascular disease to AD pathophysiology requires further elucidation.
  • White matter hyperintensity (WMH) is a key indicator of small vessel cerebrovascular disease burden.

Purpose of the Study:

  • To investigate the burden of WMH and its association with medial temporal atrophy (MTA) across different stages of AD.
  • To clarify the role of WMH in the progression of AD.
  • To identify critical stages for intervention in AD management.

Main Methods:

  • A cohort study including cognitively normal (CN) individuals, mild cognitive impairment (MCI) patients, and mild to moderate-severe AD patients.
  • Quantification of WMH and MTA by trained raters.
  • Statistical analysis using the Jonckheere-Terpstra test to assess associations between WMH and MTA across disease stages.

Main Results:

  • WMH burden significantly increased with AD severity, from CN to MCI to AD stages.
  • Severe WMH burden was present in 6.7% of CN, 9.7% of MCI, 28.4% of mild AD, and 39.7% of moderate-severe AD subjects.
  • A significant positive association between WMH and MTA was observed in MCI and mild AD stages, but not in CN or moderate-severe AD stages.

Conclusions:

  • WMH burden escalates progressively from normal cognition through MCI to AD.
  • The association between WMH and MTA is most pronounced during the MCI and mild AD phases.
  • Interventions targeting WMH, such as managing vascular risk factors, should be prioritized during MCI and mild AD to potentially slow disease progression.
Keywords:
Alzheimer's diseasemedial temporal atrophywhite matter hyperintensity

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