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Exploring the Spectrum of Subcortical Hyperintensities and Cognitive Decline
Yi-Chun Chen1, Hsien-Hao Tsao1, Yi-Chuan Chu1
1From the Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan (YC-C, YC-C, WC-H); the Dementia Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan (YC-C, YC-C, WC-H); the Department of Medicine, Chang Gung University, Taoyuan, Taiwan (HH-T); the Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan (JJ-W); the Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University, Chang Gung Memorial Hospital, Linkou, Taiwan (JJ-W); the Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan (JJ-W); the Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan (JJ-W); the Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan (JJ-W); the Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan (JD-L); the Department of Laboratory Medicine, Chang Gung Memorial Hospital at LinKou Taoyuan, Taiwan (PY-C); and the Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan (PY-C).
Periventricular white matter hyperintensities (WMH), particularly occipital caps, correlate with medial temporal lobe atrophy and Alzheimer's disease. These WMH predict cognitive decline, highlighting their clinical significance.
Area of Science:
- Neurology
- Neuroimaging
- Gerontology
Background:
- White matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) are recognized risk factors for cognitive decline.
- WMH can be categorized into periventricular WMH (pvWMH) and deep WMH, with subcortical hyperintensities encompassing additional brain regions.
Purpose of the Study:
- To investigate the interactive effects of WMH and MTA on longitudinal clinical decline in individuals aged 50-85.
- To explore the association between specific WMH patterns and cognitive function in relation to Alzheimer's disease (AD).
Main Methods:
- Prospective study with 200 participants (57 normal, 40 dysexecutive MCI, 53 amnestic MCI, 50 AD).
- Annual neuropsychological assessments over 2 years and baseline brain MRI using Scheltens' Scale for WMH and MTA evaluation.
- Cox proportional hazards models were used to assess predictors of clinical decline.
Main Results:
- MTA significantly correlated with pvWMH but not deep WMH.
- Periventricular bands (PVB) predicted 1-year clinical decline, independently of MTA.
- pvWMH, especially occipital caps, was higher in AD subjects and correlated with MTA.
Conclusions:
- Periventricular WMH, particularly occipital caps, is associated with MTA and the AD subgroup.
- Visual assessment of PVB is a significant independent predictor of 1-year clinical decline.
- Semantic fluency assessment may aid in evaluating subcortical hyperintensity burden.
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