White matter hyperintensities in vascular contributions to cognitive impairment and dementia (VCID): Knowledge gaps

Jessica Alber1, Suvarna Alladi2, Hee-Joon Bae3

  • 1Department of Biomedical and Pharmaceutical Sciences, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA.

Insights

White matter hyperintensities (WMHs), common in older adults, are linked to cognitive decline and dementia. This review highlights key questions to advance understanding and treatment of WMHs and Alzheimer's disease.

Area of Science:

  • Neurology
  • Neuroimaging
  • Geriatrics

Background:

  • White matter hyperintensities (WMHs) are prevalent in brain MRIs of older adults.
  • WMHs are often considered markers of cerebral small vessel disease.
  • They are associated with cognitive impairment, dementia, and Alzheimer's disease (AD), but also appear in healthy individuals.

Purpose of the Study:

  • To identify critical unanswered questions regarding WMHs and their relationship with cognition, dementia, and AD.
  • To foster collaboration between academic, clinical, and pharmaceutical sectors.
  • To guide future research for improved prevention and treatment strategies.

Main Methods:

  • This work is a collaborative perspective identifying key research questions.
  • It synthesizes current knowledge gaps from academic, clinical, and industry viewpoints.
  • No new experimental data was generated; it is a review and synthesis of outstanding issues.

Main Results:

  • Identified key questions include the underlying molecular and cellular changes in WMHs.
  • Explored neuropathological correlates, the role of demyelination and inflammation, and the clinical significance of WMHs in AD.
  • Addressed the utility of subdividing WMHs and identified risk factors and potential therapeutic targets.

Conclusions:

  • Answering these fundamental questions is crucial for advancing the understanding of WMHs.
  • Improved knowledge will facilitate the development of effective prevention and treatment strategies for WMHs and associated dementias.
  • Multidisciplinary collaboration is essential to tackle the complexities of WMHs in aging and neurodegenerative diseases.

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