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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.
Abstract:
White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer's disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia.
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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