White matter hyperintensity progression is associated with incident probable dementia or mild cognitive impairment

Area of Science:

• Neurology
• Radiology
• Gerontology

Background:

• White matter hyperintensity (WMH) on brain MRI is a known risk factor for dementia and mild cognitive impairment (MCI).
• The role of WMH progression as an independent risk factor for cognitive decline has not been extensively studied.

Purpose of the Study:

• To investigate the association between WMH progression and the incidence of probable dementia or MCI.
• To analyze WMH progression as an independent predictor of cognitive impairment in the SPRINT MIND trial.

Main Methods:

• A post hoc analysis of the SPRINT MIND trial data was conducted.
• WMH progression was assessed by the Z score difference in WMH volumes between baseline and 48-month follow-up MRIs.
• The primary outcome was incident probable dementia or MCI, with WMH progression analyzed as both a continuous Z score and a binary threshold (≥1.4 mL).

Main Results:

• Among 433 patients, 7.6% developed dementia/MCI over 48 months.
• Patients with WMH progression ≥1.4 mL had a significantly higher rate of dementia/MCI (12.8%) compared to those with <1.4 mL progression (4.7%).
• WMH progression, measured by Z score (OR 1.51) and the ≥1.4 mL threshold (OR 2.89), was significantly associated with increased odds of dementia/MCI.

Conclusions:

• WMH progression over 48 months is significantly associated with the development of probable dementia or MCI.
• These findings highlight WMH progression as a critical independent risk factor for cognitive decline, relevant for clinical assessment and intervention.