Lifestyle Changes Reduced Estimated White Matter Hyperintensities Based on Retinal Image Analysis

Area of Science:

• Neurology and ophthalmology
• Public health and lifestyle medicine

Background:

• Small vessel disease (SVD) is a significant risk factor for stroke and cognitive decline.
• Cerebral white matter hyperintensities (WMH) are a key indicator of SVD, often assessed through neuroimaging.
• Automatic retinal image analysis (ARIA) offers a non-invasive method to estimate WMH, potentially serving as a surrogate for SVD risk.

Purpose of the Study:

• To investigate the association between lifestyle changes, assessed via the Health-Promoting Lifestyle Profile II (HPLP-II), and the progression of WMH (ARIA-WMH) over one year.
• To explore potential interactions between lifestyle domains and diabetes status in relation to SVD risk.

Main Methods:

• A community cohort study involving 274 participants, with 193 completing follow-up assessments.
• Annual assessments included the HPLP-II questionnaire and retinal imaging for ARIA-WMH estimation.
• Statistical analyses, including multivariate models, were used to examine the relationship between changes in HPLP-II domains and ARIA-WMH progression, with consideration for diabetes status.

Main Results:

• A significant difference in ARIA-WMH change was observed between diabetic and non-diabetic participants (p=0.03).
• A significant interaction between the health responsibility (HR) domain of HPLP-II and diabetes was found (p=0.005).
• In non-diabetic individuals, improved HR was associated with decreased ARIA-WMH (p=0.003), and increased physical activity was negatively related to ARIA-WMH change (p=0.02).

Conclusions:

• Lifestyle modifications, particularly enhanced health responsibility and physical activity, are significantly associated with reduced SVD progression as indicated by ARIA-WMH.
• For non-diabetic individuals, actively managing health responsibility can mitigate the risk of developing or worsening white matter hyperintensities.