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Superficial white matter hyperintensities are associated with mild tissue alterations in vascular aging

A Aghetti1, V Bouteloup2, J Lebenberg3

  • 1AP-HP, Lariboisière Hospital, Department of Neurology and FHU NeuroVasc, Université de Paris Cité, 75475 Paris, France; Université Paris Cité, Inserm, NeuroDiderot, 75019 Paris, France.

Revue Neurologique
|April 26, 2025
PubMed

Insights

Superficial white matter hyperintensities (WMH) are distinct from other WMH, showing milder associations with brain volume and cognitive function. This suggests unique underlying mechanisms for superficial WMH in the elderly.

Area of Science:

  • Neurology
  • Radiology
  • Geriatrics

Background:

  • White matter hyperintensities (WMH) are common in the elderly, typically classified as periventricular or deep.
  • Emerging evidence suggests superficial WMH may arise from different mechanisms and indicate milder tissue changes.

Purpose of the Study:

  • To develop and validate a grading scale to distinguish superficial WMH from periventricular/deep WMH.
  • To investigate the associations between superficial WMH and MRI markers of small vessel disease and cognitive outcomes.

Main Methods:

  • Utilized data from the MEMENTO multicenter memory-clinic study.
  • Evaluated 208 participants with high WMH loads.
  • Assessed superficial WMH grades against MRI markers (lacunes, microbleeds, normalized brain volume) and cognitive scores (MMSE).

Main Results:

  • Higher superficial WMH grades correlated with larger normalized brain volumes and a higher proportion of women.
  • Conversely, higher grades of other WMH were associated with older age, more lacunes, and lower MMSE scores.
  • These findings highlight distinct characteristics of superficial WMH.

Conclusions:

  • Superficial WMH appear to be a distinct entity from periventricular and deep WMH.
  • The observed associations support the hypothesis that superficial WMH represent milder underlying brain tissue alterations.
Keywords:
AgingCerebral small vessel diseaseCognitive impairmentMRIWhite matter hyperintensities

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