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White matter hyperintensities and the risk of vascular dementia: a systematic review and meta-analysis
Wei Luo1,2, Zhiqiang Dai3, Wenjing Wu1,2
1Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Background:
White matter hyperintensities (WMHs) are hyperintense lesions observed on magnetic resonance imaging (MRI) and are unique imaging indicators of cerebral small vessel diseases. WMH-related white matter alterations have been correlated with cognitive impairment and cerebrovascular pathology. Some studies suggest that vascular hemodynamic changes contribute to WMH development, ultimately leading to vascular dementia (VaD). However, the association between WMH burden and VaD remains inconclusive. This meta-analysis aimed to quantify the relationship between WMH volume and VaD severity and to clarify the role of WMHs in VaD pathogenesis.
Methods:
A systematic literature search was performed using the MEDLINE, EMBASE, and Cochrane Library databases. A total of 15 studies with 4,061 patients were selected. The meta-analysis was performed using the RevMan software (version 5.4) and Stata software (version 14.0). All the patients underwent brain MRI to assess WMH volumes or levels, and compared the differences in WMH levels among the VaD group, the non-cognitively impaired (NCI) group, the cognitively impaired no dementia (CIND) group, and the Alzheimer's disease (AD) group.
Results:
The meta-analysis showed that all patients in the VaD group had high white matter signals on brain MRI. They also had higher WMH volumes compared to patients in the NCI, CIND, and AD groups. WMH correlated with cerebrovascular pathology, with irregular and periventricular WMHs being more specific to VaD. Sensitivity analyses were performed to identify sources of heterogeneity, while funnel plot and Egger's test suggested potential publication bias.
Conclusions:
Patients with VaD exhibit significantly greater WMH than those with AD, NCI, and CIND, reinforcing the role of cerebrovascular pathology in VaD. These findings emphasize the need for standardized imaging assessments, multi-modal biomarkers, and the development of predictive models to enhance early diagnosis, personalized risk assessment, and targeted therapeutic strategies for VaD.
Insights
Vascular dementia (VaD) patients show significantly higher white matter hyperintensities (WMH) volumes on MRI compared to other cognitive impairment groups. This highlights the role of cerebrovascular pathology in VaD development and diagnosis.
Area of Science:
- Neurology
- Radiology
- Gerontology
Background:
- White matter hyperintensities (WMH) on MRI indicate cerebral small vessel diseases.
- WMH are linked to cognitive impairment and cerebrovascular pathology, potentially contributing to vascular dementia (VaD).
- The precise association between WMH burden and VaD severity requires further clarification.
Purpose of the Study:
- To quantify the relationship between white matter hyperintensity volume and vascular dementia severity.
- To elucidate the role of white matter hyperintensities in the pathogenesis of vascular dementia.
Main Methods:
- A systematic literature search identified 15 studies with 4,061 patients.
- Meta-analysis compared WMH volumes in vascular dementia (VaD) patients versus non-cognitively impaired (NCI), cognitively impaired no dementia (CIND), and Alzheimer's disease (AD) groups.
- Brain MRI was used to assess WMH volumes and levels.
Main Results:
- Patients with VaD exhibited significantly higher white matter hyperintensity volumes compared to NCI, CIND, and AD groups.
- WMH correlated with cerebrovascular pathology; irregular and periventricular WMHs were more specific to VaD.
- Sensitivity analyses and statistical tests indicated potential publication bias.
Conclusions:
- Greater WMH burden in VaD patients reinforces the significance of cerebrovascular pathology.
- Standardized imaging, multi-modal biomarkers, and predictive models are crucial for early VaD diagnosis and treatment.
- These findings support targeted therapeutic strategies for vascular dementia.
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