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Cortical thinning and microstructural integrity disruption in white matter hyperintensities.

Xin Wang1, Jie Hu1, Xiaosan Wu2

  • 1Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, He Fei 230601, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230032, China; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230032, China.

Brain Research Bulletin
|September 9, 2025
PubMed
Summary

Cerebral small vessel disease (CSVD) patients with white matter hyperintensities (WMHs) show impaired cognition due to white matter damage and cortical thinning. This thinning in specific brain regions mediates the link between white matter changes and cognitive deficits.

Keywords:
Cognitive functionCortical atrophyWhite matter hyperintensitiesWhite matter microstructure

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Area of Science:

  • Neurology
  • Neuroimaging
  • Cognitive Neuroscience

Background:

  • Cerebral small vessel disease (CSVD) is a common cause of cognitive impairment.
  • The interplay between white matter microstructure, cortical atrophy, and cognitive function in CSVD-related white matter hyperintensities (WMHs) remains poorly understood.
  • Investigating these relationships is crucial for understanding WMH-related cognitive decline.

Purpose of the Study:

  • To elucidate the associations between white matter microstructure, cortical atrophy, and cognitive function in patients with WMHs.
  • To identify specific brain regions where cortical thinning mediates the impact of white matter changes on cognitive performance.
  • To reveal underlying mechanisms of cognitive decline in CSVD.

Main Methods:

  • Included 71 WMHs patients (mild, moderate, severe) and 35 healthy controls (HCs).
  • Assessed white matter microstructure using tract-based spatial statistics (TBSS) for fractional anisotropy (FA) and mean diffusivity (MD).
  • Measured cortical thickness using surface-based morphometry (SBM) and evaluated cognitive function with a standardized scale, followed by regression and mediation analyses.

Main Results:

  • Moderate to severe WMHs patients showed impaired cognition, reduced FA, increased MD, and decreased cortical thickness compared to HCs.
  • Cortical thinning was prominent in regions including the insula, superior frontal gyrus, and supramarginal gyrus.
  • Mediation analysis indicated that cortical thinning in specific left-hemisphere regions (e.g., insula, supramarginal gyrus) significantly mediated the relationship between white matter integrity (FA, MD) and Verbal Fluency Test (VFT) scores.

Conclusions:

  • WMHs are associated with white matter degeneration and cortical thinning, both contributing to cognitive decline.
  • Left-hemisphere cortical thinning acts as a key mediator linking white matter microstructure alterations to impaired VFT performance.
  • These findings offer insights into the neurobiological mechanisms driving cognitive deficits in CSVD.