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DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

Published on: August 26, 2014

White matter microstructural damage and its effect on cognitive impairment in patients with metabolic syndrome and

Han Liu^1,2, He Feng¹, Bo Tian¹

¹Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

Frontiers in Neurology

|February 2, 2026

Abstract

Background:

Metabolic syndrome (MetS) is linked to cerebral small vessel disease (CSVD) and cognitive impairment in the elderly, but the underlying mechanisms remain unclear. This study investigated whether white matter (WM) microstructural damage mediates the relationship between CSVD severity and cognitive function in patients with MetS.

Methods:

A total of 170 right-handed participants aged 50-80 years were recruited, including 75 with MetS and 95 healthy controls (HC). MetS participants were divided into MetS without CSVD (MetS-NCSVD, n = 22) and MetS with CSVD (MetS-CSVD, n = 53). Cognitive function was assessed using Montreal cognitive assessment, Stroop color word test (SCWT), trail making test (TMT) and geriatric depression scale. WM integrity was evaluated using diffusion tensor imaging, including fractional anisotropy (FA) and mean diffusivity (MD). Mediation analysis was performed to examine the role of WM microstructural damage in the relationship between CSVD severity and cognitive impairment.

Results:

The MetS-CSVD group had significantly lower FA and higher MD in core WM fiber tracts compared to MetS-NCSVD and HC groups (P < 0.001). In the MetS group, FA in these tracts were inversely correlated with cognitive test scores (TMT-B and SCWT-C, P < 0.001). Multiple linear regression analyses confirmed these associations (P ≤ 0.045). Mediation analysis revealed that FA values in WM fiber tracts may mediate the relationship between CSVD severity and cognitive function.

Conclusions:

Our findings suggest that WM microstructural damage may account for the association between CSVD and cognitive impairment, acting as a potential mediator in MetS patients. Future longitudinal studies are needed to validate these findings and explore causal mechanisms.

Insights

White matter damage mediates the link between cerebral small vessel disease and cognitive decline in metabolic syndrome patients. This highlights white matter integrity as a key factor in understanding cognitive impairment associated with metabolic syndrome.

Area of Science:

Neurology
Cardiology
Geriatrics

Background:

Metabolic syndrome (MetS) is associated with cognitive impairment and cerebral small vessel disease (CSVD) in older adults.
The precise mechanisms linking MetS, CSVD, and cognitive decline are not fully understood.
This study explores the mediating role of white matter (WM) damage.

Purpose of the Study:

To investigate if WM microstructural damage mediates the relationship between CSVD severity and cognitive function in patients with MetS.
To analyze the association between CSVD, WM integrity, and cognitive performance in MetS patients.

Main Methods:

Recruited 170 participants (50-80 years), including 75 with MetS (divided into MetS-NCSVD and MetS-CSVD groups) and 95 healthy controls (HC).
Assessed cognitive function using standard neuropsychological tests (MoCA, SCWT, TMT, GDS).
Evaluated WM integrity using diffusion tensor imaging (fractional anisotropy - FA, mean diffusivity - MD) and performed mediation analysis.

Main Results:

The MetS-CSVD group showed significantly reduced FA and increased MD in core WM tracts compared to MetS-NCSVD and HC groups (P < 0.001).
In MetS patients, lower FA in WM tracts correlated inversely with cognitive scores (TMT-B, SCWT-C; P < 0.001).
Mediation analysis indicated that WM microstructural damage (FA) mediates the association between CSVD severity and cognitive function.

Conclusions:

WM microstructural damage acts as a mediator linking CSVD severity to cognitive impairment in individuals with MetS.
These findings underscore the importance of WM integrity in the pathophysiology of cognitive decline in MetS.
Further longitudinal research is warranted to confirm these results and elucidate causal pathways.

Read full analysis

Keywords:

cerebral small vessel disease cognitive impairment diffusion tensor imaging metabolic syndrome white matter

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