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Periventricular white matter hyperintensities and the risk of dementia: a CREDOS study

  • Sangha Kim (a1), Seong Hye Choi (a2), Young Min Lee (a3), Min Ji Kim (a4), Young Don Kim (a1), Jin Young Kim (a1), Jin Hong Park (a1), Woojae Myung (a1), Hae Ri Na (a5), Hyun Jeong Han (a6), Yong S. Shim (a7), Jong Hun Kim (a8), Soo Jin Yoon (a9), Sang Yun Kim (a10) and Doh Kwan Kim (a1)...

Abstract

Background:

Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia.

Methods:

Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model.

Results:

Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0–36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43–3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12–3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97–132.06) and DWMH (HR 8.77; 95% CI 1.77–43.49) in more severe form (≥ 10 mm).

Conclusions:

WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.

Copyright

Corresponding author

Correspondence should be addressed to: Professor Doh Kwan Kim, MD, PhD., Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, 135-710, South Korea. Phone: +822-3410-3582; Fax: +822-3410-0941. Email: paulkim@skku.edu.

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