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

Published online by Cambridge University Press:  27 July 2015

Sangha Kim
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Seong Hye Choi
Affiliation:
Department of Neurology, Inha University School of Medicine, Incheon, South Korea
Young Min Lee
Affiliation:
Department of Psychiatry, Busan National University Hospital, Busan, South Korea
Min Ji Kim
Affiliation:
Biostatistics Team, Samsung Biomedical Research Institute, Seoul, South Korea
Young Don Kim
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Jin Young Kim
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Jin Hong Park
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Woojae Myung
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Hae Ri Na
Affiliation:
Department of Neurology, Bobath Memorial Hospital, Seongnam, South Korea
Hyun Jeong Han
Affiliation:
Department of Neurology, Dementia and Neurocognitive center, Myongji Hospital, Goyang, South Korea
Yong S. Shim
Affiliation:
Department of Neurology, Bucheon St. Mary's Hospital, The Catholic Univerisy of Korea, School of Medicine, Bucheon, South Korea
Jong Hun Kim
Affiliation:
Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, South Korea
Soo Jin Yoon
Affiliation:
Department of Neurology, Eulji University College of Medicine, Daejeon, South Korea
Sang Yun Kim
Affiliation:
Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
Doh Kwan Kim*
Affiliation:
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
*
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.

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.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2015 

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