Background: Alongside Alzheimer disease pathology, cerebral small vessel disease (CSVD) contributes to the differential progression rates from mild cognitive impairment (MCI) to dementia. Hence, identification of specific type of CSVD lesions that influence progression is needed. Objective: The objective of this study was to evaluate the role of silent CSVD in the progression from MCI to dementia and if confluent white matter hyperintensities (WMHs) pose a higher risk for progression in the clinical setting. Methods: Patients with MCI with baseline magnetic resonance imaging and longitudinal follow-up were evaluated. WMH were quantified using visual scoring at baseline (all subjects) and at end of study period (subgroup). Influences of baseline total WMH, baseline confluent WMH, and increase of WMH on progression from MCI to dementia were analyzed. Results: A total of 200 patients with a mean age of 67.9 (SD 8.7) years were evaluated. Progression to dementia was significantly higher among patients with MCI with confluent WMH (55.7% vs. 32.3%; P<0.001). The odds ratio of a patient with confluent WMH progressing to dementia was 2.66. The annual decline in Mini Mental State Examination was significantly higher in those with confluent WMH lesions (−1.60 vs. −1.20; P=0.010). In the subgroup with follow-up magnetic resonance imaging (n=70), patients who demonstrated an increase in WMH had greater decline in annual Mini Mental State Examination scores (−1.79 vs. −0.59; P=0.054). Conclusion: Confluent WMH lesions in MCI are associated with higher rates of progression to dementia.

erythema (P = 0.016) and melanin (P = 0.031) did increase at the medial inferior orbital rim at 4-6 months. A proposed theory may be due to the deeper penetration through thinner tissue of the fractionated laser penetrating the reticular dermis and vessels and potentially the orbicularis oculi causing release of haemosiderin, which may not surface until 4-6 months.Melanin values were decreasing and no longer differed significantly from pre-operative values by 2-3 months. Erythema peaked at 2-3 months most notably at the lateral inferior orbital rim in both laser groups, but the degree of erythema did not significantly differ between laser groups (P > 0.05).Our data supports the well-known post treatment erythema and pigmentation described in the literature; patients will experience minimal and temporary, if any, increase in erythema or pigmentation. The findings in this study provide objective values in the melanin and erythema post-operatively which can aid in discussing expectations among patients receiving fractionated or traditional CO2 laser skin resurfacing as adjuvant facial rejuvenation therapy with transconjunctival lower lid blepharoplasty.

No abstract