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.

Introduction: Several items pertaining to dysphasia and dysarthria of the National Institutes of Health Stroke Scale (NIHSS), originally designed in the United States, were identified as culturally unsuitable in Singapore. We compared the error rates of dysphasia objects, dysphasia phrases and dysarthria words between original versus alternative items in a cohort of Singaporean subjects without dysphasia or dysarthria. Methods: In this prospective study, 140 English-speaking Singaporean subjects without impairments of dysphasia or dysarthria had NIHSS assessment for Items 9 and 10 using the original and alternative items. Paired analyses were conducted for comparison of error rates. Results: Error rates were high for four original dysphasia objects (Hammock: 62.9%, Cactus: 38.6%, Feather: 23.6%, Glove: 20.7%) and significantly lower for alternative items (Snail: 5%, Horse: 1.4%, Hanger: 1.4%, Car: 0%) (p<0.001). For dysphasia phrases and dysarthria words, error rates were low and there were no differences in error rates between original and alternative items. Conclusion: There are cultural issues with several dysphasia objects in the original NIHSS as evidenced by high error rates, which were lowered with more culturally suitable alternatives. This study formed a basis to derive a more suitable NIHSS version for English-speaking subjects in Singapore.