Periventricular cerebral white matter lesions predict rate of cognitive decline

Abstract

The prospect of declining cognitive functions is a major fear for many elderly persons. Cerebral white matter lesions, as commonly found with magnetic resonance imaging, have been associated with cognitive dysfunction in cross-sectional studies. Only a few longitudinal studies using small cohorts confirmed these findings. We examined the relation between severity of white matter lesions and cognitive decline over a nearly 10-year period in 563 elderly subjects sampled from the general nondemented Dutch population. Severity of white matter lesions was scored for periventricular and subcortical regions separately using an extensive semiquantitative scale. Cognitive function was measured by the Mini-Mental State Examination at regular time intervals during 1990 to 2000, and magnetic resonance imaging scans were made in 1995 to 1996. More severe white matter lesions were associated with more rapid cognitive decline over a mean follow-up period of 7.3 years (standard deviation, 1.5). After adjusting for age, gender, educational level, measures of depression, and brain atrophy and infarcts, subjects with severe periventricular white matter lesions experienced cognitive decline nearly three times as fast (0.28 Mini-Mental State Examination points/year [95% confidence interval, 0.20-0.36]) as the average (0.10 points/year [95% confidence interval, 0.09-0.11]). There was no independent relationship between severity of subcortical white matter lesions and rate of cognitive decline.

Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J‐EDIT)

“…These findings were established with the canonical correlation analysis used for our study. Previous studies have investigated the relationship between WMHs and cognitive decline in nondemented and demented elderly [18,[34][35][36][37][38]. Cognitive test scores in older adults were found to be worse in the presence of severe WMHs, even after adjustments for age, gender and education [18].…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…These silent cerebral emboli are to be distinguished from covert embolic strokes secondary to long-term AF, which have been linked with long-term cognitive decline, and are much larger than the silent emboli seen peri-procedurally. 1385,1386,1387,1388 …”

White matter hyperintensities, incident mild cognitive impairment, and cognitive decline in old age

“…The degree to which WMH contribute to progressive cognitive decline among older persons initially free of cognitive impairment also is poorly understood. Cross‐sectional studies have shown that WMH are associated with subtle cognitive decrements, particularly in perceptual speed and executive functions,10, 11, 12 but little data are available on the relation of WMH with cognitive decline among persons initially free of cognitive impairment 7, 13, 14, 15, 16. A better understanding of the degree to which WMH increase the risk of MCI and contribute to progressive decline in multiple cognitive systems is needed to facilitate strategies to promote cognitive health in old age.…”