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White Matter Hyperintensities Predict Cognitive Decline: A Community-Based Study

  • Xuemei Qi (a1), Huidong Tang (a1), Qi Luo (a1), Bei Ding (a2), Jie Chen (a1), Peijing Cui (a3), Shengdi Chen (a1), Huawei Ling (a2) and Jianfang Ma (a1)...

Abstract:

Introduction: White matter hyperintensities (WMHs) were commonly seen in brain magnetic resonance imaging (MRI) of the elderly. Many studies found that WMHs were associated with cognitive decline and dementia. However, the association between WMHs in different brain regions and cognitive decline remains debated. Methods: We explored the association of the severity of WMHs and cognitive decline in 115 non-demented elderly (≥50 years old) sampled from the Wuliqiao Community located in urban area of Shanghai. MRI scans were done during 2009–2011 at the beginning of the study. Severity of WMHs in different brain regions was scored by Improved Scheltens Scale and Cholinergic Pathways Hyperintensities Scale (CHIPS). Cognitive function was evaluated by Mini-Mental State Examination (MMSE) every 2 to 4 years during 2009–2018. Results: After adjusting for confounding factors including age, gender, education level, smoking status, alcohol consumption, depression, hypertension, diabetes, hyperlipidemia, brain infarcts, brain atrophy, apoE4 status, and baseline MMSE score, periventricular and subcortical WMH lesions as well as WMHs in cholinergic pathways were significantly associated with annual MMSE decline ( p < 0.05), in which the severity of periventricular WMHs predicted a faster MMSE decline (–0.187 points/year, 95% confidence interval: –0.349, –0.026, p = 0.024). Conclusions: The severity of WMHs at baseline was associated with cognitive decline in the non-demented elderly over time. Interventions on WMH lesions may offer some benefits for cognitive deterioration.

Des hyper-signaux de la substance blanche prédicteurs du déclin cognitif : une étude menée dans une communauté locale.Introduction: Des hyper-signaux de la substance blanche (HSSB) peuvent généralement être observés lors d’examens d’imagerie par résonnance magnétique (IRM) effectués chez des personnes âgées. Plusieurs études ont également montré que les HSSB étaient associés au déclin cognitif et à la démence. Cela dit, le lien pouvant exister entre ces HSSB détectés dans diverses régions cérébrales et le déclin cognitif demeure sujet à débat. Méthodes: Nous avons décidé d’explorer l’association existant entre l’intensité des HSSB et le déclin cognitif chez 115 personnes âgées n’étant pas atteintes de démence (≥50 ans). Ces personnes avaient été recrutées au sein du quartier de Wuliqiao situé dans le grand Shanghai. Signalons que ces examens d’IRM ont été effectués au début de cette étude entre 2009 et 2011. L’intensité des HSSB dans diverses régions cérébrales a été mesurée au moyen des échelles suivantes : la Improved Scheltens Scale et la Cholinergic Pathways Hyperintensities Scale (CHIPS). En ce qui concerne la fonction cognitive, elle a été évaluée à l’aide du test de Folstein (ou mini-mental state examination) tous les 2 à 4 ans entre 2009 et 2018. Résultats: Une fois la prise en compte d’un certain nombre de facteurs de confusion (l’âge, le sexe, le niveau de scolarité, le tabagisme, la consommation d’alcool, la dépression, l’hypertension, le diabète, l’hyperlipidémie, des accidents ischémiques cérébraux, une atrophie du cerveau, la situation de l’allèle 4 du gène ApoE et le score initial au test de Folstein), il est apparu que des lésions révélées par des hyper-signaux des régions péri-ventriculaire et sous-corticale, de même que des hyper-signaux détectés dans les voies cholinergiques, étaient nettement associés à des résultats en baisse au test de Folstein en cours d’année (p < 0,05). Fait à noter, l’intensité des HSSB de la région péri-ventriculaire a aussi permis de prédire un déclin plus rapide des scores au test de Folstein (- 0,187 points/année, IC 95 % : - 0,349 - 0,026; p = 0,024). Conclusions: L’intensité des HSSB observée au début de cette étude a été associée au fil du temps au déclin cognitif de personnes âgées n’étant pas atteintes de démence. Il est donc possible que des interventions ciblant des lésions révélées par des HSSB puissent offrir certains bienfaits quand il est question de déclin cognitif.

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Corresponding author

Correspondence to: Jianfang Ma, Department of Neurology & Institute of Neurology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, China. Email: majifa@hotmail.com
Huawei Ling, Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. Email: hwl1505@sina.com

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Both authors contributed to the work equally.

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References

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