Clinical implications of white matter hyperintensities in patients with Alzheimer’s disease

Abstract

AbstractBackgroundWhite matter hyperintensities (WMHs) are commonly found on the fluid‐attenuated inversion recovery (FLAIR) or T2‐weighted magnetic resonance imaging (MRI) in elderly people. Most recent studies have shown that increased volume of WMHs has been linked to both late life depression and functional impairment such as impaired mobility, gait and motor disturbance, and poor balance in elderly. In this analysis, we examined the relationship among depressive symptoms, physical disability, quality of life and WMH severity in Alzheimer`s disease (AD).MethodThe volume of WMHs were quantified using Lesion Segmentation Toolbox (LST). After then, the volume of WMHs were adjusted by the estimated intracranial volume, and we used a logarithmic transformation to produce normally distributed data. Because WMH distribution concerns three areas (juxtaventricular, periventricular, deep area), regression analyses were also used to identify the relationship between each WMH area and clinical symptoms in AD. All subjects underwent standardized clinical interviews and neurological and physical examinations to assess their cognitive (CERAD‐K), physical function (muscle mass index, grip strength, gait speed and timed up and go test), depressive symptoms (sGDS‐15) and quality of life (SF‐36).ResultIn 112 AD, the mean age was 80.5±7.1. WMH volume was associated with s‐GDS‐K score (P=0.005). After adjusting for sGDS‐K, MMSE‐KC‐Z score and Charlson Comorbidity Index, the degree of WMH volume were significantly associated with the muscle mass index (p=0.003), gait speed (p <0.001), and Korea frail index (p =0.016). Furthermore, social function (p=0.029), physical functioning (p<0.001), bodily pain (p=0.007), role physical (0.010), mental component score (0.028) and physical component score (p=0.001) were associated with the degree of WMHs.ConclusionGiven the greater volume of WMH among AD, and considering that loss of the personal and social life of older people, these results might be relevant to the main functional problems related to aging in AD.