Abstract
Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5701) and classified into (i) stroke/transient ischemic attack (TIA), (ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or (iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. The prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3%). Bandung Indonesia showed the highest prevalence of WML, adjusted for age, sex, education, disease groups, and imaging modality. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.
Highlights
Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia
Subjects with Alzheimer’s disease (AD) dementia had a higher prevalence of moderate-to-severe WML than those with mild cognitive impairment (MCI) (41.2% vs 25.3%). This is the first multi-center study to formally assess the prevalence of moderate-to-severe WML in stroke/transient ischemic attack (TIA) and AD/MCI, in different age groups, and from 9 Asian cohorts
The prevalence of moderate-to-severe WML was higher in stroke/TIA (43.3%) than that in AD/MCI (38.2%), X2(1) = 10.6, p = 0.001
Summary
Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Subclinical sporadic cerebral small vessel disease (CSVD) has been increasingly recognized in recent years to be a prevalent and important pathological substrate for cognitive impairment and d ementia[2]. Among those who survive stroke without early-onset poststroke dementia, the presence of CSVD can increase the risk of delayed-onset poststroke dementia[9]
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