Impact of white matter hyperintensities on subjective cognitive decline phenotype in a diverse cohort of cognitively normal older adults.

Abstract

Subjective cognitive decline (SCD) is a preclinical stage of AD. White matter hyperintensities (WMH), an MRI marker of cerebral small vessel disease, associate with AD biomarkers and progression. The impact of WMH on SCD phenotype is unclear. A retrospective, cross-sectional analysis was conducted on a diverse cohort with SCD evaluated at the NYU Alzheimer's Disease Research Center between January 2017 and November 2021 (n=234). The cohort was dichotomized into none-to-mild (n=202) and moderate-to-severe (n=32) WMH. Differences in SCD and neurocognitive assessments were evaluated via Wilcoxon or Fisher exact tests, with p-values adjusted for demographics using multivariable logistic regression. Moderate-to-severe WMH participants reported more difficulty with decision making on the Cognitive Change Index (1.5 SD 0.7 vs. 1.2 SD 0.5, p=0.0187) and worse short-term memory (2.2 SD 0.4 vs. 1.9 SD 0.3, p=0.0049) and higher SCD burden (9.5 SD 1.6 vs. 8.7 SD 1.7, p=0.0411) on the Brief Cognitive Rating Scale. Moderate-to-severe WMH participants scored lower on the Mini-Mental State Examination (28.0 SD 1.6 vs. 28.5 SD 1.9, p=0.0491), and on delayed paragraph (7.2 SD 2.0 vs. 8.8 SD 2.9, p=0.0222) and designs recall (4.5 SD 2.3 vs. 6.1 SD 2.5, p=0.0373) of the Guild Memory Test. In SCD, WMH impact overall symptom severity, specifically in executive and memory domains, as well as objective performance on global and domain-specific tests in verbal memory and visual working/associative memory.