Abstract
ContextWhite matter lesions (WML) increase the risk of dementia. The relevance of WML location is less clear. We sought to determine whether a particular WML profile, based on the density and location of lesions, could be associated with an increased risk of mild cognitive impairment (MCI) or dementia over the following 7 years.MethodsIn 426 healthy subjects from a cohort of community-dwelling people aged 65 years and over (ESPRIT Project), standardized cognitive and neurological evaluations were repeated after 2, 4 and 7 years. Patterns of WML were computed with a supervised data mining approach (decision trees) using the regional WML volumes (frontal, parietal, temporal, and occipital regions) and the total WML volume estimated at baseline. Cox proportional hazard models were then constructed to study the association between WML patterns and risk of MCI/dementia.ResultsTotal WML volume and percentage of WML in the temporal region proved to be the best predictors of progression to MCI and dementia. Specifically, severe total WML load with a high proportion of lesions in the temporal region was significantly associated with the risk of developing MCI or dementia.ConclusionsAbove a certain threshold of damage, a pattern of WML clustering in the temporal region identifies individuals at increased risk of MCI or dementia. As this WML pattern is observed before the onset of clinical symptoms, it may facilitate the detection of patients at risk of MCI/dementia.
Highlights
Cerebral white matter lesions (WML) are commonly found on magnetic resonance imaging (MRI) scans of elderly people
We previously showed that the mild cognitive impairment (MCI)-R algorithm allows a better prediction of the cognitive deficits that will progress towards dementia than the original MCI criteria [25]
We examined whether a specific WML profile could be associated with an increased risk of MCI/dementia
Summary
Cerebral white matter lesions (WML) are commonly found on magnetic resonance imaging (MRI) scans of elderly people. Several studies indicate that WML load is associated with cognitive decline and incident dementia [4], other works do not support such relationship [5,6]. The association of WML with cognitive impairment in normal aging and dementia is still not fully understood. The regional distribution of WML might help understanding the relationship between WML with cognitive impairment and dementia, because the extent, and the localization of WML could determine its clinical significance. WML may cause cognitive impairment by disrupting cortical connections that are mediated by specific white matter (WM) tracts.
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