The Cerebellum Is Related to Cognitive Dysfunction in White Matter Hyperintensities.

Shanshan Cao,Yanghua Tian,Jun Zhang,Yajuan Hu,Jiajia Nie,Baogen Du,Xiaojing Wang,Chen Chen,Yuting Mo,Yuanyuan Liu,Qiang Wei,Kai Wang

doi:10.3389/fnagi.2021.670463

Abstract

ObjectiveWhite matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) is frequently presumed to be secondary to cerebral small vessel disease (CSVD) and associated with cognitive decline. The cerebellum plays a key role in cognition and has dense connections with other brain regions. Thus, the aim of this study was to investigate if cerebellar abnormalities could occur in CSVD patients with WMHs and the possible association with cognitive performances.MethodsA total of 104 right-handed patients with WMHs were divided into the mild WMHs group (n = 39), moderate WMHs group (n = 37), and severe WMHs group (n = 28) according to the Fazekas scale, and 36 healthy controls were matched for sex ratio, age, education years, and acquired resting-state functional MRI. Analysis of voxel-based morphometry of gray matter volume (GMV) and seed-to-whole-brain functional connectivity (FC) was performed from the perspective of the cerebellum, and their correlations with neuropsychological variables were explored.ResultsThe analysis revealed a lower GMV in the bilateral cerebellum lobule VI and decreased FC between the left- and right-sided cerebellar lobule VI with the left anterior cingulate gyri in CSVD patients with WMHs. Both changes in structure and function were correlated with cognitive impairment in patients with WMHs.ConclusionOur study revealed damaged GMV and FC in the cerebellum associated with cognitive impairment. This indicates that the cerebellum may play a key role in the modulation of cognitive function in CSVD patients with WMHs.

Highlights

White matter hyperintensities (WMHs) is a state of chronic hypoperfusion in the white matter, which reflects the loss of axons and myelin, myelin pallor, and gliosis
There were no significant differences between the ages, years of education, and gender distributions of the healthy controls (HC) and WMHs groups
We investigated the alterations in the volume and functional connectivity (FC) in the cerebellum due to WMHs and evaluated their relevance to cognitive function

Summary

Introduction

White matter hyperintensities (WMHs) is a state of chronic hypoperfusion in the white matter, which reflects the loss of axons and myelin, myelin pallor, and gliosis. It is described as hyperintense in the subcortical white matter displayed on T2-weighted MRI images and fluid-attenuated inversion recovery (FLAIR) images (Gebeily et al, 2014). There is growing evidence that the WMHs is imperative to cognitive dysfunction, in executive function. Niels et al reported that increasing severity of periventricular WMHs was associated with impaired information processing speed and executive function (Prins et al, 2005; Smith et al, 2011; Yamanaka et al, 2019)

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