White Matter Hyperintensities Score Research Articles

White Matter Hyperintensities (WMH) and clinical outcome after vestibular neuritis

ABSTRACT Objectives Identification of patients at high risk for chronic dizziness after Vestibular Neuritis (VN) would allow these patients to be the target of focused therapies. However, there is a discrepancy between studies with regard to which factors best predict symptom recovery. The present study provides a comprehensive evaluation of Vestibular Neuritis and the major predictors for the development of chronic vestibular insufficiency. Methods All subjects (n = 54) with acute vestibular neuritis admitted to the Department of Neurology of Beijing Luhe Hospital affiliated to Capital Medical University from 2018 to 2020 were retrospectively identified . Forty-three subjects who received a 4-test battery as well as 3.0T brain MRI, were included in the study. Patients were divided into two groups: Group 1 with complete recovery and Group 2 without recovery, as determined by symptoms 3 months after the VN episode. In addition, we recruited 21 healthy subjects to characterize the profiles of acute VN . Results The total WMH score negatively correlated with a clinical recovery (Phi coefficient = −0.808, p value = 0.000). Statistical regression for predicting the outcome of clinical recovery using cerebral white matter changes as an independent variable was significant (p = 0.004). However, clinical recovery was not associated with the nerve divisions (Phi coefficient = 0.108, p = 0.492), age (p = 0.247) and the grade of nystagmus (p = 0.797) . Conclusions A 4-test battery provides essential information to identify vestibular nerve dysfunction. Cerebral white matter change on MRI was predictive of chronic vestibular insufficiency after vestibular neuritis.

Fiber connectivity density mapping in end-stage renal disease patients: a preliminary study.

Abnormal brain structural connectivity of end-stage renal disease(ESRD) is associated with cognitive impairment. However, the characteristics of cortical structural connectivity have not been investigated in ESRD patients. Here, we study structural connectivity of the entire cerebral cortex using a fiber connectivity density(FiCD) mapping method derived from diffusion tensor imaging(DTI) data of 25 ESRD patients and 20 healthy controls, and between-group differences were compared in a vertexwise manner. We also investigated the associations between these abnormal cortical connectivities and the clinical variables using Pearson correlation analysis and multifactor linear regression analysis. Our results demonstrated that the mean global FiCD value was significantly decreased in ESRD patients. Notably, FiCD values were significantly changed(decreased or increased) in certain cortical regions, which mainly involved the bilateral dorsolateral prefrontal cortex(DLPFC), inferior parietal cortex, lateral temporal cortex and middle occipital cortex. In ESRD patients, we found a trend of negative correlation between the increased FiCD values of bilateral middle frontal gyrus and serum creatinine, urea, parathyroid hormone(PTH) levels and dialysis duration. Only the white matter hyperintensity(WMH) scores were significantly negatively correlated with the global FiCD value in multifactor regression analysis. Our results suggested that ESRD patients exhibited extensive impaired cortical structural connectivity, which was related to the severity of WMHs. A compensation mechanism of cortical structural recombination may play a role in how the brain adapts to maintain optimal network function. Additionally, the serum creatinine, urea and PTH levels may be risk factors for brain structural network decompensation in ESRD patients.

The Value of Brain Structural Magnetic Resonance Imaging Combined with APOE--ε4 Genotype in Early Diagnosis and Disease Progression of Senile Vascular Cognitive Impairment No Dementia.

Objective To explore the value of brain structure magnetic resonance imaging combined with APOE-ε4 genotype in the early diagnosis and disease progression of elderly patients with vascular cognitive impairment no dementia (VCIND). Methods The first stroke patients admitted to our hospital from March 2017 to December 2018 were collected, including 130 cases of vascular cognitive impairment no dementia (VCIND group) and 50 cases of the control group (NC group). The basic information of all subjects was recorded, and APOE-ε4 alleles of all subjects were detected. The neuropsychological test scale evaluated the cognitive psychology of the subjects, and they were scanned by multi-parameter MRI. After follow-up, VCIND patients were divided into the dementia group and the nondementia group. MRI scans were again performed, and the risk factors of VCIND patients developing dementia were analyzed. Results Compared with the NC group, patients in the VCIND group had shorter years of education, more patients with hypertension, higher levels of homocysteine (Hcy), and lower cognitive ability. Patients with White Matter Volume (WMV), White Matter Hyperintensity (WMH), Lacunar Infarction (LI), elevated Fazekas scores, and APOE-ε4 gene carriers are more likely to develop VCIND. After 12 months of follow-up, compared with the nondementia group, the number of WMV, WMH, Fazekas scores, and APOE-ε4 gene carriers in the dementia group was significantly increased. In addition, the progression-free survival rate of APOE-ε4 gene carriers was significantly lower than that of nonAPOE-ε4 gene carriers. Conclusion Years of education, hypertension, high levels of Hcy, elevated WMV, WMH, LI, and Fazekas scores, and carrying the APOE-ε4 gene are risk factors for VCIND in stroke patients. Craniocerebral structural MRI combined with APOE-ε4 genotype has a diagnostic role in the early diagnosis and disease progression of elderly patients with VCIND.

Heterogeneity of White Matter Hyperintensities in Cognitively Impaired Patients With Cerebral Small Vessel Disease.

ObjectiveSimilar white matter hyperintensities (WMH) might have different impact on the cognitive outcomes in patients with cerebral small vessel disease (CSVD). This study is to assess the possible factors related to the heterogeneity of WMH in cognitively impaired patients with CVSD.MethodsWe analyzed data from a cohort of patients with CVSD who were recruited consecutively from the Beijing Tiantan Hospital from 2015 to 2020. WMH, lacunes, enlarged perivascular space (ePVS), microbleeds and lacunar infarcts were rated on brain MRI. A score of <26 on the Montreal Cognitive Assessment (MoCA) indicated cognitive impairment. A mismatch was defined as the severity of WMH not matching the severity of cognitive dysfunction. Type-1 mismatch was defined as a mild WMH (Fazekas score = 0-1) associated with cognitive impairment, and type-2 mismatch was defined as a severe WMH (Fazekas score = 5-6) associated with normal cognitive function. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced SWI on 3-Tesla MRI was used to image the penetrating arteries in basal ganglia to explore the underlying mechanism of this mismatch. Multivariable logistic regression was used to analyze the association between the imaging features and cognitive impairment.ResultsIn 156 patients, 118 (75.6%) had cognitive impairment and 37 (23.7%) showed mismatch. Twenty five (16.0%) had type-1 mismatch and 12 (7.7%) had type-2 mismatch. Regression analysis found that WMH, lacunes, microbleeds and total CSVD scores were associated with cognitive impairment and were independent of vascular risk factors. However, lacunes, microbleeds and total CSVD scores were related to the mismatch between WMH and cognitive impairment (p=0.006, 0.005 and 0.0001, respectively). Specially, age and ePVS in basal ganglia were related to type-1 mismatch (p=0.04 and 0.02, respectively); microbleeds and total CSVD scores were related to type-2 mismatch (p=0.01 and 0.03, respectively). Although the severity of WMH was similar, the injury scores of penetrating arteries were significantly different between those with and without cognitive impairment (p=0.04).ConclusionsHeterogeneity of WMH was present in cognitively impaired patients with CSVD. Conventional imaging features and injury of penetrating arteries may account for such heterogeneity, which can be a hallmark for early identification and prevention of cognitive impairment.

Higher cerebral small vessel disease burden is associated with smaller hematoma volume in mixed-location intracerebral hemorrhage.

To study the relationship between cerebral small vessel disease (CSVD) and hematoma volume in mixed-location intracerebral hemorrhage (ICH), and non-mixed ICH (hypertensive arteriopathy/cerebral amyloid angiopathy-related ICH). We consecutively collected patients with primary ICH with MRI. Mixed-location ICH was defined as having ICH or cerebral microbleeds (CMBs) in both lobar and deep regions. CSVD markers including lacunes, white matter hyperintensities (WMH), CMBs, and enlarged perivascular spaces (EPVS) were assessed on brain MRI during hospitalization. Multivariable binary logistic regression (≥30ml vs. <30ml) and linear regression analyses (log-transformed hematoma volume as dependent variable) were implemented to explore the association between CSVD and hematoma volume. Of the 167 included patients, 69 (41.3%) had mixed-location ICH, with higher prevalence of lacune, more CMB count, higher WMH score and total CSVD score than those with non-mixed ICH (all p<.001). Higher WMH score was associated with lower risk of hematoma volume ≥30ml (adjusted OR 0.521, 95% CI 0.299-0.908, p=.021) in patients with mixed-location ICH. Also, multivariable linear regression showed the association of smaller hematoma volume with higher CSVD burden, especially in mixed-location ICH (β=-0.349, p=.019 for CMB≥5; β=-0.183, p<.001 for WMH score; β=-0.456, p=.002 for EPVS>20 in basal ganglia and/or centrum semiovale; β=-0.256, p=.002 for CSVD score), while these relationships were not observed in non-mixed ICH. Higher CSVD burden is associated with smaller hematoma volume in mixed-location ICH, but not in non-mixed ICH, which is novel and needs further studies with larger sample size to confirm our results and explore the underlying mechanisms.

Cognitive Function and White Matter Lesions in Medication-Overuse Headache.

PurposeThis study was designed to investigate the cognitive function and the white matter lesions (WMLs) and the relationship between them in medication-overuse headache (MOH) patients.MethodsSubjects were enrolled and performed Montreal Cognitive Assessment (MoCA, Chinese-Beijing Version), Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD-24), and Pittsburgh Sleep Quality Index (PSQI) to evaluate the general cognitive function, anxiety, depression and sleep quality, and they were divided into three groups according to the MoCA scores: healthy controls, MOH with normal cognition group and MOH with cognitive impairment group. All the participants underwent MRI scans and images were obtained for WML evaluation with Fazekas scale.ResultsOne hundred thirty-four participants were enrolled into this study, 46 of them for healthy controls, and 88 for MOH patients, 40 of the MOH patients for MOH with cognitive impairment group, and 48 for MOH with normal cognition group. MOH patients had significantly lower MoCA scores, including the scores of visuospatial and executive function, attention, and orientation, while they had significantly greater HAMA scores, HAMD-24 scores, PSQI scores, and deep white matter hyperintensity scores compared to healthy controls. And in MOH patients, the age, disease duration, monthly headache days, and periventricular white matter hyperintensity scores in patients with cognitive impairment were greater than those in patients with normal cognition. Moreover, the MoCA scores were negatively related to age, disease duration, monthly headache days, and Fazekas scale scores, and disease duration and monthly headache days were significant predictors of cognitive impairment in MOH patients.ConclusionMOH patients showed cognitive impairment and increased WML burden. And in MOH patients, cognitive function was negatively related to WML burden, and disease duration and monthly headache days were potential predictors of cognitive impairment. Prompt and effective treatment to stop the progression of the disease may alleviate cognitive impairment in MOH patients.

Higher Cerebral Small Vessel Disease Burden in Patients with White Matter Recent Small Subcortical Infarcts

Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI). We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. RSSI location was classified into brainstem, supratentorial subcortical structures (SSS), and centrum semiovale (CSO) regions. Clinical variables, including vascular risk factors, were collected. Radiological markers of CSVD on MRI were evaluated individually and by means of the global CSVD burden score. The associations between each RSSI location and CSVD markers were studied in uni- and multivariate logistic regression analysis. Among 475 patients with RSSI, 152 (32%) had an infarct in the brainstem, 227 (48%) in SSS, and 96 (20%) in CSO region. The median CSVD burden score was 2 (IQR, 1-3). After adjusting for confounding factors, a RSSI in CSO was associated with higher periventricular and deep white matter hyperintensity scores [OR 1.64 (95% CI, 1.16-2.33), and OR 1.44 (95% CI, 1.07-1.93), respectively]. Higher CSVD burden score was positively associated with CSO [OR 1.48 (95% CI, 1.22-1.81)] and inversely associated with SSS [0.85 (95% CI, 0.72-0.99)] location after adjusting for relevant confounders. CSO RSSI were related to a higher burden of CSVD, particularly to white matter hyperintensities, compared to other RSSI locations. The pathophysiological significance of such findings should be investigated in the future with advanced neuroimaging techniques.

White matter hyperintensities and cognition across different Alzheimer's biomarker profiles.

To examine the association between white matter hyperintensities (WMH) and cognitive domains such as memory and executive function (EF) across different clinical and biomarker categories of Alzheimer's disease (AD). Cross-sectional study. Alzheimer's Disease Neuroimaging Initiative. A total of 216 cognitively normal (CN) participants and 407 participants with mild cognitive impairment (MCI) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) at baseline. Based on the 2018 research framework, participants were classified using AT(N) (amyloid-β deposition [A], pathologic tau [T], and neurodegeneration [(N)]) biomarkers into one of three categories: biomarker negative [A - T- (N)-], amyloid negative but other biomarker positive [A - T ± (N)+ or A-T + (N)±] or amyloid positive [A + T ± (N)±]. Linear regression models were then used to examine the association between WMH and memory composite scores and EF composite scores. Higher WMH burden was associated with worse EF in both CN and MCI subgroups while a significant association between WMH and memory was only found in the MCI subgroup. Furthermore, WMH was associated with EF in the group with A - T ± (N)+ or A-T + (N)± biomarker category, but not for A - T - (N)- (normal biomarker) and A + T ± (N) ± (AD pathology). The association between higher WMH and worse memory was independent of amyloid levels in individuals with MCI with evidence of AD pathology. Vascular disease, as indexed by WMH, independent of AD pathology affects cognitive function in both CN and MCI subgroups. Future studies using the AT(N) research framework should consider white matter lesions as a key biomarker contributing to the clinical presentation of AD.

Association of Static Posturography With Severity of White Matter Hyperintensities.

Background: Impaired gait and balance are associated with severity of leukoaraiosis. Evaluation of balance is based on neurological examination using Romberg's test with bipedal standing, assessment scale, and posturographic parameters. The goal of this study was to determine the relationship between static equilibrium and grades of white matter hyperintensities (WMHs) using static posturography as a quantitative technical method.Method: One hundred and eighteen (118) patients with lacunar infarct were recruited and assessed on MRI with Fazekas's grading scale into four groups. On admission, age, gender, height, weight, Berg Balance Scale (BBS), mini-mental state examination (MMSE), and static posturography parameters were recorded, and their correlations with WMHs were determined.Results: Age was significantly and positively correlated with severity of WMHs (r = 0.39, p < 0.05). WMH score was negatively correlated with BBS score (r = −0.65, p < 0.05) and MMSE score (r = −0.79, p < 0.05). There was a significant positive correlation between track length anteroposterior (AP, with eyes closed) and severity of WMHs (r = 0.70, p < 0.05). Partial correlation analysis and multiple logistic regression analysis indicated that track length AP with eyes closed, was a predictor for the severity of WMHs (p< 0.05).Conclusion: The severity of WHMs is associated with age, cognitive decline, and impairment in balance. Posturography parameter in track length in AP direction with eyes closed in relation to cognition and balance, may be a potential marker for disease progression in WMHs.

The vessel density of the superficial retinal capillary plexus as a new biomarker in cerebral small vessel disease: an optical coherence tomography angiography study.

Optical coherence tomography angiography (OCTA) is a novel and noninvasive technique for the quantitative assessment of retinal microvascular perfusion. Since the retinal and cerebral small vessels share similar embryological origins, anatomical features, and physiological properties, altered retinal microvasculature might provide a new perspective on the mechanisms of cerebral small vessel disease (CSVD). We aimed to evaluate retinal vessel density (VD) in patients with CSVD using OCTA and identify associations with cerebral magnetic resonance imaging (MRI) markers and cognitive function. We prospectively recruited 47 CSVD patients and 30 healthy controls (HCs) to participate in the study. All participants underwent OCTA to evaluate retinal microvascular perfusion. The VDs of the macular region in the superficial retinal capillary plexus (SRCP), deep retinal capillary plexus (DRCP), and foveal avascular zone (FAZ) were determined, along with the VD of the optic nerve head (ONH) in the radial peripapillary capillary (RPC) network. Additionally, cerebral MRI and cognitive function tests were performed. In the macula area, the VD of the CSVD patients was significantly lower than HCs in the temporal quadrant of SRCP. In the ONH area, CSVD patients had lower VD than HCs in the peripapillary RPC network. According to multiple linear regression analysis, decreased VD of the macular SRCP was associated with white matter hyperintensity scores after adjustment for age, hypertension, diabetes, and hyperlipidemia. Furthermore, the VD of the macular SRCP was significantly correlated with CSVD patients' cognitive function, especially global cognition, memory function, attention function, information processing, and executive function. OCTA revealed a significant decrease in retinal microvascular perfusion in CSVD patients, and retinal hypoperfusion was related to MRI markers and cognitive function, suggesting that these parameters could have potential utility as early disease biomarkers.

Relevance of cerebral small vessel disease load scores in first-ever lacunar infarction

AimTo reveal the correlation between total cerebrovascular disease load and primary lacunar infarction. BackgroundCerebral small vessel disease (CSVD) is the lack of specific clinical manifestations, whose clinical diagnoses are highly dependent on neuroimaging results. Total CSVD load scores may be more suitable for the assessment of overall brain function damage caused by CSVD. Little is known about whether the association between imaging markers of CSVD and CSVD total load scores at the time of first-ever lacunar infarction (LI). Methodsclinical data of 396 patients hospitalised from September 2016 to May 2018 due to a first-ever LI (case group), along with patients diagnosed with CSVD based on imaging alone and those with no abnormalities (control group) based on magnetic resonance imaging (MRI). Binary logistic regression and multiple ordered logistic regression were used to analyse the characteristics of imaging markers of CSVD in patients with first-ever LI, including different total score burden and distribution, and the relationship between different markers. ResultsIn 396 patients, smoking, cholesterol level and total small vessel disease (SVD) score were all significantly associated with the first-ever LI. There were more LI, cerebral microbleeds (CMB), white matter hyperintensities (WMH), and moderate to severe enlarged perivascular spaces (EPVS) in the first-ever LI group, relative to controls (p < 0.01). The Fazekas scores for periventricular WMH, deep WMH, and total Fazekas score were all significantly higher in patients with first-ever LI relative to those with no cerebral abnormalities (p < 0.01). An analysis of various imaging markers of CSVD revealed a significant correlation between the presence and degree of any marker and the severity of other markers, even after adjusting for the presence of other markers (p < 0.05). ConclusionsThe first-ever LI group exhibited higher total CSVD score loads, a greater number of lacunae, CMB, severe WMH and moderate to severe EPVS. Smoking is an independent risk factor in patients with first-ever LI.

Microstructural Connectivity is More Related to Cognition than Conventional MRI in Parkinson's Disease.

The different effects of white matter hyperintensity (WMH) severity and WMH-associated microstructural connectivity on cognition in the early stages of Parkinson's disease (PD) have not been investigated. To investigate the differential effect of WMH severity and WMH-associated microstructural connectivity on cognition in early stages of PD. A total of 136 de novo PD patients were enrolled and divided into groups based on total WMH visual rating scores as follows: mild, moderate, and severe. Microstructural connectivity was measured using graph theoretical analysis according to WMH severity. Additionally, correlation coefficients between WMH-associated microstructural connectivity or WMH scores and cognitive performance were assessed. Patients with severe WMHs demonstrated poorer performance in language function than those with moderate WMHs, and in frontal/executive and visual memory function than those with mild WMHs. Areas of microstructural connectivity were more extensive in patients with severe WMHs compared to those with mild and moderate WMHs, involving frontal and parieto-temporal regions. WMH-associated right fronto-temporo-parietal microstructural disintegration was correlated with cognitive dysfunction in attention, frontal/executive, and memory domains, whereas there was no correlation between WMH scores and any cognitive domains. These data suggest that disruption of microstructural networks by WMHs, rather than WMH burden itself, contributed more to cognitive impairment in PD.

White Matter Hyperintensities Predict Response to Language Treatment in Poststroke Aphasia

Background White matter hyperintensities (WMH) are a radiological marker of brain health that has been associated with language status in poststroke aphasia; however, its association with language treatment outcomes remains unknown. Objective To determine whether WMH in the right hemisphere (RH) predict response to language therapy independently from demographics and stroke lesion–related factors in poststroke aphasia. Methods We used the Fazekas scale to rate WMH in the RH in 30 patients with poststroke aphasia who received language treatment. We developed ordinal regression models to examine language treatment effects as a function of WMH severity after controlling for aphasia severity, stroke lesion volume, time post onset, age, and education level. We also evaluated associations between WMH severity and both pre-treatment naming ability and executive function. Results The severity of WMH in the RH predicted treatment response independently from demographic and stroke-related factors such that patients with less severe WMH exhibited better treatment outcome. WMH scores were not significantly correlated with pretreatment language scores, but they were significantly correlated with pretreatment scores of executive function. Conclusion We suggest that the severity of WMH in the RH is a clinically relevant predictor of treatment response in this population.

Correlation between White Matter Hyperintensities Related Gray Matter Volume and Cognition in Cerebral Small Vessel Disease

Background and AimThe relationship between severity of cerebral small vessel disease, as defined by white matter hyperintensities classification, and gray matter volume of different brain regions has not been well defined. This study aimed to investigate brain regions with significant differences in gray matter volume associated with different degrees of white matter hyperintensities in patients with cerebral small vessel disease. Meanwhile, we examined whether correlations existed between gray matter volume in different brain regions and cognitive ability. Methods110 cerebral small vessel disease patients underwent 3.0T Magnetic resonance imaging scans and neuropsychological cognitive assessments. White matter hyperintensities of each subject was graded according to Fazekas grade scale and was divided into two groups: (A) White matter hyperintensities score of 1–2 points (n = 64), (B) White matter hyperintensities score of 3–6 points (n = 46). Gray matter volume was analyzed using voxel-based morphometry implemented in Statistical Parametric Mapping 12 software. ResultsBrain regions with significant differences in gray matter volume between groups were diffused throughout the brain. Patients with high white matter hyperintensities scores exhibited decreased gray matter volume in some subregions of the frontal lobes, the temporal lobes, the parahippocampal gyrus, hippocampus and thalamus (p < 0.05). Among them, gray matter volume in the ventrolateral area of right inferior temporal gyrus, together with the right posterior parietal and occipital thalamus were positively correlated with Montreal Cognitive Assessment scores (p < 0.05). Gray matter volume in the extreme ventrolateral area of right inferior temporal gyrus along with the entorhinal cortex of left parahippocampal gyrus were positively correlated with both Montreal Cognitive Assessment and Mini-Mental Status Examination scores (p < 0.05). ConclusionsCerebral small vessel disease is considered as a whole brain disease and local white matter lesions can influence the gray matter in remote areas. Reducing the severity and progression of white matter hyperintensities may help to prevent secondary brain atrophy and cognitive impairment.

Areas of white matter hyperintensities and motor symptoms of Parkinson disease.

To determine whether deep white matter and periventricular hyperintensities affect the motor symptoms of Parkinson disease (PD) differently, we analyzed MRI and dopamine transporter imaging. We analyzed the medical records of patients with de novo PD who underwent dopamine transporter PET scanning and MRI at their first visit. Deep white matter and periventricular hyperintensities were scored with a visual rating scale, and motor symptoms were assessed by Unified Parkinson's Disease Rating Scale motor score and tremor, rigidity, bradykinesia, and axial symptom subscores. The influence of white matter hyperintensity on motor symptoms was explored using multivariable linear regression models. A total of 93 patients (mean age, 67.2 ± 9.9 years; 44 male) were included and the mean motor score was 25.0 ± 10.8. Subscores for bradykinesia and axial symptoms were correlated with both deep white matter and periventricular hyperintensities scores. Multivariable linear regression models revealed that deep white matter hyperintensities score was significantly associated with subscore for bradykinesia and periventricular hyperintensities score was associated with subscores for bradykinesia and axial symptoms after adjusting for putaminal dopamine transporter availability and clinical factors. These results demonstrate that deep white matter hyperintensities are associated with bradykinesia and periventricular hyperintensities are associated with bradykinesia and axial symptoms in patients with PD independently of the severity of dopaminergic depletion.

Altered hippocampal functional connectivity in primary Sjögren syndrome: a resting-state fMRI study.

Structural and metabolic abnormalities in the hippocampus have been associated with the pathophysiological mechanism of central nervous system involvement in primary Sjögren syndrome (pSS). Nevertheless, how hippocampal function is altered in pSS remains unknown. The purpose of our study is to investigate the alterations in hippocampal functional connectivity (FC) in pSS by using resting-state functional magnetic resonance imaging (rs-fMRI). Thirty-eight patients with pSS and 38 age- and education level-matched healthy controls (HCs) underwent magnetic resonance imaging examination. Prior to each MRI examination, neuropsychological tests were performed. Left and right hippocampal FCs were analyzed by using seed-based whole-brain correlation and compared between pSS and HCs. Spearman correlation analysis was performed between the z-value of hippocampal FC in brain regions with significant difference between the two groups and neuropsychological tests/clinical data in pSS. Compared with the controls, the patients with pSS showed decreased hippocampal FC between the left hippocampus and the right inferior occipital gray (IOG)/inferior temporal gray (ITG), as well as between the right hippocampus and right IOG/middle occipital gray (MOG), left MOG, and left middle temporal gray. In addition, increased hippocampal FCs were detected between the left hippocampus and left putamen, as well as between the right hippocampus and right cerebellum posterior lobe. Moreover, the visual reproduction score positively correlated with the FC between right hippocampus and right IOG/MOG. The white matter hyperintensity score negatively correlated with the FC between left hippocampus and right IOG/ITG. In conclusion, patients with pSS suffered decreased hippocampal FC mainly sited in the occipital and temporal cortex with right hippocampal laterality. Altered hippocampal FC might be a potential biomarker in detecting brain function changes and guiding neuroprotection in pSS.

P104 White Coat Hypertension is Associated with Increased Small Vessel Disease in the Brain

ObjectiveSmall vessel disease, measured by brain white matter hyperintensity (WMH), is associated with increased stroke risk and cognitive impairment. This study aimed to explore the relationship between WMH on computerised tomography (CT) and white coat hypertension (WCH) in patients with recent transient ischaemic attack (TIA) or lacunar stroke (LS).MethodsNinety-six patients recruited for the ASIST trial (Arterial Stiffness in Lacunar Stroke and TIA) underwent measurement of clinic blood pressure (BP) and ambulatory BP monitoring (APBM) within two weeks of TIA or LS. Patients were grouped by BP phenotypes. Twenty-three patients had normotension (clinic BP <140/90 mmHg and day-time ABPM <135/85 mmHg) and 25 patients had WCH (clinic BP >140/90 mmHg and day-time ABPM <135/85 mmHg). CT brain images were scored for WMH using the four-point Fazekas visual rating scale. Patients were grouped into no-mild WMH (scores 0–1) or moderate-severe (scores 2–3) groups. The relationship between BP and WMH was explored with chi-square and logistic regression accounting for known cardiovascular risk factors (age, gender, smoking, diabetes and hyperlipidaemia).Results44% of WCH patients had moderate-severe WMH compared to 17% of normotensives (p = 0.047). Logistical regression incorporating WCH as the independent factor and cardiovascular risk factors as independent variables showed WCH to be the only independent significant factor contributing to WMH (p = 0.024).ConclusionPatients with WCH were more likely to have moderate-severe WMH on CT brain than normotensives. WCH was associated with increased WMH, independent of other cardiovascular risk factors. This study suggests that WCH is associated with increased small vessel disease in the brain and may benefit from treatment.Normotension (n = 23)WCH (n = 25)Statistical significanceFemale n(%)8 (35%)7 (28%)p = 0.613Age (years)69.7 ± 11.7976.52 ± 8.69p = 0.026Ever Smoker n(%)12 (52%)18 (72%)p = 0.156Hyperlipidaemia n(%)18 (78%)15 (60%)p = 0.458Diabetes n(%)4 (17%)7 (28%)p = 0.173No-Mild WMH n(%)19 (83%)14 (66%)p = 0.047Moderate-Severe WMH n(%)4 (17%)11 (44%)p = 0.047

Severity of White Matter Hyperintensities and Effects on All-Cause Mortality in the Mayo Clinic Florida Familial Cerebrovascular Diseases Registry

ObjectiveTo compare all-cause mortality rates across the severity range of white matter hyperintensities (WMH). Patients and MethodsBetween October 26, 2010, and October 5, 2017, the ongoing Mayo Clinic Florida Familial Cerebrovascular Diseases Registry prospectively enrolled 1011 diverse participants with and without cerebrovascular disease. T2-weighted magnetic resonance imaging of the brain was used to evaluate WMH in 455 participants using the Fazekas scale. Fazekas deep WMH (FD) and periventricular WMH (FPV) scores (0-3 points) were assigned on the basis of WMH severity. Kaplan-Meier survival analyses, Cox proportional hazards models, and estimated hazard ratios compared survival rates across FD and FPV categories. The Fisher exact and χ2 tests evaluated the relationship of categorical variables, and the Kruskal-Wallis test measured the relationship of continuous variables across FD and FPV categories. All tests were performed at a P<.05 significance level. ResultsOver a median follow-up of 3.06 years (range, 0.00-6.96 years), 96 deaths occurred. Higher FD scores corresponded to a higher likelihood of mortality (P<.001). Participants with an FD score of 3 were 4.69 (95% CI, 2.60-8.46) times more likely to die compared with those with an FD score of 0. Participants with higher FPV scores had a higher likelihood of mortality (P<.001). Participants with an FPV score of 3 were 7.04 (95% CI, 3.39-14.62) times more likely to die compared with those with an FPV score of 0. Once adjusted, age and baseline functional status explained most of the survival differences among the FD scores. ConclusionAssociations between all-cause mortality rates across the severity range of WMH were observed in the Registry. Further studies are warranted to understand the clinical importance of WMH in other clinical populations.

Abstract WP88: Relationship Between Small Vessel Ischemic White Matter Disease and Collateral Recruitment in Patients With Acute Embolic Ischemic Stroke

Introduction: White matter hyperintensities (WMH) is the most prominent neuroimaging feature of small vessel disease (SVD). SVD is thought to be a result of arteriolosclerosis, chronic hypoperfusion of white matter, selective oligodendrocyte death and degeneration of myelinated fibers. The risk of ischemic stroke is significantly increased with the presence of WMH. The presence of intracranial collaterals is a strong predictor of salvageable neurological function in acute stroke; however, the factors affecting the ability to recruit collaterals are poorly understood. We wanted to study if the presence and severity of small vessel white matter disease had an adverse effect on cerebral collateral flow in acute embolic large vessel stroke. Methods: We identified a consecutive series of adult subjects with acute embolic large vessel strokes confirmed on CT angiography (CTA) from a 10-year institutional database. Patients without a brain MRI within six months of CTA were excluded. Collateral scores of the affected hemisphere were calculated on CTA using the modified Tan scale (0-4) by two independent trained reviewers and confirmed by a neuroradiologist. The WMH was quantified using the Fazekas scale (0-3) incorporating both deep and periventricular components. Areas of restricted diffusion on brain MRI in the peri-stroke period were eliminated from the assessment of Fazekas score. Spearman’s correlation tests were performed for the association between collateral scores and WMH. Results: A total of 234 patients (mean age 70±14 years, 47% [110/234] women) satisfied the inclusion criteria. The prevalence of periventricular and deep WMH was 83% and 87% respectively. Aging had a significant impact on periventricular WMH (r=0.48, p &lt;0.001) and deep WMH (r=0.47, p &lt;0.001). However, collateral scores exhibited no statistically significant relationship with the presence or severity of periventricular scores (r=0.08, p=0.17) or deep WMH scores (r=0.01, p=0.77). Conclusions: Our results indicate that the presence of SVD does not affect cerebral collateral flow. The vascular niche and risk factors of SVD appear to be distinct from that of intracranial vessels responsible for collateral reperfusion of ischemic territory in acute large vessel embolic stroke.

Cross-sectional and longitudinal associations between total and regional white matter hyperintensity volume and cognitive and motor function in Parkinson's disease.

BackgroundWhite matter hyperintensities (WMH) are frequently observed on T2-weighted brain magnetic resonance imaging studies of healthy older adults and have been linked with impairments in balance, gait, and cognition. Nonetheless, few studies have investigated the longitudinal effects of comorbid WMH on cognition and motor function in Parkinson's disease.MethodsThe Lesion Segmentation Tool for Statistical Parametric Mapping was used to obtain total lesion volume and map regional WMH probabilities in 29 PD and 42 control participants at two study visits 18 months apart. Both cross-sectional and longitudinal comparisons were made between composite scores in the domains of executive function, memory, and language, and Unified Parkinson's Disease Rating Scale (UPDRS) scores.ResultsWe found no difference between disease and control groups in total WMH volume or progression during the study. Greater regional and global WMH at baseline was more strongly associated with lower executive function in PD subjects than in controls. Increased regional WMH was also more strongly associated with impaired memory performance in PD relative to controls. Longitudinally, no associations between cognitive change and total or regional WMH progression were detected in either group. A positive relationship between baseline regional WMH and total UPDRS scores was present in the control group, but not PD. However, greater WMH increase was associated with a greater increase in UPDRS motor sub-scores in PD.ConclusionsThese findings suggest that although PD patients do not experience greater mean WMH load than normal aged adults, comorbid WMH do exacerbate cognitive and motor symptoms in PD.