White matter hyperintensities

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As such, white matter hyperintensities have been targeted as a surrogate biomarker in intervention trials with older adults. However, it is unclear at what stage of aging white matter hyperintensities begin to relate to cognition and if they may be a viable target for early prevention. In the Dunedin Study, a population-representative cohort followed since birth, we measured white matter hyperintensities in year-old participants using T 2 -weighted magnetic resonance imaging and we assessed cognitive decline from childhood to midlife. Our results demonstrate that a link between white matter hyperintensities and early signs of cognitive decline is detectable decades before clinical symptoms of dementia emerge. Thus, white matter hyperintensities may be a useful surrogate biomarker for identifying individuals in midlife at risk for future accelerated cognitive decline and selecting participants for dementia prevention trials. However, the success of this investment hinges on developing surrogate biomarkers—biological measures that are part of the putative disease pathway and are measurable before the onset of clinical symptoms—so that prevention can target at-risk individuals before cerebral decline has taken hold. Successful surrogate biomarkers would allow clinicians to assess risk, monitor sub-clinical disease progression and intervene before clinically significant dementia symptoms manifest.

White matter hyperintensities

White matter hyperintensities WMHs are lesions in the brain that show up as areas of increased brightness when visualised by T2-weighted magnetic resonance imaging MRI. The prevailing view is that these intensities are a marker of small-vessel vascular disease and in clinical practice, are indicative of cognitive and emotional dysfunction, particularly in the ageing population. This is clearly not true. Although WMH do become more common with advancing age, their prevalence is highly variable. There is strong evidence that WMH are clinically important markers of increased risk of stroke, dementia, death, depression, impaired gait, and mobility, in cross-sectional and in longitudinal studies. They associate with brain damage such as global atrophy and other features of small vessel brain damage, with focal progressive visible brain damage, are markers of underlying subvisible diffuse brain damage, and predict infarct growth and worse outcome after large artery stroke. They could be considered as the neuroimaging marker of brain frailty. Wardlaw et al. A review by Debette and Markus sought to review the evidence of the association between WMHs and the risk of cognitive impairment, dementia, death and stroke. White matter hyperintensities are a predictor for vascular disease for which age and high blood pressure are the main risk factors. The review showed that WMHs are significantly associated with an increased risk of stroke. Even when adjusting for vascular disease risk factors, such as age and high blood pressure, this association was still significant. White matter hyperintensities are also associated with both impaired mobility and reduced cognitive functioning. Specifically, WMHs can impact on memory, vigilance and executive functioning, depending on its localisation and severity. Periventricular WMHs can affect cognitive functioning while subcortical WMHs disrupt specific motor functions based on location.

WMHs cause cognitive decline—in particular of information processing speed—and may lead to executive dysfunction and, ultimately, dementia. Eur Radiol.

Background: White matter hyperintensities are an important marker of cerebral small vessel disease. This disease burden is commonly described as hyperintense areas in the cerebral white matter, as seen on T2-weighted fluid attenuated inversion recovery magnetic resonance imaging data. Studies have demonstrated associations with various cognitive impairments, neurological diseases, and neuropathologies, as well as clinical and risk factors, such as age, sex, and hypertension. Due to their heterogeneous appearance in location and size, studies have started to investigate spatial distributions and patterns, beyond summarizing this cerebrovascular disease burden in a single metric—its volume. Here, we review the evidence of association of white matter hyperintensity spatial patterns with its risk factors and clinical diagnoses.

Federal government websites often end in. The site is secure. White matter hyperintensities WMH of presumed vascular origin, also referred to as leukoaraiosis, are a very common finding on brain magnetic resonance imaging MRI or computed tomography CT in older subjects and in patients with stroke and dementia. They are associated with cognitive impairment, triple the risk of stroke and double the risk of dementia. Knowledge of their pathology derives mostly from post mortem studies, many from some years ago. These, by their nature, were generally small, sampled from selected brain regions and probably reflect late-stage disease. They focus on features of demyelination and axonal degeneration, which may be easier to detect histopathologically than changes in extracellular fluid. Here we review advances in brain magnetic resonance imaging MRI that are revealing white matter hyperintensities at earlier stages, and changes in normal-appearing white matter that indicate tissue pathology, less marked than those found in WMH. Neuroimaging is also revealing the dynamic nature of WMH, their interactions with other pathological features such as secondary cortical and long tract damage, and contribution to accumulating brain damage. These insights provide opportunities to improve understanding the etiology and pathogenesis of small vessel disease, and represents an enormous unfinished agenda for preventing accumulation of brain damage, and its associated cognitive and physical problems, from mid to later life.

White matter hyperintensities

As such, white matter hyperintensities have been targeted as a surrogate biomarker in intervention trials with older adults. However, it is unclear at what stage of aging white matter hyperintensities begin to relate to cognition and if they may be a viable target for early prevention. In the Dunedin Study, a population-representative cohort followed since birth, we measured white matter hyperintensities in year-old participants using T 2 -weighted magnetic resonance imaging and we assessed cognitive decline from childhood to midlife. Our results demonstrate that a link between white matter hyperintensities and early signs of cognitive decline is detectable decades before clinical symptoms of dementia emerge.

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Functional impact of white matter hyperintensities in cognitively normal elderly subjects. Sensitivity encoding for fast MR imaging of the brain in patients with stroke. First, abstracts were screened, followed by reading the retrieved publications and excluding non-relevant studies. Neurology 63, — Imaging 53, — Ambulatory blood pressure and the brain: a 5-year follow-up. Effect of white matter hyperintensity on medial temporal lobe atrophy in Alzheimer's disease. The used scales were the Fazekas Fazekas et al. Heritability of leukoaraiosis in hypertensive sibships. Longitudinal studies in older adults have reported that the spread of WMHs contributes to elevated risk for ADRD and coincides with age-related cognitive decline Debette and Markus, Cerebrovasc Dis.

Leukoaraiosis is a particular abnormal change in appearance of white matter near the lateral ventricles. It is often seen in aged individuals, but sometimes in young adults. These white matter changes are also commonly referred to as periventricular white matter disease, or white matter hyperintensities WMH , due to their bright white appearance on T2 MRI scans.

Lockhart, S. Hyperintense tissue surrounding these structures; periventricular hyperintensity with constant gradient. Advanced Search. Silent brain infarcts: a systematic review. Stroke 43 , — Periventricular venous collagenosis: association with leukoaraiosis. Melazzini, L. Prevalence of cerebral white matter lesions in elderly people: A population based magnetic resonance imaging study. Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer's disease and vascular dementia. These insights provide opportunities to improve understanding the etiology and pathogenesis of small vessel disease, and represents an enormous unfinished agenda for preventing accumulation of brain damage, and its associated cognitive and physical problems, from mid to later life. Cigarette smoking is associated with reduced microstructural integrity of cerebral white matter. The effects of all these SVD features on cognition are cumulative, 65 in submission providing further indication that together these SVD features are closely related pathologically, 52 and represent cumulative brain damage, 32 the prevention of which should help ameliorate brain tissue damage, reduce loss of normal brain cognitive and physical function and preserve independent survival in old age.