Sangha Kim1, Seong Hye Choi2, Young Min Lee3, Min Ji Kim4, Young Don Kim1, Jin Young Kim1, Jin Hong Park1, Woojae Myung1, Hae Ri Na5, Hyun Jeong Han6, Yong S Shim7, Jong Hun Kim8, Soo Jin Yoon9, Sang Yun Kim10, Doh Kwan Kim1. 1. Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea. 2. Department of Neurology,Inha University School of Medicine,Incheon,South Korea. 3. Department of Psychiatry,Busan National University Hospital,Busan,South Korea. 4. Biostatistics Team,Samsung Biomedical Research Institute,Seoul,South Korea. 5. Department of Neurology,Bobath Memorial Hospital,Seongnam,South Korea. 6. Department of Neurology,Dementia and Neurocognitive center,Myongji Hospital,Goyang,South Korea. 7. Department of Neurology,Bucheon St. Mary's Hospital,The Catholic Univerisy of Korea,School of Medicine,Bucheon,South Korea. 8. Department of Neurology,National Health Insurance Corporation Ilsan Hospital,Goyang,South Korea. 9. Department of Neurology,Eulji University College of Medicine,Daejeon,South Korea. 10. Department of Neurology,Seoul National University Bundang Hospital,Seongnam,South Korea.
Abstract
BACKGROUND: Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia. METHODS: Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model. RESULTS: Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0-36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43-3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12-3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97-132.06) and DWMH (HR 8.77; 95% CI 1.77-43.49) in more severe form (≥ 10 mm). CONCLUSIONS: WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.
BACKGROUND:Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia. METHODS:Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model. RESULTS: Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0-36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43-3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12-3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97-132.06) and DWMH (HR 8.77; 95% CI 1.77-43.49) in more severe form (≥ 10 mm). CONCLUSIONS: WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.
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