Periventricular cerebral white matter lesions predict rate of cognitive decline

TLDR

Cerebral white matter lesions detected by MRI are linked to cognitive decline, but few longitudinal studies have confirmed this association in large cohorts. The study aimed to assess how white matter lesion severity predicts cognitive decline over a decade in a large Dutch elderly cohort. White matter lesion severity was scored separately for periventricular and subcortical regions using a semiquantitative scale, while cognitive function was tracked with the Mini‑Mental State Examination over 1990–2000 and MRI scans were performed in 1995–1996. Severe periventricular white matter lesions predicted a nearly threefold faster decline in Mini‑Mental State scores over 7.3 years, whereas subcortical lesion severity showed no independent effect.

Abstract

Abstract The prospect of declining cognitive functions is a major fear for many elderly persons. Cerebral white matter lesions, as commonly found with magnetic resonance imaging, have been associated with cognitive dysfunction in cross‐sectional studies. Only a few longitudinal studies using small cohorts confirmed these findings. We examined the relation between severity of white matter lesions and cognitive decline over a nearly 10‐year period in 563 elderly subjects sampled from the general nondemented Dutch population. Severity of white matter lesions was scored for periventricular and subcortical regions separately using an extensive semiquantitative scale. Cognitive function was measured by the Mini‐Mental State Examination at regular time intervals during 1990 to 2000, and magnetic resonance imaging scans were made in 1995 to 1996. More severe white matter lesions were associated with more rapid cognitive decline over a mean follow‐up period of 7.3 years (standard deviation, 1.5). After adjusting for age, gender, educational level, measures of depression, and brain atrophy and infarcts, subjects with severe periventricular white matter lesions experienced cognitive decline nearly three times as fast (0.28 Mini‐Mental State Examination points/year [95% confidence interval, 0.20–0.36]) as the average (0.10 points/year [95% confidence interval, 0.09–0.11]). There was no independent relationship between severity of subcortical white matter lesions and rate of cognitive decline.