Age and recurrent stroke are related to the severity of white matter hyperintensities in lacunar infarction patients with diabetes

Abstract

Background and purpose: White matter hyperintensities (WMH) is identified as a marker of cerebral small vessel diseases and is a major contributor to cognitive impairment, depression, gait disturbance, and urinary incontinence. However, the risk factors for WMH in patients with type 2 diabetes mellitus (T2DM) has not been well explored. Thus, in this study, we aimed to investigate the relationship between the severity of WMH and vascular risk factors in lacunar infarction patients with T2DM. Methods: Consecutive lacunar infarction patients with T2DM were recruited in this cross-sectional study. Paraventricular WMH (P-WMH) and deep WMH (D-WMH) were separately scored by the Fazekas scale, and classified into two categories by the severity. Vascular risk factors and clinical features were compared between the mild and severe WMH. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors. Results: A total of 327 participants aged 34–91 years were enrolled in this study. Compared with the patients with mild P-WMH, the patients with severe P-WMH had higher age ( P =0.031), higher proportion of hypertension ( P =0.042) and stroke ( P <0.001). Levels of TG, LDL, and HbA1c were significantly higher in patients with mild P-WMH. Compared with the patients with mild D-WMH the patients with severe D-WMH had higher age and hyperhomocysteinemia (HCY) level ( P <0.001), higher proportion of hyperlipidemia ( P =0.008), and stroke ( P <0.001). Multivariable logistic regression analyses showed that higher age and recurrent stroke were independently related to severe P-WMH and D-WMH in lacunar infarction patients with T2DM. Conclusions: Age and recurrent stroke are related to the severity of P-WMH and D-WMH in lacunar infarction patients with T2DM. Keywords: lacunar infarction, type 2 diabetes mellitus, white matter hyperintensities, leukoaraiosis