Coevolution of white matter hyperintensities and cognition in the elderly

Pauline Maillard, Owen Carmichael, Evan Fletcher, Bruce R Reed, Dan M Mungas, Charles DeCarli

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Objective: To investigate the effects of baseline white matter hyperintensity (WMH) and rates of WMH extension and emergence on rate of change in cognition (episodic memory and executive function). Methods: A total of 150 individuals including cognitively normal elderly individuals and those with Alzheimer disease and mild cognitive impairment completed serial episodic memory and executive function evaluations and serial MRI scans sufficient for longitudinal measurement of WMH (mean delay 4.0 years). Incident WMH voxels were categorized as extended (baseline WMH that grew larger) or emergent (newly formed WMH). We used a stepwise regression approach to investigate the effects of baselineWMH and rates ofWMH extension and emergence on rate of change in cognition (episodic memory and executive function). Results: WMH burden significantly increased over time, and approximately 80% of incident WMH voxels represented extensions of existing lesions. Each 1 mL/y increase in WMH extension was associated with an additional 0.70 SD/y of subsequent episodic memory decrease (p = 0.0053) and an additional 0.55 SD/y of subsequent executive function decrease (p = 0.022). Emergent WMHs were not found to be associated with a change in cognitive measures. Conclusions: Aging-associated WMHs evolve significantly over a 4-year period. Most of this evolution represents worsening injury to the already compromised surround of existing lesions. Increasing WMH was also significantly associated with declining episodic memory and executive function. This finding supports the view that white matter disease is an insidious and continuously evolving process whose progression has clinically relevant cognitive consequences.

Original languageEnglish (US)
Pages (from-to)442-448
Number of pages7
JournalNeurology
Volume79
Issue number5
DOIs
StatePublished - Jul 31 2012

Fingerprint

Cognition
Episodic Memory
Executive Function
White Matter
Coevolution
Leukoencephalopathies
Alzheimer Disease
Magnetic Resonance Imaging
Lesion
Wounds and Injuries

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Coevolution of white matter hyperintensities and cognition in the elderly. / Maillard, Pauline; Carmichael, Owen; Fletcher, Evan; Reed, Bruce R; Mungas, Dan M; DeCarli, Charles.

In: Neurology, Vol. 79, No. 5, 31.07.2012, p. 442-448.

Research output: Contribution to journalArticle

Maillard, Pauline ; Carmichael, Owen ; Fletcher, Evan ; Reed, Bruce R ; Mungas, Dan M ; DeCarli, Charles. / Coevolution of white matter hyperintensities and cognition in the elderly. In: Neurology. 2012 ; Vol. 79, No. 5. pp. 442-448.
@article{2edcc9bdf9824e3a8f8b55ff4c432e78,
title = "Coevolution of white matter hyperintensities and cognition in the elderly",
abstract = "Objective: To investigate the effects of baseline white matter hyperintensity (WMH) and rates of WMH extension and emergence on rate of change in cognition (episodic memory and executive function). Methods: A total of 150 individuals including cognitively normal elderly individuals and those with Alzheimer disease and mild cognitive impairment completed serial episodic memory and executive function evaluations and serial MRI scans sufficient for longitudinal measurement of WMH (mean delay 4.0 years). Incident WMH voxels were categorized as extended (baseline WMH that grew larger) or emergent (newly formed WMH). We used a stepwise regression approach to investigate the effects of baselineWMH and rates ofWMH extension and emergence on rate of change in cognition (episodic memory and executive function). Results: WMH burden significantly increased over time, and approximately 80{\%} of incident WMH voxels represented extensions of existing lesions. Each 1 mL/y increase in WMH extension was associated with an additional 0.70 SD/y of subsequent episodic memory decrease (p = 0.0053) and an additional 0.55 SD/y of subsequent executive function decrease (p = 0.022). Emergent WMHs were not found to be associated with a change in cognitive measures. Conclusions: Aging-associated WMHs evolve significantly over a 4-year period. Most of this evolution represents worsening injury to the already compromised surround of existing lesions. Increasing WMH was also significantly associated with declining episodic memory and executive function. This finding supports the view that white matter disease is an insidious and continuously evolving process whose progression has clinically relevant cognitive consequences.",
author = "Pauline Maillard and Owen Carmichael and Evan Fletcher and Reed, {Bruce R} and Mungas, {Dan M} and Charles DeCarli",
year = "2012",
month = "7",
day = "31",
doi = "10.1212/WNL.0b013e3182617136",
language = "English (US)",
volume = "79",
pages = "442--448",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Coevolution of white matter hyperintensities and cognition in the elderly

AU - Maillard, Pauline

AU - Carmichael, Owen

AU - Fletcher, Evan

AU - Reed, Bruce R

AU - Mungas, Dan M

AU - DeCarli, Charles

PY - 2012/7/31

Y1 - 2012/7/31

N2 - Objective: To investigate the effects of baseline white matter hyperintensity (WMH) and rates of WMH extension and emergence on rate of change in cognition (episodic memory and executive function). Methods: A total of 150 individuals including cognitively normal elderly individuals and those with Alzheimer disease and mild cognitive impairment completed serial episodic memory and executive function evaluations and serial MRI scans sufficient for longitudinal measurement of WMH (mean delay 4.0 years). Incident WMH voxels were categorized as extended (baseline WMH that grew larger) or emergent (newly formed WMH). We used a stepwise regression approach to investigate the effects of baselineWMH and rates ofWMH extension and emergence on rate of change in cognition (episodic memory and executive function). Results: WMH burden significantly increased over time, and approximately 80% of incident WMH voxels represented extensions of existing lesions. Each 1 mL/y increase in WMH extension was associated with an additional 0.70 SD/y of subsequent episodic memory decrease (p = 0.0053) and an additional 0.55 SD/y of subsequent executive function decrease (p = 0.022). Emergent WMHs were not found to be associated with a change in cognitive measures. Conclusions: Aging-associated WMHs evolve significantly over a 4-year period. Most of this evolution represents worsening injury to the already compromised surround of existing lesions. Increasing WMH was also significantly associated with declining episodic memory and executive function. This finding supports the view that white matter disease is an insidious and continuously evolving process whose progression has clinically relevant cognitive consequences.

AB - Objective: To investigate the effects of baseline white matter hyperintensity (WMH) and rates of WMH extension and emergence on rate of change in cognition (episodic memory and executive function). Methods: A total of 150 individuals including cognitively normal elderly individuals and those with Alzheimer disease and mild cognitive impairment completed serial episodic memory and executive function evaluations and serial MRI scans sufficient for longitudinal measurement of WMH (mean delay 4.0 years). Incident WMH voxels were categorized as extended (baseline WMH that grew larger) or emergent (newly formed WMH). We used a stepwise regression approach to investigate the effects of baselineWMH and rates ofWMH extension and emergence on rate of change in cognition (episodic memory and executive function). Results: WMH burden significantly increased over time, and approximately 80% of incident WMH voxels represented extensions of existing lesions. Each 1 mL/y increase in WMH extension was associated with an additional 0.70 SD/y of subsequent episodic memory decrease (p = 0.0053) and an additional 0.55 SD/y of subsequent executive function decrease (p = 0.022). Emergent WMHs were not found to be associated with a change in cognitive measures. Conclusions: Aging-associated WMHs evolve significantly over a 4-year period. Most of this evolution represents worsening injury to the already compromised surround of existing lesions. Increasing WMH was also significantly associated with declining episodic memory and executive function. This finding supports the view that white matter disease is an insidious and continuously evolving process whose progression has clinically relevant cognitive consequences.

UR - http://www.scopus.com/inward/record.url?scp=84866108904&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866108904&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3182617136

DO - 10.1212/WNL.0b013e3182617136

M3 - Article

C2 - 22815562

AN - SCOPUS:84866108904

VL - 79

SP - 442

EP - 448

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 5

ER -