Yuanjing Li: Association of white matter hyperintensity accumulation with domain-specific cognitive decline: a 15-year population-based study
From Amanda Klein
Association of white matter hyperintensity accumulation with domain-specific cognitive decline: a 15-year population-based study
Background: White matter hyperintensities (WMHs) could partly account for
cognitive deterioration in late life. We aimed to investigate the association of global
and regional WMHs with domain-specific cognitive decline in older adults.
Methods: This population-based cohort study included 510 participants (age ≥60
years, 58.4% female) who were free of dementia at baseline (2001-2004). We
assessed global and regional WMHs according to the modified Scheltens’ scale from
baseline to the 6-year follow-up, and we used a neuropsychological test battery to
assess cognitive performance in different domains from baseline to the 15-year
follow-up. Data were analyzed using linear mixed-effects models.
Results: Overall, greater loads of WMHs at baseline were associated with faster
decline in letter fluency, perceptual speed, and global cognition(P<0.05). Specifically,
higher baseline load of global WMHs was related to faster decline in executive
function (multiple-adjusted β-coefficient and 95% CI: -0.020 [-0.035, -0.006]). Higher
baseline load of periventricular WMHs was associated with faster decline in category
fluency (-0.009 [-0.016, -0.002]); this association existed only in APOE ε4 carriers
but not in non-carriers (P for interaction=0.046). Furthermore, faster accumulations
of global, deep, and periventricular WMHs were related to accelerated decline in
perceptual speed (P<0.05); faster accumulation of deep WMHs was related to
accelerated decline in executive function (-0.061 [-0.118, -0.004]) and global
cognition (-0.020[-0.038, -0.002]).
Conclusions: Greater loads of WMHs are associated with faster decline in language
fluency, perceptual speed, and global cognition in older adults. Carrying APOE ε4
allele could exacerbate the deterioration in category fluency due to higher WMH
burdens. Furthermore, the decline in perceptual speed, executive function, and
global cognition is susceptible to faster WMH accumulation.