White Matter Hyperintensity Predicts the Risk of Incident Cognitive Decline in Community Dwelling Elderly

Article type: Research Article

Authors: Ding, Ding^{a; b; *} | Xiong, Yunyun^c | Zhao, Qianhua^{a; b} | Guo, Qihao^{a; b} | Chu, Shuguang^{b; d} | Chu, Winnie W.C.^e | Luo, Jianfeng^f | Liang, Xiaoniu^{a; b} | Zheng, Li^{a; b} | Hong, Zhen^{a; b} | Wong, Lawrence K.S.^{f; g} | Mok, Vincent C.T.^{g; *}

Affiliations: [a] Institute of Neurology, Huashan Hospital, Fudan University, WHO Collaborating Center for Research and Training in Neurosciences, Shanghai, China | [b] National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China | [c] Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China | [d] Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China | [e] Department of Radiology and Organ Imaging, The Chinese University of Hong Kong, Shatin, Hong Kong, China | [f] Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China | [g] Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China

Correspondence: [*] Correspondence to: Ding Ding, MPH, PhD, Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Rd., Shanghai 200040, China. Tel.: +86 21 52888158; E-mail: dingding@huashan.org.cn and Vincent Mok, MD, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Tel.: +852 35052211; E-mail: vctmok@cuhk.edu.hk.

Abstract: Background:Unlike western countries, data on white matter hyperintensity (WMH) in community dwelling elderly in Asian population is very limited. Objective:To examine the relation between baseline WMH burden and the risk of incident cognitive decline in a community-based cohort with Chinese-dwelling elderly. Methods:We prospectively evaluated the incident cognitive decline for 226 participants in the Shanghai Aging Study. Baseline WMH severity was visually rated by the age-related white matter changes (ARWMC) scale based on MRI. Cox proportional hazards regression model was used to estimate the relative risk (RR) of total ARWMC scale, global ARWMC score, presence of lacune and microbleed, for incident cognitive decline by adjusting potential confounders. Results:Forty subjects were identified with incident cognitive decline (new onset 34 mild cognitive impairment and 6 dementia) during a median duration of 6 years follow–up. The incidence of cognitive decline was 3.0 (95% confidence interval [CI] 2.2–4.1) per 100 person-years. Increasing total ARWMC scale [RR1.21 (95% CI 1.06–1.39), p = 0.004)], confluent WMH [RR3.16 (95% CI 1.50–6.64), p = 0.002), and presence of lacunes [RR 2.73 (95% CI 1.21–6.15)] at baseline were independent predictors of incident cognitive decline. Conclusion:Our study demonstrated that confluent WMH may increase the risk of incident cognitive decline by 3 folds in community dwelling subjects. Small vessel disease may cause heavy burden of cognitive impairment in the elderly in China.

Keywords: Cognitive decline, dementia, mild cognitive impairment, small vessel disease, white matter hyperintensity

DOI: 10.3233/JAD-170876

Journal: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1333-1341, 2018