The association between white matter hyperintensity shape and cognitive functioning: The SMART‐MR study
Alzheimer s & Dementia, vol. 16
Abstract
Abstract Background White matter hyperintensities (WMHs) are associated with cognitive decline and increased risk of dementia, including Alzheimer’s disease. However, the association between WMH and cognitive functioning is weak, presumably due to heterogeneity of the underling WMH pathology. Recently, WMH shape has been related to the severity of the underlying pathology and, compared to volume, may provide a novel metric for WMH burden. We examined the relationship between WMH volume, shape and cognitive functioning in patients with arterial disease. We hypothesized that WMH shape was related to cognitive functioning, independent of WMH volume. Methods In the SMART‐MR study, we performed cross‐sectional analyses in 563 patients (58±10 years) with available brain MRI and data on cognitive functioning. WMH volume and shape were automatically determined on MRI data. Linear regression analyses were used to estimate the association between Z‐scores of WMH volume, WMH shape features (concavity index, solidity, convexity, fractal dimension and eccentricity) and Z‐scores of cognitive functioning, adjusted for age, sex, education, and reading ability. Results A larger WMH volume was associated with poorer executive functioning (b=0.09; 95% CI ‐0.17 to ‐0.01; p=0.02), but not memory functioning. A more complex shape of periventricular/confluent WMH was associated with poorer executive functioning (concavity index: [b=‐0.13; 95% CI ‐0.20 to ‐0.06; p <0.0001]; solidity: [b=0.09; 95% CI 0.02 to 0.17; p=0.014) and poorer memory scores (fractal dimension: b=‐0.10; 95% CI ‐0.18 to ‐0.02; p=0.02). Moreover, the association between WMH shape measured by the concavity index and executive functioning was independent of WMH volume (b=‐0.12; 95% CI ‐0.19 to ‐0.04; p=0.003). Figure 1 presents an example of two patients with similar WMH volume but a 2.7 standard deviation difference in concavity index. Conclusions A more complex shape of WMH shape was associated with poorer cognitive functioning. Our results suggest that WMH shape contains additional information about WMH burden, not otherwise captured by WMH volume.
Authors 7
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Maarten H.T. Zwartbol corresponding
University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht Utrecht Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
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University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht Utrecht Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
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Myriam G. Jaarsma‐Coes Aachen
Leiden University Medical Center · University Medical Center Utrecht
Affiliation as printed
Leiden University Medical Center Leiden Netherlands
University Medical Center Utrecht Utrecht Netherlands
Leiden University Medical Center, Leiden, Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
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University Medical Center Utrecht
Affiliation as printed
Image Sciences Institute University Medical Center Utrecht Utrecht Netherlands
Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
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University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht Utrecht Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
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Jeroen de Bresser Aachen Department of Radiology Leiden University Medical Center Leiden Netherlands Department of Radiology, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Department of Radiology Leiden University Medical Center Leiden Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
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University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht Utrecht Netherlands
University Medical Center Utrecht, Utrecht, Netherlands
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