Objectives: MRI white matter hyperintensity (WMH) volume is associated with cognitive impairment. We hypothesized that specific loci of WMH would correlate with cognition even after accounting for total WMH volume.Methods: Subjects were identified from a prospective community-based study: 40 had normal cognition, 94 had mild impairment (defined here as a Clinical Dementia Rating [CDR] score of 0.5 without dementia), and 11 had mild Alzheimer's dementia. Factor analysis of a 22-item neuropsychological battery yielded 4 factors (episodic memory, executive function, spatial skills, and general knowledge). MRI WMH segmentation and analysis was performed using FreeSurfer software.Results: Higher WMH volume was independently associated with lower executive function and episodic memory factor scores. Voxel-based general linear models showed loci where WMH was strongly inversely associated with specific cognitive factor scores (p Ͻ 0.001), controlling for age, education, sex, APOE genotype, and total WMH volume. For episodic memory, clusters were observed in bilateral temporal-occipital and right parietal periventricular white matter, and the left anterior limb of the internal capsule. For executive function, clusters were observed in bilateral inferior frontal white matter, bilateral temporal-occipital and right parietal periventricular white matter, and the anterior limb of the internal capsule bilaterally.Conclusions: Specific WMH loci are closely associated with executive function and episodic memory, independent of total WMH volume. The anatomic locations suggest that WMH may cause cognitive impairment by affecting connections between cortex and subcortical structures, including the thalamus and striatum, or connections between the occipital lobe and frontal or parietal lobes. Neurology ® 2011;76:1492-1499 GLOSSARY AD ϭ Alzheimer disease; CADASIL ϭ cerebral autosomal dominant arteriopathy with stroke and ischemic leukoencephalopathy; CDR ϭ Clinical Dementia Rating; DSM-IV ϭ Diagnostic and Statistical Manual of Mental Disorders, 4th edition; FA ϭ fractional anisotropy; MCI ϭ mild cognitive impairment; PDW ϭ proton density-weighted; SPGR ϭ spoiled gradient recalled; T1W ϭ T1-weighted; T2W ϭ T2-weighted; TE ϭ echo time; TR ϭ repetition time; WMH ϭ white matter hyperintensity.There is growing recognition that ischemic brain lesions are a significant contributor to cognitive impairment and that many cases of dementia are mixed, with a cerebrovascular component.1 Ischemic white matter lesions, seen on MRI as white matter hyperintensity (WMH), have previously been associated with decreased performance on neuropsychological testing, 2,3 and risk of mild cognitive impairment 4 and dementia. 5 It has been hypothesized that WMH interfere with cognitive processing by impairing the speed or fidelity of signal transmission through affected areas. 6 The direct evidence to support this hypothesis is scant, however. 6We reasoned that if WMH impair white matter function, then clinical impairments should be associated with WM...

Advanced cerebrovascular β-amyloid deposition (cerebral amyloid angiopathy, CAA) is associated with cerebral microbleeds, but the precise relationship between CAA burden and microbleeds is undefined. We used T2*-weighted MRI and noninvasive amyloid imaging with Pittsburgh Compound B (PiB) to analyze the spatial relationship between CAA and microbleeds. On co-registered PET and MRI images, PiB retention was increased at microbleed sites compared to simulated control lesions (p=0.002) and declined with increasing distance from the microbleed (p<0.0001). These findings indicate that microbleeds occur preferentially in local regions of concentrated amyloid and support therapeutic strategies aimed at reducing vascular amyloid deposition.Cerebrovascular deposition of β-amyloid (cerebral amyloid angiopathy, CAA) is most commonly recognized during life as a cause of brain hemorrhage. Hemorrhages associated with CAA can be large, symptomatic strokes or small, typically asymptomatic cerebral microbleeds (CMB). CMB are sensitively imaged by T2*-weighted MRI and have been implicated as markers of, and possible contributors to, small vessel-related brain injury.1Although the link between CAA and CMB is well established,1 the precise mechanism by which vascular amyloid leads to microhemorrhage remains incompletely understood. It is unknown, for example, whether CMB occur preferentially at sites of greatest amyloid deposition. Circumstantial evidence supports this possibility, as both CAA pathology2 and CAA-related CMB3 tend to favor occipital cortex. Further, a recent study suggested that brains with many CAA-related CMB have greater thickness of vascular amyloid than brains with few CMB. METHODS Image Acquisition and AnalysisWe performed T2*-weighted MR and PiB-PET imaging on 16 CAA patients (Table 1) recruited at Massachusetts General Hospital.3 All subjects were diagnosed as probable CAA based on the Boston criteria (7 with supporting pathology, 9 by multiple lobar hemorrhages/ CMB),7 were nondemented, and free of symptoms suggestive of new stroke for 1 year prior to PiB-PET. PiB was prepared and PET acquisition performed using methods previously described.5 PET data were reconstructed and expressed as a distribution volume ratio (DVR) with cerebellum as reference tissue. Each subject also underwent research T2*-weighted MRI for detection of CMB.Full details of MRI acquisition, processing, identification of CMB, co-registration of T2*-weighted and PET images (Figures. 1A and B), and scoring of PiB values are provided in the Supplemental Methods. MR imaging was performed at 1.5 Tesla using protocols for gradient-echo (GRE) or susceptibility-weighted imaging (SWI) as described.8 PiB-PET values within a CMB were measured and averaged to provide mean DVR per voxel for each microbleed. PiB-PET values were also measured in five concentric "shells," each 2 mm in thickness, surrounding each CMB ( Figure 1C). To provide an appropriate control comparison for the observed CMB, 200 "simulated" CMB lesions were distributed thr...

Background MRI evidence of small vessel disease is common in intracerebral hemorrhage (ICH). We hypothesized that ICH caused by cerebral amyloid angiopathy (CAA) or hypertensive vasculopathy would have different distributions of MRI T2 white matter hyperintensity (WMH) and microbleeds (MB). Methods Data were analyzed from 133 consecutive patients with primary supratentorial ICH and adequate MRI sequences. CAA was diagnosed using the Boston criteria. WMH segmentation was performed using a validated semi-automated method. WMH and MB were compared according to site of symptomatic hematoma origin (lobar vs. deep) or by pattern of hemorrhages, including both hematomas and MB, on MRI GRE sequence (grouped as lobar only--probable CAA, lobar only--possible CAA, deep hemispheric only, or mixed lobar and deep hemorrhages). Results Lobar and deep hemispheric hematoma patients had similar median nWMH volumes (19.5 cm vs. 19.9 cm3, p=0.74) and prevalence of ≥1 MB (54% vs. 52%, p=0.99). The supratentorial WMH distribution was similar according to hemorrhage location category, however the prevalence of brainstem T2 hyperintensity was lower in lobar hematoma vs. deep hematoma (54% vs. 70%, p=0.004). Mixed ICH was common (23%). Mixed ICH patients had large nWMH volumes and a posterior distribution of cortical hemorrhages similar to that seen in CAA. Conclusions WMH distribution is largely similar between CAA-related and non-CAA-related ICH. Mixed lobar and deep hemorrhages are seen on MRI GRE in up to one quarter of patients; in these patients both hypertension and CAA may be contributing to the burden of WMH.