on behalf of the European Task Force on Age-Related White Matter Changes Background and Purpose-MRI is more sensitive than CT for detection of age-related white matter changes (ARWMC).Most rating scales estimate the degree and distribution of ARWMC either on CT or on MRI, and they differ in many aspects. This makes it difficult to compare CT and MRI studies. To be able to study the evolution and possible effect of drug treatment on ARWMC in large patient samples, it is necessary to have a rating scale constructed for both MRI and CT. We have developed and evaluated a new scale and studied ARWMC in a large number of patients examined with both MRI and CT. Methods-Seventy-seven patients with ARWMC on either CT or MRI were recruited and a complementary examination (MRI or CT) performed. The patients came from 4 centers in Europe, and the scans were rated by 4 raters on 1 occasion with the new ARWMC rating scale. The interrater reliability was evaluated by using statistics. The degree and distribution of ARWMC in CT and MRI scans were compared in different brain areas. Results-Interrater reliability was good for MRI (ϭ0.67) and moderate for CT (ϭ0.48). MRI was superior in detection of small ARWMC, whereas larger lesions were detected equally well with both CT and MRI. In the parieto-occipital and infratentorial areas, MRI detected significantly more ARWMC than did CT. In the frontal area and basal ganglia, no differences between modalities were found. When a fluid-attenuated inversion recovery sequence was used, MRI detected significantly more lesions than CT in frontal and parieto-occipital areas. No differences were found in basal ganglia and infratentorial areas. Conclusions-We present a new ARWMC scale applicable to both CT and MRI that has almost equal sensitivity, except for certain regions. The interrater reliability was slightly better for MRI, as was the detectability of small lesions. Key Words: dementia Ⅲ magnetic resonance imaging Ⅲ rating scales Ⅲ tomography, x-ray computed Ⅲ white matter W hite matter changes (WMC) are defined as areas with high signal intensities on T2-weighted MRI and as areas with low attenuation on CT. The mechanisms for development of WMC are not fully understood, but several histopathologic correlates have been reported. These include enlarged perivascular (Virchow-Robin) spaces, as well as degeneration of myelin and axons with increased intracellular and extracellular water content, gliosis, and even infarction. [1][2][3][4][5][6][7][8][9][10] The clinical significance of WMC has not been fully elucidated. There is a relationship between several cerebrovascular risk factors and the presence of WMC. One of the strongest risk factors, apart from hypertension, is that of age. 11-13 Henceforth, we will designate WMC as "age-related white matter changes" (ARWMC).There is also evidence for a relationship between ARWMC and cognitive impairment in demented patients 14 -16 as well as in healthy elderly individuals. 13,[17][18][19] However, the extent of this association is still controv...

To evaluate whether magnetic resonance imaging (MRI) of white matter changes in Alzheimer’s disease either under- or overestimates the findings on neuropathology. Postmortem MRI and neuropathological examination were performed on 6 brains from elderly individuals with a postmortem diagnosis of AD. Using a specially designed brain slicer, the brains were cut corresponding to the MRI images, and stained by Luxol Fast Blue. Quantitative analysis of white matter changes on MRI and neuropathology was performed using stereological principles. Measures from MRI and pathology were highly correlated (r² = 0.71). However, pathology showed significantly more extensive changes than did MRI in all cases, with a mean of 54% larger areas. The lesions not identified with MRI represented, however, only minor changes with lower intensity of myelin staining and with an accentuation of the distance between fibres but with preserved axonal network and glial cell density.

Visual acuity and common medical examination did not distinguish convicted older drivers with crashes or other moving violations from controls. There was evidence that even mild cognitive impairment contributed to the risk of losing a driving license because of crashes.

IntroductionThe underlying pathological mechanisms linking cardiovascular burden to cognitive decline remain unclear.MethodsWe investigated the associations of the Framingham general cardiovascular risk score (FGCRS), apolipoprotein E (APOE) ε4, and brain structure with the Mini‐Mental State Examination (MMSE) decline using the 9‐year follow‐up data from Swedish National Study on Aging and Care in Kungsholmen (n = 2189, age ≥60) and the embedded magnetic resonance imaging (MRI) (n = 448) studies. Volumes of white matter hyperintensities (WMHs), total gray matter, ventricles, and hippocampus were assessed in the MRI sample.ResultsA higher FGCRS was associated with faster MMSE decline in young‐old people (60–72 years) but not in old‐old (≥78 years). Larger volumes of cerebral WMHs and ventricles and smaller volumes of total gray matter and hippocampus were all associated with accelerated MMSE decline (P < .01); these associations were stronger among APOE ε4 carriers than noncarriers. Simultaneously entering multiple brain lesion markers as mediators in the model substantially attenuated the association between FGCRS and MMSE decline.DiscussionThe effect of cardiovascular risk burden on cognitive deterioration in old age is largely mediated by mixed brain lesions.