No abstract

No abstract

Objectives The relationship between cognitive decline and white matter lesions (WMLs) on brain MRI remains controversial, with different findings among ethnic groups. We studied WMLs and five-year cognitive decline in elderly Japanese-American men. Design Longitudinal cohort study. Setting Population-based study in Honolulu, Hawaii. Participants Japanese-American men ages 74–95 years from the Honolulu-Asia Aging Study (HAAS), who were free of prevalent dementia, underwent a protocol brain MRI scan at the fifth HAAS examination (1994–96) and returned for cognitive testing 5 years later, n=267. Measurements WMLs were dichotomized as present (grade 3–9, 38.2%) and absent (grade 1–2, 61.8%). Cognitive function was measured by the Cognitive Abilities Screening Instrument (CASI) and 5-year cognitive decline was defined as a drop in CASI score of >=12 points (1 SD). Results Men with white matter lesions on MRI at baseline were significantly more likely to experience cognitive decline at 5 years compared to those without (22.4% versus 34.4%, p=0.03). Using multiple logistic regression, adjusting for age, education, apoE4 allele, large or small infarcts on MRI, baseline CASI score and hypertension, those with WMLs were significantly more likely to develop 5-year cognitive decline (OR=2.00; 95% CI=1.10 to 3.65, p=0.02). This association was stronger in men who were cognitively intact and free of ApoE4 genotype and clinical stroke at baseline. Conclusion Presence of white matter lesions on MRI was significantly associated with higher odds of five-year cognitive decline among older Japanese-American men. Presence of white matter lesions may help identify people at risk for developing dementia, who may benefit from early intervention.