Progression of White Matter Hyperintensities Contributes to Lacunar Infarction

Abstract

Both white matter hyperintensities (WMHs) and lacunar infarctions (LIs) are magnetic resonance imaging (MRI) markers of cerebral small vessel disease (SVD). However, the association between WMH and LI remains unclear. In this study, we asked whether WMH progression is related to LI occurrence using retrospective data. Overall, 8475 WMH patients with at least two MRI images were screened, and 187 patients were included in the final study; 76 patients had WMH with LI (WL), and 111 patients had WMH without LI (WOL). The 187 patients were divided into three groups according to WMH progression: Group 1 (no progression), Group 2 (0-53.64% WMH progression) and Group 3 (≥53.64% WMH progression). We found that both WMH volumes and Fazekas scores were higher in WL patients compared with those in WOL patients according to the 1st and 2nd MRI images (P<0.001), whereas WMH progression was not significantly different between these two groups (P>0.05). Importantly, we found that the occurrence rates for LI were increased in Groups 2 and 3 compared with those in Group 1. Multiple logistic regression analysis demonstrated that the risk of LI occurrence was significantly increased in Group 2 versus that in Group 1 (odds ratio, 3.36; 95% CI, 1.48 to 7.67; P=0.004) after adjusting for the baseline patient characteristics and the interval between the two MRI scans. Additionally, with a stratification time of less than 24 months, the risk of LI occurrence was higher in Group 2 versus that in Group 1, after adjusting for baseline confounding factors (odds ratio, 3.68; 95% CI, 1.51 to 8.99; P=0.004). In conclusion, we found that WMH progression was significantly associated with LI occurrence, particularly within the first two years, and that this progression could serve as an independent indicator of LI development.

Plasma Lipoprotein-Associated Phospholipase A2 and Superoxide Dismutase are Independent Predicators of Cognitive Impairment in Cerebral Small Vessel Disease Patients: Diagnosis and Assessment

“…Recent findings have indicated that WMHs are associated with the cognitive impairment in CSVD [4,[29][30][31], and our results (Fig. 3D, E) are consistant with these findings.…”

“…Worldwide, the number of CSVD patients is more common in Asians than in Caucasians [5]. Growing evidence has shown that systemic inflammatory mediators such as superoxide dismutase (SOD) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are associated with CSVD and cognitive impairment [4,[6][7][8]. However, the role of Lp-PLA2 and SOD, especially SOD, in CSVD patients with cognitive impairment is largely unknown.…”

Impaired Structural Network Properties Caused by White Matter Hyperintensity Related to Cognitive Decline

“…(3) internal carotid artery or vertebral artery stenosis (>50%) or coronary atherosclerosis heart disease; (4) WMH due to immune-mediated inflammatory demyelinating disease (multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis), metabolic leukodystrophy and genetic leukoencephalopathy; (5) other neurological disorders, such as AD, Parkinson's disease, epilepsy; (6) systemic disease, such as cancer, shock, and anemia; (7) prominent impairments of audition or vision.…”

“…Increasing evidences have confirmed that WMH can lead to cognitive impairment (CI) and is associated with an increased prevalence of stroke, dementia, and death (5,6). Additionally, different lesion sites of WMH are closely related to different cognitive aspects.…”

Decreased Cerebrovascular Reserve is the Initial Cause of White Matter Hyperintensity Related Cognitive Decline

“…A great number of studies have reported that WMH can cause vascular cognitive impairment (CI), especially in domains of executive function, attention, working memory and information processing speed. Furthermore, WMH is correlated closely with increased prevalence of stroke, dementia, and death [6,7]. WMH is known to be highly related to age [8], as well as independently related to risk factors for cardiac and cerebral vascular disease [9,10].…”