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The association between white matter hyperintensity shape and cognitive functioning: The SMART‐MR study
Author(s) -
Zwartbol Maarten H.T.,
Ghaznawi Rashid,
JaarsmaCoes Myriam,
Kuijf Hugo J.,
Hendrikse Jeroen,
de Bresser Jeroen,
Geerlings Mirjam I.
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.044784
Subject(s) - hyperintensity , cognition , dementia , medicine , cognitive decline , effects of sleep deprivation on cognitive performance , cardiology , psychology , audiology , disease , magnetic resonance imaging , psychiatry , radiology
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.