Predictors for cognitive decline in patients with confluent white matter hyperintensities

V. Mok, Y. Xiong, K.K. Wong, A. Wong, R. Schmidt, W.W.C. Chu, X. Hu, E.Y. Lung Leung, S. Chen, Y. Chen, W.K. Tang, Xiangyan Chen, C.L. Ho, K.S. Wong, S.T.C. Wong

Research output: Journal article publicationJournal articleAcademic researchpeer-review

20 Citations (Scopus)


Background: Although patients harboring confluent white matter hyperintensities (WMH) are at high risk of cognitive decline, this risk varies among individuals. We investigated the predictors for cognitive decline in stroke patients with confluent WMH. Methods: We followed up 100 stroke patients with confluent WMH who were participants of the VITAmins TO Prevent Stroke study for 2 years. We investigated the association between clinical features, apolipoprotein E status, imaging measures (infarcts, microbleeds, volumes of WMH, cortical gray matter [cGM], lateral ventricles, and hippocampi), and B vitamins with changes in cognitive measures (clinical dementia rating scale, Mini-Mental State Examination, Mattis dementia rating scale - initiation/perseveration subscale). We performed Pittsburgh compound B imaging among dementia converters. Results: Multivariate regression analysis showed that increase in clinical dementia rating scale grade was associated with cGM atrophy, absence of hyperlipidemia, and lower diastolic blood pressure at baseline. cGM atrophy and absence of hyperlipidemia were also associated with deterioration in Mini-Mental State Examination and Mattis dementia rating scale - initiation/perseveration subscale scores. Pittsburgh compound B retention typical of Alzheimer's disease was found only in 10% of dementia converters. Incident stroke and B vitamins were not associated with cognitive decline. Conclusions: Among stroke patients with confluent WMH, cGM atrophy and absence of hyperlipidemia are important predictors for cognitive decline. Significant cognitive decline can occur in the absence of incident stroke or Alzheimer's pathology. © 2012 The Alzheimer's Association. All rights reserved.
Original languageEnglish
JournalAlzheimer's and Dementia
Issue numberSUPPL. 5
Publication statusPublished - 1 Oct 2012
Externally publishedYes


  • Alzheimer's disease
  • Cognitive decline
  • PiB
  • Stroke
  • White matter hyperintensities

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience

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