title: Do white matter changes contribute to the subsequent development of dementia in patients with mild cognitive impairment? A longitudinal study.
abstract: OBJECTIVE
  White matter lesions on brain CT or MRI are a frequent finding in patients with Alzheimer's disease. However, little is known about the prognostic significance of these changes in cognitively impaired individuals who are at risk for subsequent development of dementia. This study aims at investigating the potential impact of white matter lucencies (WML) on brain CT on the course of mild cognitive impairment.
  
  
  METHODS
  Twenty-seven patients (mean age 72, SD 4.03) with mild cognitive impairment (MCI) and no signs of cerebrovascular disease were prospectively examined. At their initial presentation, all patients underwent a structured interview for the diagnosis of dementia (SIDAM) and a brain CT. Linear measures of atrophy and visual ratings of white matter changes were performed. At follow-up (mean interval 29 months), these patients were re-examined with the SIDAM. Eight patients had developed dementia and met clinical criteria for Alzheimer's disease (crossover group).
  
  
  RESULTS
  Evaluation of the initial CT scans revealed significantly more frequent and extended white matter abnormalities and a higher degree of temporal lobe atrophy in the crossover group as compared to the cognitively stable group. In the crossover group, high WML severity initially was associated with a lesser degree of temporal lobe atrophy and higher global cognitive performance.
  
  
  CONCLUSIONS
  We conclude that WML play a role in the dementia process and that they might accelerate cognitive decline in individuals with mild cognitive impairment. WML should be included in prospective studies of MCI as potential predictor variables.
authors.affiliation: Department of Psychiatry, University of Leipzig, Liebigstr. 22, D-04107 Leipzig, Germany. wolfh@medizin.uni-leipzig.de
authors.forename: H
authors.initials: H
authors.lastname: Wolf
authors.forename: G M
authors.initials: GM
authors.lastname: Ecke
authors.forename: S
authors.initials: S
authors.lastname: Bettin
authors.forename: J
authors.initials: J
authors.lastname: Dietrich
authors.forename: H J
authors.initials: HJ
authors.lastname: Gertz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology*; D003704:Dementia / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D013702:Temporal Lobe / Q000473:pathology*; D014057:Tomography, X-Ray Computed