Neuroanatomical localisation and clinical correlates of white matter lesions in the elderly.
BACKGROUND
White matter lesions (WML) in elderly people co-occur with hypertension, depression, and cognitive impairment. Little is known about the density and distribution of WML in normal elderly people, whether they occur randomly in the aging brain or tend to cluster in certain areas, or whether patterns of WML aggregation are linked to clinical symptoms.


OBJECTIVE
To describe patterns of WML distribution in a large representative population of elderly people using non-inferential cluster analysis; and to determine the extent to which such patterns are associated with clinical symptomatology.


METHODS
A population sample of 1077 elderly people was recruited. Multiple analysis of correspondence followed by automatic classification methods was used to explore overall patterns of WML distribution. Correspondence was then sought between these patterns and a range of cerebrovascular, psychiatric, and neurological symptoms.


RESULTS
Three distinct patterns of spatial localisation within the brain were observed, corresponding to distinct clusters of clinical symptoms. In particular WML aggregation in temporal and occipital areas was associated with greater age, hypertension, late onset depressive disorder, poor global cognitive function, and overall WML frequency.


CONCLUSIONS
WML localisation is not random in the aging brain, and their distribution is associated with age and the presence of clinical symptoms. Age differences suggest there may be patterns of progression across time; however, this requires confirmation from longitudinal imaging studies.
Institut National de la Santé et de la Recherche Médicale, INSERM EMI 0361, Epidemiology of Nervous System Pathologies, Montpellier, France. artero@montp.inserm.fr
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S
Artero
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H
Tiemeier
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ND
Prins
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R
Sabatier
M M B
MM
Breteler
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K
Ritchie
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000150:complications* / Q000523:psychology*; D016000:Cluster Analysis; D003072:Cognition Disorders / Q000188:drug therapy*; D015331:Cohort Studies; D003863:Depression / Q000150:complications / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged