title: White matter lesion progression, brain atrophy, and cognitive decline: the Austrian stroke prevention study.
abstract: White matter lesions progress over time, but the clinical consequences are widely unknown. Three-hundred twenty-nine elderly community-dwelling volunteers underwent serial magnetic resonance imaging scanning and cognitive testing at baseline and at 3- and 6-year follow-up. We measured the changes in white matter lesion and brain parenchymal volumes. After 6 years, the median increase in white matter lesion load was 0.2 cm3 (interquartile range [IQR], 0.0-0.80 cm3) with a maximum of 31.4 cm3. The median loss of brain volume was 2.3% (IQR, 1.13-3.58%). Increasing white matter lesion volume was correlated with loss of brain volume (p < 0.0001) and performance decline in tests of memory (p = 0.022), conceptualization (p = 0.046), and visuopractical skills (p = 0.005). Associations between changes in white matter lesion load and cognitive functioning were no longer significant when adding change in brain volume to the models, suggesting that cognitive decline related directly to loss of brain substance with progression of lesion burden.
authors.affiliation: Department of Neurology, Medical University Graz, Austria. reinhold.schmidt@meduni-graz.at
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.forename: Katja
authors.initials: K
authors.lastname: Petrovic
authors.forename: Stephen
authors.initials: S
authors.lastname: Smith
authors.forename: Helena
authors.initials: H
authors.lastname: Schmidt
authors.forename: Paul M
authors.initials: PM
authors.lastname: Matthews
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
mesh_terms: D000368:Aged; D001284:Atrophy / Q000209:etiology; D001317:Austria / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009483:Neuropsychological Tests; D013997:Time Factors