title: White matter lesions are prevalent but differentially related with cognition in aging and early Alzheimer disease.
abstract: BACKGROUND
  White matter lesions (WMLs) are prevalent in nondemented aging and in Alzheimer disease (AD). Their relationship with cognition in the earliest stages of AD is unknown.
  
  
  OBJECTIVE
  To assess the relationship between WMLs and cognition in nondemented aging and in early-stage AD.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Alzheimer Disease Research Center, St Louis, MO.
  
  
  METHODS
  Participants were nondemented (n = 88) or had very mild (n = 48) or mild (n = 20) AD.
  
  
  METHODS
  Regression coefficients for deep WMLs and periventricular WMLs (PVWMLs) as predictors of cognition, after controlling for age, educational achievement, brain atrophy, and infarctlike lesions.
  
  
  RESULTS
  White matter lesions were present in nondemented aging and in early-stage AD, with no group differences in deep WML burden and a modest PVWML burden increase in the AD group. The prevalence of infarctlike lesions was equivalent between groups. Age and hypertension were related to deep WML burden and PVWML burden. Deep WML burden and PVWML burden were associated with reduced global cognition in AD but not in nondemented aging. A PVWML x AD status interaction for global cognition suggests that the relationship between PVWMLs and cognition is modified by AD. In AD, global cognitive reductions were related to impairments in visual memory, processing speed, and executive function.
  
  
  CONCLUSIONS
  White matter lesions are prevalent in nondemented aging and in early-stage AD, and their presence influences cognitive impairment in the earliest stages of AD. Individuals with early-stage AD may be more vulnerable to the cognitive effect of WMLs than nondemented aging individuals with similar WML burden.
authors.affiliation: Department of Neurology, Washington University, St Louis, MO, USA. jburns2@kumc.edu
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Burns
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Church
authors.forename: David K
authors.initials: DK
authors.lastname: Johnson
authors.forename: Chengjie
authors.initials: C
authors.lastname: Xiong
authors.forename: Daniel
authors.initials: D
authors.lastname: Marcus
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Fotenos
authors.forename: Abraham Z
authors.initials: AZ
authors.lastname: Snyder
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
authors.forename: Randy L
authors.initials: RL
authors.lastname: Buckner
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology* / Q000523:psychology; D000544:Alzheimer Disease / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D003072:Cognition Disorders / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D058225:Plaque, Amyloid / Q000473:pathology; D011237:Predictive Value of Tests; D015995:Prevalence