title: Progression of white matter hyperintensities and incidence of new lacunes over a 3-year period: the Leukoaraiosis and Disability study.
abstract: OBJECTIVE
  We studied the natural course of white matter hyperintensities (WMH) and lacunes, the main MRI representatives of small vessel disease, over time and evaluated possible predictors for their development.
  
  
  METHODS
  Baseline and repeat MRI (3-year follow-up) were collected within the multicenter, multinational Leukoaraiosis and Disability study (n=396). Baseline WMH were scored on MRI by the Fazekas scale and the Scheltens scale. WMH progression was assessed using the modified Rotterdam Progression scale (absence/presence of progression in 9 brain regions). Baseline and new lacunes were counted per region. WMH and lacunes at baseline and vascular risk factors were evaluated as predictors of WMH progression and new lacunes.
  
  
  RESULTS
  WMH progressed (mean+/-SD=1.9+/-1.8) mostly in the subcortical white matter, where WMH was also most prevalent at baseline. The majority of new lacunes, which were found in 19% of the subjects (maximum=9), also appeared in the subcortical white matter, mainly of the frontal lobes, whereas most baseline lacunes were located in the basal ganglia. Baseline WMH and lacunes predicted both WMH progression and new lacunes. Furthermore, previous stroke, diabetes, and blood glucose were risk factors for WMH progression. Male sex, hypertension, systolic blood pressure, previous stroke, body mass index, high-density lipoprotein, and triglyceride levels were risk factors for new lacunes.
  
  
  CONCLUSIONS
  WMH and lacunes progressed over time, predominantly in the subcortical white matter. Progression was observed especially in subjects with considerable WMH and lacunes at baseline. Moreover, the presence of vascular risk factors at baseline predicted WMH progression and new lacunes over a 3-year period.
authors.affiliation: Department of Neurology, Alzheimer Center and Image Analysis Center, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. AA.Gouw@vumc.nl
authors.forename: Alida A
authors.initials: AA
authors.lastname: Gouw
authors.forename: Wiesje M
authors.initials: WM
authors.lastname: van der Flier
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Elisabeth C W
authors.initials: EC
authors.lastname: van Straaten
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pantoni
authors.forename: Anna
authors.initials: A
authors.lastname: Poggesi
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
authors.forename: Lars O
authors.initials: LO
authors.lastname: Wahlund
authors.forename: Gunhild
authors.initials: G
authors.lastname: Waldemar
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001479:Basal Ganglia / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D020520:Brain Infarction / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D015994:Incidence; D049292:Leukoaraiosis / Q000453:epidemiology* / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors