title: MRI-detected white matter lesions: do they really matter?
abstract: Despite extensive research over the last decades the clinical significance of white matter lesions (WMLs) is still a matter of debate. Here, we review current knowledge of the correlation between WMLs and cognitive functioning as well as their predictive value for future stroke, dementia, and functional decline in activities of daily living. There is clear evidence that age-related WMLs relate to all of these outcomes on a group level, but the inter-individual variability is high. The association between WMLs and clinical phenotypes exists particularly for early confluent to confluent changes, which are ischaemic in aetiology and progress quickly over time. One reason for the variability of the relationship between WMLs and clinic on an individual level is probably the complexity of the association. Numerous factors such as cognitive reserve, concomitant loss of brain volume, and ultrastructural changes have been identified as mediators between white matter damage and clinical findings, and need to be incorporated in the consideration of WMLs as visible markers of these detrimental processes.
authors.affiliation: Division of Special Neurology, Department of Neurology, Medical University of Graz, Graz, Austria. reinhold.schmidt@medunigraz.at
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Anja
authors.initials: A
authors.lastname: Grazer
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.forename: Nina
authors.initials: N
authors.lastname: Homayoon
authors.forename: Aga
authors.initials: A
authors.lastname: Pluta-Fuerst
authors.forename: Petra
authors.initials: P
authors.lastname: Schwingenschuh
authors.forename: Petra
authors.initials: P
authors.lastname: Katschnig
authors.forename: Margherita
authors.initials: M
authors.lastname: Cavalieri
authors.forename: Helena
authors.initials: H
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Langkammer
authors.forename: Franz
authors.initials: F
authors.lastname: Ebner
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
mesh_terms: D000203:Activities of Daily Living; D001921:Brain / Q000473:pathology* / Q000648:ultrastructure; D001931:Brain Mapping; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003704:Dementia / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging