title: Periventricular white matter hyperintensities and the risk of dementia: a CREDOS study.
abstract: BACKGROUND
  Cerebral white matter hyperintensities (WMH) are prevalent incident findings on brain MRI scans among elderly people and have been consistently implicated in cognitive dysfunction. However, differential roles of WMH by region in cognitive function are still unclear. The aim of this study was to ascertain the differential role of regional WMH in predicting progression from mild cognitive impairment (MCI) to different subtypes of dementia.
  
  
  METHODS
  Participants were recruited from the Clinical Research Center for Dementia of South Korea (CREDOS) study. A total of 622 participants with MCI diagnoses at baseline and follow-up evaluations were included for the analysis. Initial MRI scans were rated for WMH on a visual rating scale developed for the CREDOS. Differential effects of regional WMH in predicting incident dementia were evaluated using the Cox proportional hazards model.
  
  
  RESULTS
  Of the 622 participants with MCI at baseline, 139 patients (22.3%) converted to all-cause dementia over a median of 14.3 (range 6.0-36.5) months. Severe periventricular WMH (PWMH) predicted incident all-cause dementia (Hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.43-3.43) and Alzheimer's disease (AD) (HR 1.86; 95% CI 1.12-3.07). Subcortical vascular dementia (SVD) was predicted by both PWMH (HR 16.14; 95% CI 1.97-132.06) and DWMH (HR 8.77; 95% CI 1.77-43.49) in more severe form (≥ 10 mm).
  
  
  CONCLUSIONS
  WMH differentially predict dementia by region and severity. Our findings suggest that PWMH may play an independent role in the pathogenesis of dementia, especially in AD.
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Sangha
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Neurology,Inha University School of Medicine,Incheon,South Korea.
authors.forename: Seong Hye
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Psychiatry,Busan National University Hospital,Busan,South Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Lee
authors.affiliation: Biostatistics Team,Samsung Biomedical Research Institute,Seoul,South Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Young Don
authors.initials: YD
authors.lastname: Kim
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Jin Hong
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Woojae
authors.initials: W
authors.lastname: Myung
authors.affiliation: Department of Neurology,Bobath Memorial Hospital,Seongnam,South Korea.
authors.forename: Hae Ri
authors.initials: HR
authors.lastname: Na
authors.affiliation: Department of Neurology,Dementia and Neurocognitive center,Myongji Hospital,Goyang,South Korea.
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Han
authors.affiliation: Department of Neurology,Bucheon St. Mary's Hospital,The Catholic Univerisy of Korea,School of Medicine,Bucheon,South Korea.
authors.forename: Yong S
authors.initials: YS
authors.lastname: Shim
authors.affiliation: Department of Neurology,National Health Insurance Corporation Ilsan Hospital,Goyang,South Korea.
authors.forename: Jong Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurology,Eulji University College of Medicine,Daejeon,South Korea.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Yoon
authors.affiliation: Department of Neurology,Seoul National University Bundang Hospital,Seongnam,South Korea.
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Psychiatry,Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,South Korea.
authors.forename: Doh Kwan
authors.initials: DK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000473:pathology*; D015331:Cohort Studies; D015140:Dementia, Vascular / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D066127:White Matter / Q000473:pathology*
keywords: Alzheimer’s disease; dementia; mild cognitive impairment; subcortical vascular dementia; white matter hyperintensity