title: Peripheral (deep) but not periventricular MRI white matter hyperintensities are increased in clinical vascular dementia compared to Alzheimer's disease.
abstract: Vascular dementia (VAD) is a complex diagnosis at times difficult to distinguish from Alzheimer's disease (AD). MRI scans often show white matter hyperintensities (WMH) in both conditions. WMH increase with age, and both VAD and AD are associated with aging, thus presenting an attribution conundrum. In this study, we sought to show whether the amount of WMH in deep white matter (dWMH), versus periventricular white matter (PVH), would aid in the distinction between VAD and AD, independent of age.
  
  
  
  Blinded semiquantitative ratings of WMH validated by objective quantitation of WMH volume from standardized MRI image acquisitions. PVH and dWMH were rated separately and independently by two different examiners using the Scheltens scale. Receiver operator characteristic (ROC) curves were generated using logistic regression to assess classification of VAD (13 patients) versus AD (129 patients). Clinical diagnoses were made in a specialty memory disorders clinic.
  
  
  
  Using PVH rating alone, overall classification (area under the ROC curve, AUC) was 75%, due only to the difference in age between VAD and AD patients in our study and not PVH. In contrast, dWMH rating produced 86% classification accuracy with no independent contribution from age. A global Longstreth rating that combines dWMH and PVH gave an 88% AUC.
  
  
  
  Increased dWMH indicate a higher likelihood of VAD versus AD. Assessment of dWMH on MRI scans using Scheltens and Longstreth scales may aid the clinician in distinguishing the two conditions.
authors.affiliation: Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Smith
authors.affiliation: Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky.
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Johnson
authors.affiliation: Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington Kentucky.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Van Eldik
authors.affiliation: Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Jicha
authors.affiliation: Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Schmitt
authors.affiliation: Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Pathology & Laboratory Medicine University of Kentucky College of Medicine Lexington Kentucky.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nelson
authors.affiliation: Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Statistics University of Kentucky Lexington Kentucky.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kryscio
authors.affiliation: Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky.
authors.forename: Ronan R
authors.initials: RR
authors.lastname: Murphy
authors.affiliation: Department of Diagnostic Radiology Mayo Clinic Scottsdale Arizona.
authors.forename: Clinton V
authors.initials: CV
authors.lastname: Wellnitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging*; D001921:Brain / Q000000981:diagnostic imaging; D015140:Dementia, Vascular / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012372:ROC Curve; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Image quantitation; magnetic resonance imaging; vascular dementia; white matter ratings