Severe Cerebral White Matter Hyperintensities Predict Severe Cognitive Decline in Patients With Cerebrovascular Disease History

Background and Purpose-Cerebral white matter hyperintensities (WMHs) are believed to be the consequence of small vessel disease, and it is uncertain whether their extent predicts the risk of dementia in patients with vascular disease history. Method-Brain MRI was performed in 226 participants of the PROGRESS study. WMH severity was assessed using a visual rating scale. During follow-up, patients were classified for incident severe cognitive deterioration (including dementia) using standard criteria. Results-Over 4-year follow-up, the incidence of severe cognitive deterioration ranged from 1.1 to 9.1 per 100 person-years in patients with respectively no or severe WMHs at baseline. In multivariable analysis, incident severe cognitive deterioration was associated with baseline severe WMHs (odds ratio=7.7, P<0.005). Conclusion-Higher WMH load is a strong predictor of dementia and cognitive decline in patients with cerebrovascular disease history. (Stroke. 2009; 40: 2219-2221.)