J Clin Neurol.  2019 Jan;15(1):46-53. 10.3988/jcn.2019.15.1.46.

White-Matter Hyperintensities and Lacunar Infarcts Are Associated with an Increased Risk of Alzheimer's Disease in the Elderly in China

• Ye S
• Dong S
• Tan J
• Chen L
• Yang H
• Chen Y
• Peng Z
• Huo Y
• Liu J
• Tang M
• Li Y
• Zhou H
• Tao Y

• KMID: 2451144
• DOI: http://doi.org/10.3988/jcn.2019.15.1.46

Abstract

BACKGROUND AND PURPOSE
This study investigated the contribution of white-matter hyperintensities (WMH) and lacunar infarcts (LI) to the risk of Alzheimer's disease (AD) in an elderly cohort in China.
METHODS
Older adults who were initially cognitively normal were examined with MRI at baseline, and followed for 5 years. WMH were classified as mild, moderate, or severe, and LI were classified into a few LI (1 to 3) or many LI (≥4). Cognitive function was assessed using the Mini Mental State Examination and the Activities of Daily Living scale.
RESULTS
Among the 2,626 subjects, 357 developed AD by the end of the 5-year follow-up period. After adjusting for age and other potential confounders, having only WMH, having only LI, and having both WMH and LI were associated with an increased risk of developing AD compared with having neither WMH nor LI. Moderate and severe WMH were associated with an increased risk of developing AD compared with no WMH. Furthermore, patients with many LI had an increased risk of developing AD compared with no LI.
CONCLUSIONS
Having moderate or severe WMH and many LI were associated with an increased risk of developing AD, with this being particularly striking when both WMH and LI were present.

Keyword

Alzheimer's disease; small-vessel diseases; white-matter hyperintensities

MeSH Terms

Activities of Daily Living
Adult
Aged*
Alzheimer Disease*
China*
Cognition
Cohort Studies
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Strikes, Employee
Stroke, Lacunar*

Figure

• 

  Fig. 1 Incidence of AD during the 5-year follow-up. At the end of the follow-up, the incidence of AD dementia was significantly higher in patients with only WMH, only LI, and both WMH and LI than in those with neither WMH nor LI (p<0.01). AD: Alzheimer's disease, LI: lacunar infarcts, WMH: white-matter hyperintensities.

• 

  Fig. 2 Relationships of WMH and LI with cognitive function scores at the end of the follow-up. A: Patients with only WMH, only LI, and both WMH and LI had lower mean MMSE scores than those with neither WMH nor LI (p<0.01). B: Patients with only WMH, only LI, and both WMH and LI had higher mean ADL scores than those with neither WMH nor LI (p<0.01). ADL: Activities of Daily Living, LI: lacunar infarcts, MMSE: Mini Mental State Examination, WMH: white-matter hyperintensities.

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