Predictors for cognitive decline in patients with confluent white matter hyperintensities

Vincent Mok, Yunyun Xiong, Kelvin K. Wong, Adrian Wong, Reinhold Schmidt, Winnie W.C. Chu, Xintao Hu, Eric Yim Lung Leung, Sirong Chen, Yangkun Chen, Wai Kwong Tang, Xiangyan Chen, Chi Lai Ho, Ka Sing Wong, Stephen T.C. Wong

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background: Although patients harboring confluent white matter hyperintensities (WMH) are at high risk of cognitive decline, this risk varies among individuals. We investigated the predictors for cognitive decline in stroke patients with confluent WMH. Methods: We followed up 100 stroke patients with confluent WMH who were participants of the VITAmins TO Prevent Stroke study for 2 years. We investigated the association between clinical features, apolipoprotein E status, imaging measures (infarcts, microbleeds, volumes of WMH, cortical gray matter [cGM], lateral ventricles, and hippocampi), and B vitamins with changes in cognitive measures (clinical dementia rating scale, Mini-Mental State Examination, Mattis dementia rating scale - initiation/perseveration subscale). We performed Pittsburgh compound B imaging among dementia converters. Results: Multivariate regression analysis showed that increase in clinical dementia rating scale grade was associated with cGM atrophy, absence of hyperlipidemia, and lower diastolic blood pressure at baseline. cGM atrophy and absence of hyperlipidemia were also associated with deterioration in Mini-Mental State Examination and Mattis dementia rating scale - initiation/perseveration subscale scores. Pittsburgh compound B retention typical of Alzheimer's disease was found only in 10% of dementia converters. Incident stroke and B vitamins were not associated with cognitive decline. Conclusions: Among stroke patients with confluent WMH, cGM atrophy and absence of hyperlipidemia are important predictors for cognitive decline. Significant cognitive decline can occur in the absence of incident stroke or Alzheimer's pathology.

Original languageEnglish (US)
Pages (from-to)S96-S103
JournalAlzheimer's and Dementia
Issue numberSUPPL. 5
StatePublished - Oct 2012


  • Alzheimer's disease
  • Cognitive decline
  • PiB
  • Stroke
  • White matter hyperintensities

ASJC Scopus subject areas

  • Health Policy
  • Epidemiology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Developmental Neuroscience
  • Clinical Neurology


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