Periventricular rather than deep white matter hyperintensities are associated with white matter lesion relevant vascular cognitive impairment

Objective: Cerebral white matter hyperintensities (WMHs) are frequent findings on MRI in the elderly. This study is to investigate impacts of WMHs severity and location on cognitive performance in white matter lesion relevant vascular cognitive impairment (VCI) patients. Methods: Fifty-nine subjects with WMHs on MRI were included within three groups: normal control (NC), VCI-no dementia (VCI-ND) and vascular dementia (VaD). WMH volumes were evaluated by Fazekas visual scale and segmental volumetric. Spearman correlation analysis, receiver operator characteristic curve (ROC) and multiple linear regression analysis were employed. Results: WMH volumes and Fazekas scores gradually increased from NC through VCI-ND to VaD patients. Correlations between cognitive performances and periventricular WMHs were significantly stronger than that of deep WMHs. WMH volumes were significantly correlated with Fazekas scores particularly for periventricular WMHs. ROC analysis showed a cut-off value of periventricular WMHs rather than deep WMH to distinguish VCI from NC. Linear regression analysis demonstrated that periventricular WMHs were independent predictors for cognitive impairments of VCI patients, adjusted for age, sex and education. Conclusion: Periventricular rather than deep WMHs are associated with white matter lesions induced vascular cognitive decline and could serve as a neuroimaging marker for vascular cognitive impairments in clinical practice.