Cited by 60Dementia and Cognitive Impairment ResearchAdvanced Neuroimaging Techniques and ApplicationsAlzheimer's disease research and treatments

White matter abnormalities and cognition in aging and Alzheimer disease

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Peter, Christopher, Sathe, Aditi, Shashikumar, Niranjana, Pechman, Kimberly R., Workmeister, Abigail W., Jackson, T. Bryan, Huo, Yuankai, Mukherjee, Shubhabrata +337 more·2025·JAMA Neurology

Abstract

Importance There has yet to be a large-scale study quantifying the association between white matter microstructure and cognitive performance and decline in aging and Alzheimer disease (AD). Objective To investigate the associations between tract-specific white matter microstructure and cognitive performance and decline in aging and AD-related cognitive impairment. Design, Setting, and Participants This prognostic study of aging and AD, a secondary data analysis of multisite cohort studies, acquired data from 9 cohorts between September 2002 and November 2022. Participants were eligible if they had diffusion-weighted magnetic resonance imaging (dMRI) data, domain-specific cognitive composite z scores, demographic and clinical data, were aged 50 years or older, and passed neuroimaging quality control. Demographic and clinical covariates included age, sex, education, race and ethnicity, APOE haplotype status (ε2, ε3, ε4), and clinical status. The present study was conducted from June 2024 to February 2025. Exposures White matter microstructure and cognitive performance and decline. Main Outcomes and Measures Clinical diagnosis, imaging measures (dMRI, T1-weighted MRI, and amyloid and tau positron emission tomography), and cognitive tests. Results Of 4467 participants who underwent 9208 longitudinal cognitive sessions, 2698 (60.4%) were female, and the mean age (SD) was 74.3 (9.2) years; 3213 were cognitively unimpaired, 972 had mild cognitive impairment, and 282 had AD dementia. White matter free water (FW) showed the strongest associations with cross-sectional cognitive performance and longitudinal cognitive decline across all domains, particularly memory. FW in limbic tracts, such as the cingulum, presented the strongest associations with both memory performance (cingulum: β = −0.718; P < .001; fornix: β = −1.069; P < .001) and decline (cingulum: β = −0.115; P < .001; fornix: β = −0.153; P < .001). White matter FW measures interacted with baseline diagnosis, gray matter atrophy, APOE ε4 status, and amyloid positivity to predict poorer cognitive performance and accelerated cognitive decline. Noteworthy interactions include fornix FW and hippocampal volume (β = 10.598; P < .001), cingulum FW and SPARE-AD index (β = −0.532; P < .001), and inferior temporal gyrus transcallosal tract FW and baseline diagnosis (β = −0.537; P < .001), all predicting poorer memory performance. Conclusions and Relevance White matter microstructural changes, particularly FW, play a critical role in cognitive decline in aging and AD-related cognitive impairment. These findings highlight the importance of FW correction in dMRI studies and highlight the limbic system, especially the cingulum and fornix, as key regions associated with cognitive decline; the interaction models highlight that integrating FW-corrected metrics with other AD biomarkers may further elucidate the biological mechanisms of neurodegeneration in aging.

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Crossref · 10.1001/jamaneurol.2025.1601

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  • White-matter free water has shown associations with cognitive performance and subsequent decline, particularly in limbic tracts.

    “White-matter free water has shown associations with cognitive performance and subsequent decline, particularly in limbic tracts (Nakaya et al., 2022; Peter et al., 2025).”

    From 40 Years of diffusion MRI in the brain: From history to emerging frontiers (2026) · cites this paper as Peter et al., 2025

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Authors
Peter, C., Sathe, A., Shashikumar, N., Pechman, K. R., Workmeister, A. W., Jackson, T. B., Huo, Y., Mukherjee, S., Mez, J., Dumitrescu, L. C., Gifford, K. A., Bolton, C. J., Gaynor, L. S., Risacher, S. L., Beason-Held, L. L., An, Y., Arfanakis, K., Erus, G., Davatzikos, C., Tosun-Turgut, D., Habes, M., Wang, D., Toga, A. W., Thompson, P. M., Zhang, P., Schilling, K. G., Albert, M., Kukull, W., Biber, S. A., Landman, B. A., Bendlin, B. B., Johnson, S. C., Schneider, J., Barnes, L. L., Bennett, D. A., Jefferson, A. L., Resnick, S. M., Saykin, A. J., Crane, P. K., Cuccaro, M. L., Hohman, T. J., Archer, D. B., Alzheimer’s Disease Sequencing Project Phenotype Harmonization Consortium (ADSP-PHC) Analyst Team, Adegoke, O., Aisen, P., Apostolova, L. G., Ashford, M., Barnes, L., Beckett, L., Bernard, M., Bernhardt, H., Borowski, B., Cabrera, Y., Cairns, N. J., Carrillo, M., Chen, K., Choe, M., Clanton, T., Coker, G., Conti, C., Crawford, K., Das, S., DeCarli, C., Donohue, M., Faber, K., Fleisher, A., Flenneiken, D., Fletcher, E., Fockler, J., Forghanian-Arani, A., Foroud, T. M., Fox, N. C., Franklin, E., Gessert, D., González, H., Green, R. C., Gunter, J., Harvey, D., Hergesheimer, L., Ho, C., Householder, E., Hsaio, J. K., Jack, C. R., Jackson, J., Jagust, W., Jahanshad, N., Jimenez, G., Jin, C., Jones, D., Kantarci, K., Khachaturian, Z., Knaack, A., Koeppe, R. A., Kormos, A., Landau, S., Mahboubi, P., Malone, I., Masliah, E., Masterman, D., Mathis, C., Miller, G., Montine, T., Moore, S., Morris, J. C., Neu, S., Neuhaus, J., Nho, K., Nir, T. M., Nosheny, R., Nudelman, K., Okonkwo, O., Perrin, R. J., Peterson, R., Pizzola, J., Potter, W., Rafii, M., Raman, R., Reid, R., Reiman, E. R., Risacher, S. L., Rossi Chen, S., Ryan, L., Salazar, J., Saykin, A. J., Schwarz, C., Senjem, M., Shaffer, E., Shaw, L. M., Shen, L., Silverberg, N., Smith, S., Taylor-Reinwald, L., Thal, L., Thomopoulos, S. I., Thompson, P., Toga, A. W., Tosun-Turgut, D., Trojanowski, J. Q., Truran Sacrey, D., Veitch, D., Vemuri, P., Walter, S., Ward, C., Weiner, M. W., Wilmes, K., Yushkevich, P. A., Zimmerman, C., Albert, M., Rodzon, B., Soldan, A., Pettigrew, C., Farrington, L., Grega, M., Rudow, G., Rudow, S., Miller, M., Bakker, A., Ratnanather, T., Kolasny, A., Oishi, K., Younes, L., Moghekar, A., Na, C.-H., Worley, P., Ervin, A., Shade, D., Jones, J., Coulibaly, H., Wang, M.-C., Zhu, D., Wang, J., Troncoso, J., Nauen, D., Ellis, K., Haines, J., Lynn, A., Williams, S. M., Wheeler, N. R., Lerner, A. J., Bartlett, J., Benchek, P., Song, Y., Gim, J., Barral Rodriguez, S., De Jager, P., Leal, S., Ma, Y., Mayeux, R., Reitz, C., Reyes-Dumeyer, D., Vardarajan, B. N., Ahmad, S., Comic, H., Craft, H., Jo, T., Risacher, S. L., Saykin, A. J., Byun, M. S., Lee, D. Y., Yi, D., McNeil, J., Andrews, S., Fulton-Howard, B., Goate, A., Humphrey, J., Marcora, D., Patel, T., Raj, T., Renton, A., Sharp, A., Vialle, R., Foroud, T., Lacy, K., Knowles, D., Lakhani, C., Das, A., Lin, T., Freudenberg-Hua, Y., Wang, S., Greicius, M., Kundaje, A., Montgomery, S., Corces, R., Guðnason, V., Beecham, G., Cuccaro, M., Griswold, T., Hamilton-Nelson, K., Kunkle, B., Kushch, N., Martin, E., Mena, P., Pericak-Vance, P., Rajabli, F., Schmidt, M., Slifer, S., Vance, J., Nuytemans, K., Whitehead, P., Adams, L. D., Gilbert, J. R., Kardia, S., Smith, J., Zhao, W., Amin, N., van Duijn, C., Cantwell, L. B., Chou, Y.-F., Davatzikos, C., Nicaretta, H., Kuzma, A. B., Lee, W.-P., Leung, F., Malamon, J., Naj, A., Schellenberg, J., Wang, L.-S., Valladares, O., Lerro Rose, A., Wilk, A., Dombrosk, B., Greenfest-Allen, E., Robbins, F., White, H., Haut, J., Brettschneider, J., Cifello, J., Sha, J., Manuel, J., Bass, L., Qu, L., Carter, L., Kirsch, M., Moon, M. K., Saravanan, N., Kuksa, P., Ho, P.-C., Keskinen, P., Gangadharan, P., Tate, S., Iqbal, T., Chuang, S., Horng, W., Zhao, Y., Ren, Y., Jin, J., Katanic, Z., Frayabi, R. B., Li, M., Cranney, M., Arya, K., Huang, H., Thomopolous, S., Fornage, M., Sarnowski, C., St. George-Hyslop, P., Bis, J., Blue, L., Horimoto, A., Nafikov, R., Thornton, T., Wijsman, E., Temple, S., Day, T., Lin, E., Psaty, B., Bacikova, D., Dalgard, C., Fongang, B., Jian, X., Sargurupremraj, M., Satizabal, C., Seshadri, S., Zare, H., Bras, J., Guerreiro, R., Below, P., Dumitrescu, L., Hohman, T., Cruchaga, C., Dutcher, S., Fernandez, V., Neupane, A., Tzeng, J.-Y., Chou, S.-Y., Chesi, A. F. A., Grant, S. F. A., Alzheimer’s Disease Neuroimaging Initiative (ADNI), T. B. O. C. D. A. N. A. (. S. T., Zaras, D., Yang, Y., Durant, A., Kanakaraj, P., Kim, M. E., Gao, C., Newlin, N. R., Ramadass, K., Khairi, N. M., Li, Z., Yao, T., Choi, S.-E., Klinedinst, B., Lee, M. L., Scollard, P., Trittschuh, E. H., & Sanders, E. A.
Affiliations
  • Vanderbilt University (US)
  • University of Washington (US)
  • Boston University (US)
  • Vanderbilt Memory and Alzheimer’s Center, Vanderbilt University School of Medicine, Nashville, Tennessee
  • Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
  • National Institutes of Health (US)
  • Rush University Medical Center (US)
  • Department of Radiology, University of Pennsylvania, Philadelphia
  • The University of Texas at San Antonio Health Science Center (US)
  • Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
  • University of Wisconsin–Madison (US)
  • Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
  • University of Miami (US)
  • and the Alzheimer’s Disease Sequencing Project Phenotype Harmonization Consortium (ADSP-PHC) Analyst Team
Corresponding author
Archer, Derek B.
ORCID
Venue
JAMA Neurology
Published
2025-08-01
Volume
82
Issue
8
Pages
825
ISSN
2168-6149 (ISSN-L)
OpenAlex
W4411149570
Cited by
59
References
50
Citations by year
2026: 52 · 2025: 7
FWCI
34.88
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Neurology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Digital Commons-TMC (Texas Medical Center) (submittedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by)
Funders
  • National Institute on Aging (U19AG033655, R01AG056405, R01AG034962, R01AG080821, P01AG052350, P30AG066507, R01AG073439, P30AG072976, R01AG085571, P30AG066530, P30AG072947, P30AG072975, U01AG068057)
  • National Institute of Biomedical Imaging and Bioengineering
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
Keywords
white matter microstructure, cognitive decline, Alzheimer's disease, aging, free water, diffusion MRI, cingulum, fornix, memory, APOE ε4, amyloid, hippocampal volume, gray matter atrophy, mild cognitive impairment, dementia, white matter hyperintensities, longitudinal cognitive assessment
MeSH terms
Aged, Aged, 80 and over, Aging, Alzheimer Disease, Cognition, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Cohort Studies, Diffusion Magnetic Resonance Imaging, Positron-Emission Tomography, Cognitive Dysfunction, White Matter

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