White matter hyperintensities in Alzheimer's disease: Beyond vascular contribution
Open accessAbstract
White matter hyperintensities (WMH), frequently seen in older adults, are usually considered vascular lesions, and participate in the vascular contribution to cognitive impairment and dementia. However, emerging evidence highlights the heterogeneity of WMH pathophysiology, suggesting that non‐vascular mechanisms could also be involved, notably in Alzheimer's disease (AD). This led to the alternative hypothesis that in AD, part of WMH may be secondary to AD‐related processes. The current perspective brings together the arguments from different fields of research, including neuropathology, neuroimaging and fluid biomarkers, and genetics, in favor of this alternative hypothesis. Possible underlying mechanisms leading to AD‐related WMH, such as AD‐related neurodegeneration or neuroinflammation, are discussed, as well as implications for diagnostic criteria and management of AD. We finally discuss ways to test this hypothesis and remaining challenges. Acknowledging the heterogeneity of WMH and the existence of AD‐related WMH may improve personalized diagnosis and care of patients.
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White matter microstructural changes may be not only a marker of small vessel injury but also directly related to AD pathology.
“Emerging evidence suggests that white matter microstructural changes may be not only a marker of small vessel injury but also directly related to AD pathology. 53 , 54”
From White matter hyperintensity modulates the amyloid‐tau‐cognition association and anti‐amyloid treatment efficacy in asymptomatic older adults (2025) · cites this paper as [54]
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- Authors
- Garnier‐Crussard, A., Cotton, F., Krolak‐Salmon, P., & Chételat, G.
- Affiliations
- Lyon 1 Université (FR)
- Inserm (FR)
- Corresponding author
- Chételat, Gaël
- Venue
- Alzheimer's & Dementia
- Publisher
- Wiley
- Published
- 2023-04-07
- Volume
- 19
- Issue
- 8
- Pages
- 3738-3748
- ISSN
- 1552-5260 (ISSN-L)
- 1552-5279
- OpenAlex
- W4362705667
- Cited by
- 139
- References
- 54
- Citations by year
- 2026: 42 · 2025: 56 · 2024: 34 · 2023: 7
- FWCI
- 28.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Alzheimer s & Dementia (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- white matter hyperintensities, Alzheimer's disease
- MeSH terms
- Aged, Alzheimer Disease, Humans, Magnetic Resonance Imaging, Neuroimaging, Cognitive Dysfunction, White Matter
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