White matter hyperintensities, cognitive impairment and dementia: an update
Abstract
White matter hyperintensities (WMHs) in the brain are the consequence of cerebral small vessel disease, and can easily be detected on MRI. Over the past three decades, research has shown that the presence and extent of white matter hyperintense signals on MRI are important for clinical outcome, in terms of cognitive and functional impairment. Large, longitudinal population-based and hospital-based studies have confirmed a dose-dependent relationship between WMHs and clinical outcome, and have demonstrated a causal link between large confluent WMHs and dementia and disability. Adequate differential diagnostic assessment and management is of the utmost importance in any patient, but most notably those with incipient cognitive impairment. Novel imaging techniques such as diffusion tensor imaging might reveal subtle damage before it is visible on standard MRI. Even in Alzheimer disease, which is thought to be primarily caused by amyloid, vascular pathology, such as small vessel disease, may be of greater importance than amyloid itself in terms of influencing the disease course, especially in older individuals. Modification of risk factors for small vessel disease could be an important therapeutic goal, although evidence for effective interventions is still lacking. Here, we provide a timely Review on WMHs, including their relationship with cognitive decline and dementia.
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Previous studies investigating the relationship between WMH and cognition have reported contradictory results.
“However, studies investigating the relationship between WMH and cognition have reported contradictory results.”
From White matter hyperintensity modulates the amyloid‐tau‐cognition association and anti‐amyloid treatment efficacy in asymptomatic older adults (2025) · cites this paper as [14]
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- Authors
- Prins, N. D., & Scheltens, P.
- Affiliations
- Amsterdam Neuroscience (NL)
- Corresponding author
- Scheltens, Philip
- Venue
- Nature Reviews Neurology
- Published
- 2015-02-17
- Volume
- 11
- Issue
- 3
- Pages
- 157-165
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- OpenAlex
- W2089435027
- Cited by
- 1,284
- References
- 132
- Citations by year
- 2026: 117 · 2025: 183 · 2024: 159 · 2023: 126 · 2022: 143 · 2021: 130 · 2020: 102 · 2019: 100 · 2018: 75 · 2017: 65 · 2016: 61 · 2015: 19 · 2012: 1
- FWCI
- 9.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Neurology (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- white matter hyperintensities, cerebral small vessel disease, cognitive impairment, dementia, cognitive decline, Alzheimer's disease, vascular pathology, diffusion tensor imaging, dementia prevention, risk factors, older adults, brain MRI
- MeSH terms
- Brain, Cognition Disorders, Dementia, Humans, Magnetic Resonance Imaging, Leukoencephalopathies
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