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MRI-detected white matter lesions: do they really matter?

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Abstract

Despite extensive research over the last decades the clinical significance of white matter lesions (WMLs) is still a matter of debate. Here, we review current knowledge of the correlation between WMLs and cognitive functioning as well as their predictive value for future stroke, dementia, and functional decline in activities of daily living. There is clear evidence that age-related WMLs relate to all of these outcomes on a group level, but the inter-individual variability is high. The association between WMLs and clinical phenotypes exists particularly for early confluent to confluent changes, which are ischaemic in aetiology and progress quickly over time. One reason for the variability of the relationship between WMLs and clinic on an individual level is probably the complexity of the association. Numerous factors such as cognitive reserve, concomitant loss of brain volume, and ultrastructural changes have been identified as mediators between white matter damage and clinical findings, and need to be incorporated in the consideration of WMLs as visible markers of these detrimental processes.

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Abbreviations

AD:

Alzheimer’s disease

ADAS:

Alzheimer’s disease assessment scale

ARIC:

Atherosclerosis risk in communities

DM II:

Diabetes mellitus type 2

CDR:

Clinical dementia rating (scale)

CASCADE:

Cardiovascular determinants of dementia (study)

LADIS:

Leukoaraiosis and disability (study)

MCI:

Mild cognitive impairment

MEMO:

Memory and morbidity in Augsburg elderly (study)

MMSE:

Mini mental state examination

MRI:

Magnetic resonance imaging

PROSPER:

Prospective study of Pravastatin in the elderly at risk

SMART-MR:

Second manifestations of ARTerial disease-MR substudy

WMH:

White matter hyperintensities

WML:

White matter lesions

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Correspondence to Reinhold Schmidt.

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This article is dedicated to Professor Kurt Jellinger in admiration of his outstanding research achievements in the field of dementia and in appreciation of his long-standing support for our research group.

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Schmidt, R., Grazer, A., Enzinger, C. et al. MRI-detected white matter lesions: do they really matter?. J Neural Transm 118, 673–681 (2011). https://doi.org/10.1007/s00702-011-0594-9

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