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white matter lesions in 40 year old

We find the best specialist for your medical problem This further suggests a need for interventions that increase brain resiliency and boost tissue regeneration in those at highest risk (e.g. High-resolution structural images were obtained using a T1-weighted MP-RAGE sequence with the following parameters: Repetition Time (TR) = 2400ms; Echo Time (TE) = 1.98ms; 208 sagittal slices; flip angle = 9; Field of View (FOV) = 224mm; matrix = 256256; slice thickness = 0.9mm with no gap (voxel size 0.9mm 0.875mm 0.875mm); and total scan time = 6min and 52s. 3D FLAIR images were obtained with the following parameters: TR = 8000ms; TE = 399ms; 160 sagittal slices; FOV = 240mm; matrix = 232256; slice thickness = 1.2mm (voxel size 0.9mm 0.9mm 1.2mm); and total scan time = 5min and 38s. To identify and extract WMH volume, T1-weighted and FLAIR images for each participant were run through Unidentified Bright Object (UBO) Detector (Jiang et al., 2018), a cluster-based, fully automated, pipeline that uses FMRIBs Automated Segmentation Tool (Zhang et al., 2001) to identify candidate clusters. The authors suggested that these abnormalities might be of ischaemic origin, secondary to atherosclerosis or vasculitis. The cohort matches the New Zealand National Health and Nutrition Survey on adult health indicators (e.g. Sex and total brain volume were used as covariates in all analyses. M. D C Neurology. She had presented at age 40 with clumsiness of the right hand, and over the next 10 years had become increasingly unsteady, with subjective cognitive decline and bladder urgency. Moreover, white matter hyperintensity volume was associated with greater cognitive decline from childhood to midlife (=0.09, P<0.001). There is confluence (merging together) so that there is a cloud surrounding the upper ventricles. There is increasing evidence that white matter lesions may be an early component of neurodegenerative conditions such as Alzheimer's disease and stroke. One reason for this inconsistency could be that older adults have accumulated decades of irrevocable age-related tissue damage. sharing sensitive information, make sure youre on a federal TBI causes damage to both white . White matter hyperintensities (WMHs) are a frequent finding on T2-weighted MRI of the brain in elderly individuals, but their prevalence and severity in younger asymptomatic populations is less well studied. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). dysmyelinating disorders. A 52-year-old woman with intellectual disability was admitted to the hospital due to pneumonia. This study aims to examine the correlation of WMHs with migraine features and explore the relationship between WMHs and migraine prognosis. Map of the sample (. Severe PVM. 2023 Jan;44(1):171-180. doi: 10.1007/s10072-022-06408-x. MRI of her brain showed diffuse hyperintensities on T 2-weighted and fluid attenuated inversion recovery images in the bilateral cerebral white matter.Laboratory examination revealed sustained high levels of serum KL-6. and transmitted securely. He undertook several junior doctor posts in the North West of England and at the National Hospital The clinical presentation of characteristic focal neurologic attacks as well as ruling out other MS mimics is essential to making an accurate diagnosis, she told Neurology Advisor. Some studies have found that white matter lesions tend to be seen on the majority of brain scans in older adults but are far less frequently seen on brain scans in younger people. While cerebrovascular risk factors such as hypertension, diabetes, high homocysteine, and so forth, are known risk factors for white matter hyperintensities, a significant proportion of the variance is unexplained. White matter hyperintensities on T2-weighted magnetic resonance imaging are frequent incidental findings in the brains of elderly individuals. 11 junio, 2020. This is because the nerve signals cant get through as normal. White matter diseases include a wide spectrum of disorders that have in common impairment of normal myelination, either by secondary destruction of previously myelinated structures (demyelinating processes) or by primary abnormalities of myelin formation (dysmyelinating processes). Alijanpourotaghsara A, Strelnikov D, Piroska M, Szalontai L, Forgo B, Jokkel Z, Persely A, Hernyes A, Kozak LR, Szabo A, Maurovich-Horvat P, Tarnoki AD, Tarnoki DL. Neuroimage. This site needs JavaScript to work properly. Front Neurol. Table 1 shows the prevalence of . Fourth, the association between volume and change in IQ was tested using ordinary least squares multiple regression. 2021 Oct 12;13(10):e18708. However, their significance and correlation to migraine disease burden remain unclear. . results of a one-year exercise intervention. Al-Hashel JY, Alroughani R, Gad K, Al-Sarraf L, Ahmed SF. AJR:151,August1988 MAOFWHITE MATTER DISEASE 363 Fig.6.-A, MRimage2500/80 shows diffuse confluent highsignalthroughout whitematter in 4-year-old boywithmetachromatic leukodystro- To view unlimited content, log in or register for free. 2009 Sep;35(4):386-93. doi: 10.1016/j.encep.2008.06.008. CTscan(notshown) wasnormal. 8600 Rockville Pike These appear as bright areas or white matter hyperintensities on somebrain MRI scans. (/?<0.002) was detected in the 51-70-year-old group with WMLs (Table 1). Debette , Mormino E, Johnson K. Valds Hernndez 40 years) with no typical vascular risk factors and/or with a suggestive family history, clinicians should con-sider a monogenic small-vessel disease (Case 4). Would you like email updates of new search results? They can reflect normal aging; white matter deteriorates as people age. PMC Non-specific white matter lesions are sometimes seen in people withmigraine. White matter disease can be broadly grouped into: demyelinating disorders. Our results demonstrate that a link between white matter hyperintensities and early signs of cognitive decline is detectable decades before clinical symptoms of dementia emerge. White matter tracts are affected, including those of the cerebral hemispheres, infratentorium, and spinal cord. Analyses reported here were checked for reproducibility by an independent data-analyst, who recreated the code by working from the manuscript and applied it to a fresh dataset. Epub 2022 Oct 26. High blood pressure (hypertension ) is a very common cause. Genetic factors, alone or in interaction with environmental factors, appear to be important. His areas of expertise include vascular neurology, stroke, cerebrovascular disease, late-onset epilepsy, migraine and neurological disorders. Purpose of review: http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. In a population-representative birth cohort of individuals now in midlife, we found that WMHs are (i) common, (ii) associated with cognitive abilities in childhood and midlife and (iii) associated with cognitive decline from childhood to midlife. However, an accurate diagnosis can be made only after thorough review of images obtained from the entire brain and by understanding the clinical context, Drs Lange and Melisaratos concluded. Close more info about Differentiating Multiple Sclerosis Mimics on MRI. The right column presents UBO labelling (red) of WMHs in the raw images from the left column. Assessments were carried out at birth and at ages 3, 5, 7, 9, 11, 13, 15, 18, 21, 26, 32, 38, and most recently (completed April 2019) 45years, when 94.1% (N=938) of the 997 participants still alive took part. Schindler LS, Subramaniapillai S, Barth C, van der Meer D, Pedersen ML, Kaufmann T, Maximov II, Linge J, Leinhard OD, Beck D, Gurholt TP, Voldsbekk I, Suri S, Ebmeier KP, Draganski B, Andreassen OA, Westlye LT, de Lange AG. Little is known about the links between WMH and vascular risk factors, cortical -amyloid (A) load, and cognition in cognitively unimpaired adults across the entire lifespan, especially in young and middle-aged adults. Typical examples are shown in Figures 1-8. With other imaging techniques, a white matter lesion may appear as a black hole, which indicates damage to the axons. Clipboard, Search History, and several other advanced features are temporarily unavailable. White matter. Incidental Findings on Brain MRI. White matter disease is the wearing away of tissue in the largest and deepest part of your brain that has a number of causes, including aging. Secondary analyses using the four sub-indexes of adult IQ showed that larger WMH volume was associated with lower scores on processing speed ( = 0.14, 95% CI = 0.20 to 0.07; P<0.001), verbal comprehension ( = 0.14, 95% CI = 0.21 to 0.07; P<0.001) and perceptual reasoning ( = 0.13, 95% CI = 0.19 to 0.06; P<0.001). National Library of Medicine The authors declare no competing interests. Liu Y, Liu D, Liu M, Li K, Shi Q, Wang C, Pan Z, Zhou L. Neurol Sci. R The dataset reported in the current article is not publicly available due to the lack of informed consent and ethical approval but is available from the corresponding author on reasonable request by qualified scientists. Older brains are characterized by age-related deterioration and may be less responsive to intervention (Sperling et al., 2014; Moffitt et al., 2017). Figure 1. MRI brain shows white matter lesions scattered diffusely in the frontal and temporal lobes. 3. Unauthorized use of these marks is strictly prohibited. The left column presents a raw FLAIR image for three representative participants with low, intermediate and high WMH load. White matter hyperintensities (WMHs) are frequently seen on MRI scans of the brain in older people. J Neurol Sci. Epub 2008 Sep 23. First, descriptive statistics was generated for the sample as a whole (Table1). Epub 2005 Oct 25. Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. The .gov means its official. White matter lesions observed on brain MRI are usually characteristic and occur in specific areas including the corpus callosum and pons. Is it meaningful? . Using K-nearest neighbours algorithms, clusters in the MRI images are classified as WMHs or non-WMHs (i.e. White matter signal hyperintensities in the brains of patients with late paraphrenia and the normal, community-living elderly. White matter lesions have been repeatedly associated with gait disturbances and mobility difficulties. He took up his post as Professor of Clinical Neuroscience at Lancaster University in 2017 alongside his NHS role. This time has just been booked by another user. (C) Association between WMH volume and cognitive decline. FOIA Requests require a concept paper describing the purpose of data access, ethical approval at the applicants university and provision for secure data access. People who have mild forms of microvascular ischemic brain disease may have no symptoms. P 25-year-old female patient, not known to have any chronic illness, presented with migraine without aura for 6-year duration of grade II severity, not responding to medical treatment. His areas of expertise include vascular neurology, stroke, cerebrovascular disease, late-onset epilepsy, migraine and neurological disorders. Standardized methods to examine such pathology and its determinants will help inform strategies for their prevention, which is an important component of a healthy ageing agenda. Longitudinal studies show that those with baseline lesions have a greater progression over time. Unable to load your collection due to an error, Unable to load your delegates due to an error, Preparation for kNN classification feature space: (, Some kNN classification results. BMI = body mass index. Clipboard, Search History, and several other advanced features are temporarily unavailable. It is sensible to make sure that treatable conditions such as high blood pressure are recognised and treated in case the white matter lesions are due to this. White matter disease, or leukoaraiosis, involves the degeneration of white matter in the brain. Subscribe to our Newsletter to stay up to date on the latest news, TOP DOCTORS | 85 Tottenham Court Road, London, W1T 4TQ. Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP). These nerves are also called white matter. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Reduced coupling between offline neural replay events and default mode network activation in schizophrenia, Cognitive correlates of antisaccade behaviour across multiple neurodegenerative diseases, Uncovering spatiotemporal patterns of atrophy in progressive supranuclear palsy using unsupervised machine learning, Brain-derived neurotrophic factor released from blood platelets prevents dendritic atrophy of lesioned adult central nervous system neurons. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. Dr Schiess added that ancillary testing, including blood work, CSF findings, optical coherence tomography (OCT), and evoked potentials can also facilitate diagnosis. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. Longitudinal studies have shown that WMHs tend to grow and expand from existing lesions and that higher baseline volumes predict faster accumulation of WMHs and more rapid cognitive decline in older adults (Maillard et al., 2012; Prins and Scheltens, 2015). Jiang Slow walking. New imaging techniques present an opportunity to examine white matter pathology in great detail in younger populations. Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures. Christidi F, Tsiptsios D, Sousanidou A, Karamanidis S, Kitmeridou S, Karatzetzou S, Aitsidou S, Tsamakis K, Psatha EA, Karavasilis E, Kokkotis C, Aggelousis N, Vadikolias K. Neurol Int. All statistical analyses were done using R (v.3.4.5). Distribution of WMHs in 45-year-old participants from the Dunedin Study. this complication is seen in up to 40 % of patients receiving intrathecal methotrexate [29, 30]. Second, WMH volume was log-transformed for normality. Neurology. Brain lesions are areas of damaged brain tissue. A 69-year-old, male, with a left frontal meningioma, . Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Correspondence to: Dr. Ahmad R. Hariri, PhD Department of Psychology & Neuroscience Laboratory of NeuroGenetics Cognition and Cognitive Neuroscience, Training Program Duke University Durham, NC 27708, USA E-mail: A fast diffeomorphic image registration algorithm, Cerebral white matter lesions and cognitive function: the Rotterdam scan study, Neuroimaging findings in midlife and risk of late-life dementia over 20 years of follow-up, Looking for system integrity in cognitive epidemiology, The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis, White matter hyperintensities and imaging patterns of brain ageing in the general population, UBO Detectora cluster-based, fully automated pipeline for extracting white matter hyperintensities, White matter hyperintensities are a core feature of Alzheimers disease: evidence from the dominantly inherited Alzheimer network, Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the cardiovascular health study, Coevolution of white matter hyperintensities and cognition in the elderly, The longitudinal study of aging in human young adults: knowledge gaps and research agenda. A sensitivity analysis using a difference score (adult IQ childhood IQ) as a measure of change in IQ rather than a residualized change score did not change the results. Study members in all panels are grouped into deciles defined by SDs from the mean WMH volume (mm3), ranging from 1.5 to 1.5 SDs in 0.5 SD increments. A. He had imaging that noted a subacute infarct in the left parietal lobe along with multiple areas of white matter signal abnormalities and The lesions are not confined to white matter tracts and may also involve central grey matter. The possibility of . They found a rather high prevalence, roughly 40%-80 in persons . 2007 Jan 16;68(3):214-22. doi: 10.1212/01.wnl.0000251302.55202.73. Please enable it to take advantage of the complete set of features! Further complicating the process are the numerous other disorders that can cause the same imaging findings that are characteristic of MS.2 These encompass a wide range of conditions, including various inflammatory disorders, CNS infections, genetic disorders, nutritional deficiencies, and more. Over time these exposures may lead to negative health outcomes, such as higher risk for cardiovascular disease, brain damage and higher blood pressure, which contribute to increased WMH volume in midlife. official website and that any information you provide is encrypted With the wide use of brain MRI, white matter hyperintensity (WMH) is frequently observed in clinical patients. Damage to the very small blood vessels in the brain can cause white matter lesions. The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients. White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. Please choose an alternative time. Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. To do this, WMH volume was regressed on adult IQ, adjusting for childhood IQ. 2004 May;22(1):144-54. doi: 10.1016/j.neuroimage.2003.12.027. Risk factors of white matter hyperintensities in migraine patients. Changes in mood . poor nutrition, smoking, drug abuse, lead exposure). 6, 7, 11, 18 A few case reports describe focal lesions in the white matter in IBD patients who developed neurological symptoms. Brain lesions and cerebral functional impairment in migraine patients. Successful surrogate biomarkers would allow clinicians to assess risk, monitor sub-clinical disease progression and intervene before clinically significant dementia symptoms manifest. However, the success of this investment hinges on developing surrogate biomarkersbiological measures that are part of the putative disease pathway and are measurable before the onset of clinical symptomsso that prevention can target at-risk individuals before cerebral decline has taken hold. Preparation for kNN classification feature, Preparation for kNN classification feature space: ( a ) A candidate WMH cluster, Some kNN classification results. Neurologists order brain scanswhich might show white matter lesionsfor a wide variety of motor symptoms (such as weakness, incoordination, and gait disorder), sensory symptoms (such as numbness, tingling, and visual loss), and neurobehavioral problems (such as memory loss, language impairment, and personality changes). oldpatientwithKrabbedisease. He has published over 100 publications in peer-reviewed medical journals and regularly engages in peer-review and editorial work. White matter lesions might be referred to as age-related, wear-and-tear changes. This research was supported by National Institute on Aging (Grant Nos. Professor Emsley was appointed Consultant Neurologist with special interest in Stroke Neurology at Lancashire Teaching Hospitals NHS Foundation Trust in 2008, and in 2014, he became the Clinical Director for Neurology at the Trust for three years. Neuroimage Clin. Psychiatry Res. Ops! Ramirez J, Holmes MF, Scott CJM, Ozzoude M, Adamo S, Szilagyi GM, Goubran M, Gao F, Arnott SR, Lawrence-Dewar JM, Beaton D, Strother SC, Munoz DP, Masellis M, Swartz RH, Bartha R, Symons S, Black SE; ONDRI Investigators. Professor Emsley graduated with an MBChB in 1996 from the University of Manchester. Search for other works by this author on: Department of Medicine, University of Otago, Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Social, Genetic, & Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, & Neuroscience, Kings College London, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Center for Genomic and Computational Biology, Duke University. is supported by the National Science Foundation Graduate Research Fellowship (Grant No. The site is secure. White matter is tissue that includes nerve fibers (axons), which connect nerve cells. 2022;36:103239. doi: 10.1016/j.nicl.2022.103239. , Scheltens P. Sperling These abnormalities can also be seen in elderly people and patients with stroke and dementia. Would you like email updates of new search results? February 27, 2023 alexandra bonefas scott No Comments . There was also a trending association between larger volume and decreased working memory ability ( = 0.06, 95% CI = 0.13 to 0.00; P=0.06). Lee WMHs were delineated from FLAIR and T1-weighted scans by using a computer algorithm, further verified and then classified using k-nearest neighbor (kNN) algorithm into deep WMH (DWMH), and periventricular WMH (PVWMH), which included extended periventricular "rims" and frontal and occipital "caps". , Viqar F, Zimmerman ME, Narkhede A, Tosto G, Benzinger TLS, et al. The premise and analysis plan for this project were pre-registered on https://sites.google.com/site/dunedineriskconceptpapers/documents. 150. NCI CPTC Antibody Characterization Program. Brain scans requested in this situation can be reassuring but they may show unexpected or incidental findings. Bethesda, MD 20894, Web Policies If you smoke, it is sensible to stop. MRI differential diagnosis of suspected multiple sclerosis. . eCollection 2021 Oct. Endres D, Matysik M, Feige B, Venhoff N, Schweizer T, Michel M, Meixensberger S, Runge K, Maier SJ, Nickel K, Bechter K, Urbach H, Domschke K, Tebartz van Elst L. Diagnostics (Basel). This is important because even sub-clinical cognitive decline impacts daily functioning and psychological well-being (Tucker-Drob, 2011). As the brain ages, it begins to accrue small microbleeds and lesions in white matter that are detectable as WMHs using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) (Iadecola, 2013). They may also reflect a mixture of inflammation, swelling, and damage to the myelin. The CSF fraction increased significantly with age, consistent with previous reports. Case 4 A 32-year-old woman born of consanguineous parents gave a 3-year history of slowly progressive gait distur-bance, headaches and subcortical cognitive dysfunc-tion. White matter hyperintensities proliferate as the brain ages and are associated with increased risk for cognitive decline as well as Alzheimers disease and related dementias. leukodystrophies (note, however, that many . 2020 Aug 11;11:847. doi: 10.3389/fneur.2020.00847. MRI imaging of the brain provides the objective support needed to endorse the diagnosis, though it is only one of many tools that help guide the diagnostic process, according to Dale J. Lange, MD, and Darius P. Melisaratos, MD, of Hospital for Special Surgery (HSS) in New York. , Shibata DK, Windham BG, Mosley TH, West NA, Knopman DS. We report the topography of WMHs on T2-weighted fluid inversion recovery (FLAIR) MRI in 428 individuals aged 44-48 years recruited randomly from a healthy community sample. For further information, read our Privacy Policy. Urinary incontinence. Periventricular white matter lesions Periventricular white matter changes (3-13 mm from the ventricular surface) are thought to be haemodynamically determined rather than only related to small vessel disease 8. You may be attended by another doctor who is member of the Team. Additional support was provided by the Jacobs Foundation. WASHINGTON -- Age-related changes in the brain -- the appearance, starting around age 60, of "white-matter lesions" among the brain's message-carrying axons -- significantly affect cognitive. R TE Objectives To compare the performances of lung ultrasonography (LUS) versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome (HFRS). One solution is to assess WMHs in midlife, a time when the brain may be more responsive to interventions and has yet to be affected by decades of age-related organ decline. This difference was exacerbated in adulthood; larger WMH volume was associated with lower IQ ( = 0.15, 95% CI = 0.22 to 0.09; P<0.001; Fig. Mood changes, such as depression. The only way to tell is to determine if there are co-existing abnormalities in other parts of the brain and this must be incorporated within the context of the clinical condition, they said. However, it is unclear at what stage of aging white matter hyperintensities begin to relate to cognition and if they may be a viable target for early prevention. 2006 Feb 15;29(4):1031-9. doi: 10.1016/j.neuroimage.2005.08.057. Consequently, WMHs have been targeted as a surrogate biomarker for dementia prevention trials (Debette and Markus, 2010). However, for additional quality assurance, every participants UBO-generated WMH map was visually inspected to check for false positives (e.g. Historical note and terminology. White matter is made up of tracts, or bundles, each of which contains millions of nerve fibers that connect gray matter regions throughout the central nervous system. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). A 44-year-old man with a 30-pack-year history of smoking presented with 2 months of headaches. problems . A special focus on vascular white matter lesions will be developed in view of the cognitive impairment these lesions can produce and the . Y He undertook several junior doctor posts in the North West of England and at the National Hospital for Neurology and Neurosurgery in London before becoming a member of the Royal College of Physicians of London (MRCP) in 1999. Cognitive decline is depicted here as the change from group mean childhood IQ score to group mean adult IQ score, for groups defined based on the level of white matter hyperintensities. Tracy dArbeloff and Maxwell L Elliott contributed equally to this work. The 60-year-old father of the main resident of the home got into a confrontation with the four suspects outside around 4:40 a.m. As the confrontation escalated, the suspects shot the man in the head. Given that prevention of damage is often more efficacious than reversal of damage (Sperling et al., 2014; Moffitt et al., 2017), particularly in the brain, our results suggest that lifestyle and pharmaceutical interventions aimed at slowing the progression of WMHs in midlife may be promising complements to interventions in older adults. "Most clinically stable MS patients get one surveillance MRI per year," says Dr. Miller. 1995 Jul 15;38(2):86-91. doi: 10.1016/0006-3223(94)00248-2. Vasculitic autoimmune diseases such as systemic lupus erythematosus(SLE) and Sjgrens syndrome can also result in white matter abnormalities on MRI. anti-drug messaging, better nutrition) in high-risk children could limit the burden of cognitive decline and ADRD later in life. We found that white matter hyperintensities were common at age 45 and that white matter hyperintensity volume was modestly associated with both lower childhood ( = 0.08, P=0.013) and adult IQ (=0.15, P<0.001). White matter hyperintensities (WMH) are very frequent in older adults and associated with worse cognitive performance. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Different Types of MRIs. Disclaimer. areas such as the septum that appear similar to WMHs on FLAIR images). The resulting WMH probability maps were thresholded at 0.7, which is the suggested standard (Jiang et al., 2018). , Booth T, Murray C, Gow AJ, Penke L, Morris Z, et al. Please login or register first to view this content. Lastly, participants with larger WMH volume experienced more cognitive decline by midlife ( = 0.09, 95% CI = 0.13 to 0.02; P<0.001; Fig. BMC Neurol. Thus, our findings suggest that WMHs may be a surrogate biomarker for identifying individuals in midlife who are at risk for future clinically significant cognitive decline or ADRD.

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