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Neuropsychologic correlates of MRI white matter hyperintensities

A study of 150 normal volunteers

Departments of Neurology (Drs. Schmidt, Fazekas, Offenbacher, Grieshofer, Koch, and Lechner, and T. Dusek, E. Zach, and B. Reinhart) and Internal Medicine (Drs. Eber and Schumacher), and the Institute for Social Medicine (Dr. Freidl), Karl Franzens University Graz, Austria.

To determine the effects of MRI white matter hyperintensities (WMH) on cognitive functioning, we used neuropsychologic tests and MRI to study 150 elderly volunteers free of neuropsychiatric or general disease. There were 76 (50.3%) individuals without and 74 (49.7%) with WMH. The latter subset was older (61.3 ± 6.6 years versus 58.5 ± 5.8 years, p = 0.0051, had a higher mean arterial blood pressure (103.7 ± 11.4 mm Hg versus 99.9 ± 10.3 mm Hg, p = 0.03), and a larger ventricular-to-intracranial-cavity ratio (6.3 ± 5.6% versus 4.7 ± 1.6%, p = 0.02). Individuals with WMH performed worse than their counterparts without such abnormalities on all tests administered. After adjusting for the group differences in age, arterial blood pressure, and ventricular size, we noted statistically significant results on form B of the Trail Making Test (121.8 ± 37.8 msec versus 100.3 ± 47.9 msec, p = 0.04), a complex reaction time task (680.8 ± 104.9 msec versus 607.1 ± 93.9 msec, p >= 0.001), and the assembly procedure of the Purdue Pegboard Test (27.5 ± 5.8 versus 30.6 ± 5.9, p = 0.02). Partial correlations did not reveal any relationship between test scores and the semiautomatically assessed total area of WMH. Our data suggest that the presence of WMH exerts a subtle effect on neuropsychologic performance of normal elderly individuals, which becomes particularly evident on tasks measuring the speed of more complex mental processing.

Address correspondence and reprint requests to Dr. Reinhold Schmidt, Department of Neurology, Karl Franzens University Graz, Auenbruggerplatz 22, A-8036 Graz, Austria.

Supported by the Steimermärkische Krankenanstalten GmbH and the "Jubiläumsfond" of the Austrian National Bank, project no. 3095.

Presented in part at the 45th annual meeting of the American Academy of Neurology, New York, NY, April 1993.

Received February 25, 1993. Accepted for publication in final form May 25, 1993.

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