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From the School of Psychiatry (P.S., W.W., X.C., H.B.), University of New South Wales; Neuropsychiatric Institute (P.S., W.W., X.C.), Academic Department for Old Age Psychiatry (H.B.), the Prince of Wales Hospital, Sydney, Australia.
Address correspondence and reprint requests to Professor Perminder Sachdev, NPI, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia; e-mail: p.sachdev{at}unsw.edu.au
Objective: The aims of this study were to examine white matter hyperintensities (WMHs) in the brains of elderly individuals, the rate of progression, the anatomic regions most vulnerable, and the predictors of change.
Methods: We examined 51 healthy volunteers (mean age 71 years) with T2-weighted brain MRI on the same scanner 3 years apart. WMH volumes were determined by an automated method, and the anatomic location of change was determined for both deep WMHs (DWMHs) and periventricular WMHs (PVWMHs).
Results: The total brain WMH volume increased by 39.6%, i.e., 13.2% per year, with the change in DWMH being 43.8% and 29.7% in PVWMH. The increase was significant in all regions except the occipital lobe and cerebellum. Age, sex, and cerebrovascular risk factors were not significant predictors of WMH progression. The main predictor of progression was baseline level of WMH. The number of WMH lesions increased by a mean of 1.78, and the progression was mainly accounted for by an increase in very large (>16 mm) lesions. Eight subjects showed a slight decrease in WMH.
Conclusions: White matter hyperintensities are progressive in most elderly individuals with an increasing rate of progression as the burden of lesions increases. The rate of progression is greater in deep white matter and in the anterior brain regions. Risk factors for progression are not well understood, and genetic and other environmental factors must be examined. Quantitation of white matter hyperintensities may serve as a surrogate marker of the progression of small vessel disease.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 16 issue to find the link for this article.
The study was supported by grants from the National Health and Medical Research Council of Australia, the Rebecca Cooper Foundation, and the Fairfax Family Foundation and a Fellowship from the NSW Institute of Psychiatry.
Disclosure: The authors report no conflicts of interest.
Received December 3, 2005. Accepted in final form September 29, 2006.
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