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(Stroke. 2009;40:2219.)
© 2009 American Heart Association, Inc.

Research Letters

Severe Cerebral White Matter Hyperintensities Predict Severe Cognitive Decline in Patients With Cerebrovascular Disease History

Carole Dufouil; Ophélia Godin; John Chalmers; Oghuzan Coskun; Stephen MacMahon; Nathalie Tzourio-Mazoyer; Marie-Germaine Bousser; Craig Anderson; Bernard Mazoyer; Christophe Tzourio for the PROGRESS MRI Substudy Investigators

From Inserm, U708 (C.D., O.G., C.T.), Paris, France; Université Pierre et Marie Curie-Paris6 (C.D., O.G., C.T.), Paris, France; The George Institute for International Health (J.C., S.M., C.A.), Sydney, Australia; CHU de Caen (O.C., B.M.), Caen, France; CNRS, CEA UMR6232 (N.T.-M., B.M.), Caen, France; Université de Caen Basse-Normandie (N.T.-M., B.M.), Caen, France; AP-HP, Hôpital Lariboisière (M.-G.B., C.T.), Service de Neurologie, Paris, France; and the Institut Universitaire de France (B.M.), Paris, France.

Correspondence to Carole Dufouil, INSERM Unit 708, Hôpital La Salpêtrière, 75651 Paris Cedex 13 France. E-mail carole.dufouil{at}upmc.fr

Background and Purpose— Cerebral white matter hyperintensities (WMHs) are believed to be the consequence of small vessel disease, and it is uncertain whether their extent predicts the risk of dementia in patients with vascular disease history.

Method— Brain MRI was performed in 226 participants of the PROGRESS study. WMH severity was assessed using a visual rating scale. During follow-up, patients were classified for incident severe cognitive deterioration (including dementia) using standard criteria.

Results— Over 4-year follow-up, the incidence of severe cognitive deterioration ranged from 1.1 to 9.1 per 100 person-years in patients with respectively no or severe WMHs at baseline. In multivariable analysis, incident severe cognitive deterioration was associated with baseline severe WMHs (odds ratio=7.7, P<0.005).

Conclusion— Higher WMH load is a strong predictor of dementia and cognitive decline in patients with cerebrovascular disease history.

Key Words: dementia • stroke • cognitive decline • cerebrovascular disorders • MRI • hypertension