White matter hyperintensities are significantly associated with cortical atrophy in Alzheimer's disease

Background and objective: Methodological variability in the assessment of white matter hyperintensities (WMH) in dementia may explain inconsistent reports of its prevalence and impact on cognition. We used a method of brain MRI segmentation for quantifying both tissue and WMH volumes in Alzheimer's disease (AD) and examined the association between WMH and structural and cognitive variables. Methods: A consecutive series of 81 patients meeting NINCDS-ADRDA criteria for probable AD was studied. Nineteen healthy volunteers of comparable age served as the control group. Patients had a complete neurological and neuropsychological evaluation, and a three dimensional MRI was obtained. Images were segmented into grey matter, white matter, and cerebrospinal fluid. WMH were edited on segmented images, and lobar assignments were based on Talairach coordinates. Results: Mild and moderate to severe AD patients had significantly more WMH than controls (p < 0.05). WMH preferentially involved the frontal lobes (70%), were inversely correlated with grey matter cortical volume (R-2 = 0.23, p < 0.001), and were significantly associated with vascular risk factors and with a worse performance on memory tasks. Conclusion: Objective measurements of tissue volumes in AD demonstrated that WMH are significantly related to cortical atrophy and neuropsychological impairment.