MRI white matter hyperintensities - Three-year follow-up of the Austrian stroke prevention study

Objective: To determine the rate, clinical predictors, and cognitive conseq uences of MRI white matter hyperintensity evolution over 3 years. Methods: In the setting of the Austrian Stroke Prevention Study, 1.5-T MRI was perfo rmed at baseline and at a 3-year follow-up in 273 community-dwelling elderl y (mean age, 60 +/- 6.1 years) without neuropsychiatric disease. At each vi sit individuals underwent a structured clinical interview and examination, EKG, echocardiography, extensive laboratory workup, and demanding neuropsyc hological testing. MR images were read by three independent raters, and the change of white matter hyperintensities from baseline was assessed by dire ct image comparison. The change was graded as absent, minor, or marked. Min or change was defined as a. difference of no more than one to four punctate lesions between both scans. A change was considered to be marked if there was a difference of more than four abnormalities or a transition to early-c onfluent and confluent lesions. Results: Combined ratings indicated lesion progression in 49 individuals (17.9%). Lesion progression was minor in 27 p articipants (9.9%) and was marked in 22 (8.1%). Regression of white matter hyperintensities did not occur. Diastolic blood pressure (odds ratio, 1.07/ mm Hg) and early-confluent or confluent white matter hyperintensities at ba seline (odds ratio, 2.62) were the only significant predictors of white mat ter hyperintensity progression. Lesion progression had no influence on the course of neuropsychological test performance over the observational period . Conclusions: White matter hyperintensities progress in elderly normal sub jects. Our data may be used as a reference for future observational and int erventional studies on white matter hyperintensity progression in various C NS diseases. The lack, of an association between lesion progression and cog nitive functioning needs to be explored further.