White matter hyperintensities, cognitive decline and dementia risk in a community- dwelling cohort of northern Manhattan

INTRODUCTION: White matter hyperintensities (WMH) are common markers of cerebral small vessel disease, but the cognitive impact of their regional distribution is not well understood. METHODS We analyzed brain MRI and neuropsychological data from 1,290 stroke-free participants in the Northern Manhattan Study. WMH volumes were quantified by vascular territory, and associations with cognitive performance and dementia risk were evaluated. RESULTS Higher anterior circulation WMH volume was associated with lower global cognition and poorer episodic memory, semantic memory, and processing speed at baseline and follow-up. Posterior circulation WMH predicted greater decline in executive function. Total WMH and anterior WMH volumes were associated with increased dementia risk. DISCUSSION Total and regional WMH volumes can provide important information about cognitive outcomes and dementia risk, helping to understand which patients may have higher risk of worse cognitive outcomes. Then, tailored strategies can be used to individualize patient care and preserve overall brain health.