Mapping Cerebral Small Vessel Disease in Superagers: Insights from White Matter Hiperintensity and DTI Analysis

Motivation: White matter integrity can contribute to cognitive resilience in superagers, but this has not been investigated. Goal(s): Identify differences in cerebral small vessel disease between superagers and age-matched healthy older adults. Approach: We conducted a regional-zonal analysis to map global and regional white matter hyperintensities (WMH) and utilized diffusion tensor imaging (DTI) to assess microstructural white matter integrity. Results: Results showed that superagers have a lower WMH burden, particularly in the temporo-occipital lobes, which are critical for episodic memory, and exhibited higher fractional anisotropy (FA), suggesting that both macro- and microstructural white matter integrity can contribute to their preserved cognitive function. Impact: A lower burden of cerebral small vessel disease (CSVD) at both macro- and microstructural levels may contribute to the superagers' phenotype, emphasizing the importance of managing known CSVD risk factors, including hypertension, diabetes, hyperlipidemia, and smoking.