After adjusting for covariates, race was not a statistically significant independent predictor of white matter hyperintensity burden across the Alzheimer's disease spectrum.
Cross-Sectional (n=1,649)
Does race independently predict white matter hyperintensity burden across the Alzheimer's disease spectrum?
Race does not independently predict white matter hyperintensity burden in Alzheimer's disease when adjusting for structural and demographic factors such as age, education, and MRI technique.
Objectives/Goals: This study investigates racial differences in white matter hyperintensity (WMH) burden across the Alzheimer’s disease spectrum, adjusting for demographic and clinical variables, to clarify mechanisms driving disparities and improve equity in diagnosis and prevention. Methods/Study Population: We analyzed cross-sectional MRI and clinical data from 1,649 participants in the Alzheimer’s Disease Neuroimaging Initiative (ADNI): 682 cognitively normal (CN), 584 with mild cognitive impairment (MCI), and 383 with AD. Of these, 124 participants (7.5%) identified as African American: CN (n=70), MCI (n=39), and AD (n=15). Linear mixed effects models were used to evaluate the effect of race, cognitive status, time since first MRI, age, sex, education, intracranial volume (ICV), MRI acquisition type, and APOE ε4 status on total WMH volume. Results/Anticipated Results: Older age, greater time since MRI, and larger ICV were significantly associated with increased WMH burden across cognitive groups. Use of FLAIR imaging was negatively associated with WMH volume, reflecting differences in image acquisition sensitivity. Higher educational attainment was linked to lower WMH burden, suggesting a possible neuroprotective effect. The most pronounced associations were observed within the AD subgroup. After adjusting for all covariates, race was not a statistically significant independent predictor of WMH burden. Discussion/Significance of Impact: Although race did not independently predict WMH burden, structural and demographic factors – such as age, education, and MRI technique – significantly influenced WMH volume. Findings underscore the interplay of biological, social, and technical variables in brain aging and the need for greater African American inclusion.
Ekuta et al. (2026) conducted a cross-sectional in Alzheimer's disease spectrum (n=1,649). Race (African American) vs. Other races was evaluated on Total white matter hyperintensity (WMH) volume. After adjusting for covariates, race was not a statistically significant independent predictor of white matter hyperintensity burden across the Alzheimer's disease spectrum.