White matter hyperintensities volume and cognition: A meta-analysis

Background Cerebral small vessel disease (CSVD) is prevalent in the elderly and leads to an increased risk of cognitive impairment and dementia. The volume of white matter hyperintensities (WMHs) increases with age, which affects cognition. Objective To explore the relationship between WMH volume and cognitive decline in patients with CSVD. Methods We performed a systematic search of PubMed, Embase, and the Web of Science databases from their respective creation dates to the 5 May 2022 to identify all the clinical studies on either mild cognitive impairment (MCI) or dementia in regards to WMH volume in CSVD. Results White matter hyperintensities was associated with the risk of both the MCI and dementia, with a 35% increased risk relative risk (RR) = 1.35; (95% CI: 1.01–1.81) of progression from cognitively unimpaired (CU) to MCI (six studies, n = 2,278) and a 49% increased risk RR = 1.49; (95% CI: 1.21–1.84) of progression to dementia (six studies, n = 6,330). In a subgroup analysis, a follow-up period of over 5 years increased the risk of MCI by 40% RR = 1.40; (95% CI: 1.07–1.82) and dementia by 48% RR = 1.48; (95% CI: 1.15–1.92). Conclusion White matter hyperintensities was found to be substantially correlated with the risk of cognitive impairment. Furthermore, cognitive decline was found to be a chronic process, such that WMH predicted the rate of cognitive decline in CSVD beyond 5 years. The cognitive decline observed in patients with WMH may, therefore, be minimized by early intervention.