Review

White Matter Lesions and Brain Atrophy: More than Shared Risk Factors? A Systematic Review
Auke P.A. Appelman^{a, b}, Lieza G. Exalto^c, Yolanda van der Graaf^b, Geert Jan Biessels^c, Willem P.T.M. Mali^a, Mirjam I. Geerlings<sup>b

a</sup>Department of Radiology,
^bJulius Center for Health Sciences and Primary Care, and
^cRudolf Magnus Institute of Neurosciences, Department of Neurology, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands

Address of Corresponding Author

Cerebrovasc Dis 2009;28:227-242 (DOI: 10.1159/000226774)

  Key Words

• Lacunar infarcts
• White matter hyperintensities
• Brain atrophy
• Magnetic resonance imaging
• Systematic reviews
• Vascular risk factors

  Abstract

Background: White matter lesions (WML) and brain atrophy are often found on MRI in the elderly. Shared vascular risk factors may be an explanation for their concomitance. However, disturbances of white matter integrity could also be involved in the pathogenesis of brain atrophy. Our objective was to systematically review studies that investigated the relation between WML and brain atrophy on MRI, and to investigate whether there is sufficient evidence to indicate that this relation is independent of shared risk factors. Methods: We searched PubMed for studies published in English between 1980 and October 2007, combining search terms for WML and brain atrophy. Articles that studied the relation between WML and brain atrophy were included if they met the following criteria: (1) original study, (2) MRI used for imaging, (3) assessment methods for WML and brain atrophy specified, and (4) a sample size of at least 20 participants. We recorded type and age of the study population, type and assessment of WML and brain atrophy, and variables for which adjustments were made in the analyses. Results: We identified 48 studies that met our inclusion criteria. A significant relation between WML and brain atrophy was found in 37 out of 48 studies. The source of the study population (e.g. clinic or population based) did not affect this relation. However, only 10 studies adjusted for shared risk factors, of which 9 found an association. Conclusions: The majority of studies found an association between WML and brain atrophy, but it is not yet clear if this association is independent of shared risk factors.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Mirjam Geerlings
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Stratenum 6.131, PO Box 85500
NL-3508 GA Utrecht (The Netherlands)
Tel. +31 88 755 93 94, Fax +31 88 755 54 85, E-Mail m.geerlings@umcutrecht.nl

  Article Information

Received: September 29, 2008
Accepted: April 16, 2009
Published online: July 2, 2009
Number of Print Pages : 16
Number of Figures : 1, Number of Tables : 3, Number of References : 99