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Background Grip strength is an indicator of physical function with potential predictive value for health in ageing populations. We assessed whether trends in grip strength from midlife predicted later-life brain health and cognition. Methods 446 participants in an ongoing British birth cohort study, the National Survey of Health and Development (NSHD), had their maximum grip strength measured at ages 53, 60–64, and 69, and subsequently underwent neuroimaging as part of a neuroscience sub-study, referred to as “Insight 46”, at age 69–71. A group-based trajectory model identified latent groups of individuals in the whole NSHD cohort with below- or above-average grip strength over time, plus a reference group. Group assignment, plus standardised grip strength levels and change from midlife were each related to measures of whole-brain volume (WBV) and white matter hyperintensity volume (WMHV), plus several cognitive tests. Models were adjusted for sex, body size, head size (where appropriate), sociodemographics, and behavioural and vascular risk factors. Results Lower grip strength from midlife was associated with smaller WBV and lower matrix reasoning scores at age 69–71, with findings consistent between analysis of individual time points and analysis of trajectory groups. There was little evidence of an association between grip strength and other cognitive test scores. Although greater declines in grip strength showed a weak association with higher WMHV at age 69–71, trends in the opposite direction were seen at individual time points with higher grip strength at ages 60–64, and 69 associated with higher WMHV. Conclusions This study provides preliminary evidence that maximum grip strength may have value in predicting brain health. Future work should assess to what extent age-related declines in grip strength from midlife reflect concurrent changes in brain structure.

Cerebral white matter (WM) lesion load, as measured by white matter hyperintensity (WMH) volume with magnetic resonance imaging (MRI), has been associated with increasing age and cardiovascular risk factors, like hypertension. Physical sports activity (PSA) may play an important role in maintaining WM in the context of healthy aging. In 196 healthy older adults, we investigated whether participants reporting high levels of PSA ( = 36) had reduced total and regional WMH volumes compared to those reporting low levels of PSA ( = 160). Age group [young-old (YO) = 50-69 years; old-old (OO) = 70-89 years], PSA group, and age by PSA group interaction effects were tested, with sex, hypertension, and body mass index (BMI) as covariates. We found significant main effects for age group and age by PSA group interactions for total, frontal, temporal, and parietal WMH volumes. There were no main effects of PSA group on WMH volumes. The OO group with low PSA had greater total, frontal, temporal, and parietal WMH volumes than the YO with low PSA and OO with high PSA groups. WMH volumes for the YO and OO groups with high PSA were comparable. These findings indicate an age group difference in those with low PSA, with greater WMH volumes in older adults, which was not observed in those with high PSA. The results suggest that engaging in high levels of PSA may be an important lifestyle factor that can help to diminish WMH lesion load in old age, potentially reducing the impact of brain aging.

Hippocampal volume is particularly sensitive to the accumulation of total brain white matter hyperintensity volume (WMH) in aging, but how the regional distribution of WMH volume differentially impacts the hippocampus has been less studied. In a cohort of 194 healthy older adults ages 50–89, we used a multivariate statistical method, the Scaled Subprofile Model (SSM), to (1) identify patterns of regional WMH differences related to left and right hippocampal volumes, (2) examine associations between the multimodal neuroimaging covariance patterns and demographic characteristics, and (3) investigate the relation of the patterns to subjective and objective memory in healthy aging. We established network covariance patterns of regional WMH volume differences associated with greater left and right hippocampal volumes, which were characterized by reductions in left temporal and right parietal WMH volumes and relative increases in bilateral occipital WMH volumes. Additionally, we observed lower expression of these hippocampal-related regional WMH patterns were significantly associated with increasing age and greater subjective memory complaints, but not objective memory performance in this healthy older adult cohort. Our findings indicate that, in cognitively healthy older adults, left and right hippocampal volume reductions were associated with differences in the regional distribution of WMH volumes, which were exacerbated by advancing age and related to greater subjective memory complaints. Multivariate network analyses, like SSM, may help elucidate important early effects of regional WMH volume on brain and cognitive aging in healthy older adults.

Cerebral White Matter Hyperintensity (WMH) lesions have been identified as markers of cerebrovascular diseases and they are associated with increased risk of cognitive impairment. In this study, we investigated the relationship between midlife cardiovascular risk factors and late life WMH volumes two decades later, and examined their association with cognitive performance. 135 participants from the Women’s Healthy Ageing Project had completed midlife cardiovascular risk measurement in 1992 and late life brain MRI scan and cognitive assessment in 2012. In these community-dwelling normal aging women, we found that higher midlife Framingham Cardiovascular Risk Profile (FCRP) score was associated with greater WMH volume two decades later, and was predominantly driven by the impact of HDL cholesterol level, controlling for age, education and APOE ε4 status. Structural equation modelling demonstrated that the relationship between midlife FCRP score and late life executive function was mediated by WMH volume. These findings suggest intervention strategies that target major cardiovascular risk factors at midlife might be effective in reducing the development of WMH lesions and thus late life cognitive decline.

Background: Cerebrovascular dysfunction has been proposed as a possible mechanism underlying cognitive impairment in the context of type 2 diabetes mellitus (DM). Although magnetic resonance imaging (MRI) evidence of cerebrovascular disease, such as white matter hyperintensities (WMH), is often observed in DM, the vascular dynamics underlying this pathology remain unclear. Thus, we assessed the independent and combined effects of DM status and different vascular hemodynamic measures (i.e., systolic, diastolic, and mean arterial blood pressure and pulse pressure index [PPi]) on WMH burden in cognitively unimpaired (CU) older adults and those with mild cognitive impairment (MCI). Methods: 559 older adults (mean age: 72.4 years) from the Alzheimer’s Disease Neuroimaging Initiative were categorized into those with diabetes (DM+; CU = 43, MCI = 34) or without diabetes (DM-; CU = 279; MCI = 203). Participants underwent BP assessment, from which all vascular hemodynamic measures were derived. T2-FLAIR MRI was used to quantify WMH burden. Hierarchical linear regression, adjusting for age, sex, BMI, intracranial volume, CSF amyloid, and APOE ε4 status, examined the independent and interactive effects of DM status and each vascular hemodynamic measure on total WMH burden. Results: The presence of DM ( p = 0.046), but not PPi values ( p = 0.299), was independently associated with greater WMH burden overall after adjusting for covariates. Analyses stratified by cognitive status revealed a significant DM status x PPi interaction within the MCI group ( p = 0.001) such that higher PPi values predicted greater WMH burden in the DM + but not DM- group. No significant interactions were observed in the CU group (all p s > 0.05). Discussion: Results indicate that higher PPi values are positively associated with WMH burden in diabetic older adults with MCI, but not their non-diabetic or CU counterparts. Our findings suggest that arterial stiffening and reduced vascular compliance may have a role in development of cerebrovascular pathology within the context of DM in individuals at risk for future cognitive decline. Given the specificity of these findings to MCI, future exploration of the sensitivity of earlier brain markers of vascular insufficiency (i.e., prior to macrostructural white matter changes) to the effects of DM and arterial stiffness/reduced vascular compliance in CU individuals is warranted.

Cerebrovascular disease is an independent risk factor for dementia that may also be synergistic with Alzheimer’s disease. In recent years attention has switched from cerebral infarcts to microvascular disease as the primary cause of cerebrovascular cognitive decline, with damage to the white matter the primary mechanism. Uncertainties remain regarding the risks posed by different types vascular threat, the extent to which cerebrovascular damage occurs in middle age, and whether relatively “normal” amounts of white matter damage are accompanied by meaningful degrees of cognitive decline. We explored these issues via laboratory, cardiovascular, cognitive, and magnetic resonance imaging (MRI) data in 67 middle-aged cognitively normal offspring of dementia patients. The sample was enriched for vascular risk. Plasma insulin, 24-h systolic blood pressure, body mass index, age, and % small dense LDL cholesterol were the strongest correlates of MRI white matter hyperintensity (WMH) volume. With shared variance controlled for, 24 h systolic BP, plasma insulin, and age remained as significant predictors of WMH volume. An interaction variable (24 h BP * insulin) did not improve the prediction of WMH. WMH volume correlated negatively with cognition. No evidence for an ApoE ε4 effect emerged for either WMH or cognition. Hypertension and hyperinsulinemia appear to pose independent, consequential threats to the cerebral small vessel vasculature in middle age, reflected in the presence of areas of WMH on MRI scans. Our data show that even modest WMH volumes in middle age are associated with cognitive decrement, underscoring the importance of aggressive treatment and lifestyle modifications to address vascular risk throughout adulthood.

To investigate the relationship between white matter hyperintensity (WMH) burden and infarct volume with functional outcomes in patients with anterior choroidal artery (AChA) territory infarction. This retrospective cohort study included patients with AChA territory infarction admitted to two comprehensive stroke centers between September 2018 and September 2024. WMH burden was assessed using the Fazekas visual rating scale and an automated volumetric quantification method based on lesion prediction algorithms. Acute infarct volume was precisely measured using fully automated threshold segmentation. Poor functional outcome was defined as a modified Rankin Scale (mRS) score ≥3 at 90 days. Associations were evaluated using multivariable logistic regression models with stepwise adjustment for confounders, and predictive performance was assessed using receiver operating characteristic curve analysis. Restricted cubic spline (RCS) regression was employed to explore non-linear associations, followed by piecewise regression analysis based on threshold effects. A total of 216 patients were included, of whom 73 (33.80%) had poor functional outcomes at 90 days. After adjusting for potential confounders, both WMH burden and infarct volume were independently associated with poor functional outcomes at 90 days, with infarct volume demonstrating superior predictive performance (AUC: 0.80 vs. 0.67). For each 1-mL increase in WMH volume, the risk of poor outcomes increased by 2% (adjusted OR = 1.02, 95% CI: 1.01-1.03,  = 0.032). RCS analysis revealed a non-linear association between infarct volume and poor outcomes, with a threshold of 2.7 mL. When infarct volume was below this threshold, each 1-mL increase in infarct volume was associated with a 5.31-fold increased risk of poor outcomes (adjusted OR = 5.31, 95% CI: 3.07-9.73; standardized OR = 3.03, 95% CI: 2.11-4.53). In patients with AChA territory infarction, both WMH burden and infarct volume can independently predict functional outcomes at 90 days. Infarct volume exhibits a non-linear association with outcomes, with a critical threshold of 2.7 mL identified.

To investigate the associations of white matter hyperintensity (WMH) burden and infarct volume with early neurological progression in anterior choroidal artery (AChA) territory infarction, and to identify potential imaging-based predictive thresholds. This retrospective cohort study consecutively enrolled AChA infarct patients admitted to two comprehensive stroke centers between September 2018 and September 2024. WMH burden and infarct volume were assessed using the Fazekas visual rating scale and an automated volumetric quantification method based on lesion prediction algorithm, respectively. The primary outcome was early neurological progression. Multivariate logistic regression models with stepwise adjustment for confounders were used to evaluate the associations of WMH burden and infarct volume with early progression. Restricted cubic spline regression was performed to explore non-linear relationships and to determine thresholds. Continuous variables were standardized, and piecewise regression analysis was conducted based on the identified thresholds. Subgroup analyses with interaction tests were performed to assess the consistency of these associations across different populations. A total of 216 patients were included, of whom 82 (38.0%) experienced early neurological progression. After adjustment for potential confounders, WMH burden showed a significant non-linear association with progression risk. For WMH volumes <66.1 mL, each standard deviation increase was associated with a 74% higher risk of progression (standardized OR: 1.74, 95% CI: 1.29-2.40,  < 0.001). Compared with the lowest quartile, patients in the highest WMH quartile showed significantly increased risk (adjusted OR: 5.32, 95% CI: 1.48-13.88,  = 0.009). This association was confirmed by Fazekas scale analysis, with grade 3 patients showing substantially higher risk than grade 0 (adjusted OR: 6.22, 95% CI: 1.74-25.42,  = 0.007). Infarct volume demonstrated a similar non-linear pattern; for volumes <1.1 mL, each standard deviation increase was associated with 59% higher progression risk (standardized OR: 1.59, 95% CI: 1.04-2.47,  = 0.036). Quartile analysis revealed the highest risk in the third quartile compared to the lowest (adjusted OR: 5.63, 95% CI: 2.06-15.40,  < 0.001). This study revealed non-linear associations of WMH and infarct volume with early progression in AChA infarct patients.

White matter hyperintensities (WMH) are a key imaging feature of cerebral small-vessel disease (CSVD). However, there is a lack of standardized methods for determining WMH volume, and the value of total white matter (WM) volume in the assessment of cognitive impairment in patients with CSVD remains unknown. We aimed to explore the correlations of WMH volume and WM volume with cognitive dysfunction and its components in patients with CSVD. We also aimed to compare the value of the Fazekas score, WMH volume, and ratio of WMH volume to total WM volume in the assessment of cognitive dysfunction. The study included 99 patients with CSVD. Patients were categorized into following groups based on MoCA scores: patients with mild cognitive impairment and those without. Brain magnetic resonance images were processed to investigate differences in WMH and WM volumes between the groups. Logistic regression analysis was used to determine whether these two factors were independent risk factors for cognitive dysfunction. Correlation analysis was used to examine the relationships of WMH and WM volume with different types of cognitive impairment. Receiver operating characteristic curves were used to compare the effectiveness of the WMH score, WMH volume, and WMH to WM ratio for evaluating cognitive dysfunction. There were significant differences in age, education level, WMH volume, and WM volume between the groups ( < 0.05). After adjusting for age and education, the multivariate logistic analysis indicated that both WMH volume and WM volume were independent risk factors for cognitive dysfunction. Correlation analysis indicated that WMH volume was mainly related to cognition involving the visual space and delayed recall. WM volume was not strongly associated with different types of cognitive dysfunction. The WMH to WM ratio was the strongest predictor, with an area under the curve value of 0.800 and a 95% confidence interval of 0.710-0.891. Increases in WMH volume may aggravate cognitive dysfunction in patients with CSVD, and a higher WM volume may reduce the effect of WMH volume on cognitive function to a certain extent. The ratio of WMH to total WM volume may reduce the impact of brain atrophy, allowing for more accurate evaluation of cognitive dysfunction in older adults with CSVD.

Both presence of white matter hyperintensities (WMH) and smaller total gray matter volume on brain magnetic resonance imaging (MRI) are common findings in old age, and contribute to impaired cognition. We tested whether total WMH volume and gray matter volume had independent associations with cognition in community-dwelling individuals without dementia or mild cognitive impairment (MCI). We used data from participants of the Rush Memory and Aging Project. Brain MRI was available in 209 subjects without dementia or MCI (mean age 80; education = 15 years; 74 % women). WMH and gray matter were automatically segmented, and the total WMH and gray matter volumes were measured. Both MRI-derived measures were normalized by the intracranial volume. Cognitive data included composite measures of five different cognitive domains, based on 19 individual tests. Linear regression analyses, adjusted for age, sex, and education, were used to examine the relationship of logarithmically-transformed total WMH volume and of total gray matter volume to cognition. Larger total WMH volumes were associated with lower levels of perceptual speed ( p  < 0.001), but not with episodic memory, semantic memory, working memory, or visuospatial abilities (all p  > 0.10). Smaller total gray matter volumes were associated with lower levels of perceptual speed ( p  = 0.013) and episodic memory ( p  = 0.001), but not with the other three cognitive domains (all p  > 0.14). Larger total WMH volume was correlated with smaller total gray matter volume ( p  < 0.001). In a model with both MRI-derived measures included, the relation of WMH to perceptual speed remained significant ( p  < 0.001), while gray matter volumes were no longer related ( p  = 0.14). This study of older community-dwelling individuals without overt cognitive impairment suggests that the association of larger total WMH volume with lower perceptual speed is independent of total gray matter volume. These results help elucidate the pathological processes leading to lower cognitive function in aging.