Changes in Cortical Thickness are Associated with Cognitive Impairments in Patients with White Matter Lesions

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TL;DR

This study found that patients with white matter lesions and vascular dementia have significantly reduced cortical thickness in several brain regions, including the frontal, temporal, and insular areas, compared to healthy controls. These reductions in cortical thickness were positively correlated with executive function, suggesting that cortical atrophy contributes to cognitive decline in these patients. The findings improve the understanding of the relationship between white matter lesions, cortical morphology, and cognitive impairment.

Full summary

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**Background:** White matter lesions (WMLs) are known to play a role in cognitive decline and dementia. It has been hypothesized that cognitive impairment in patients with WMLs is related to cortical atrophy and changes in cortical thickness network measurements in certain brain regions. This study aimed to investigate the characteristics of cortical thickness in patients with WMLs and the relationship these characteristics have with cognitive function.

**Methods:** A total of 76 patients with WMLs and 37 healthy controls (HCs) were enrolled in this study. All participants underwent magnetic resonance imaging (MRI) scans. Cortical reconstruction and segmentation were performed on the participants’ three-dimensional (3D) T1-weighted images using the FreeSurfer image analysis suite. The patients were further divided into two subgroups: those with WMLs and nondementia vascular cognitive impairment (WML-VCIND) and those with WMLs and vascular dementia (WML-VaD). Cortical thickness analysis was performed, and Pearson’s correlation analysis was used to explore the relationship between cognitive manifestations and cortical thickness in patients with WMLs.

**Key Results:** WML-VaD patients were significantly older than WML-VCIND patients and HCs (P = 0.01). There was a significant difference in Montreal Cognitive Assessment (MoCA) scores (P < 0.0001) and executive function (P < 0.0001) between the participants in the WML and HC groups. Significantly decreased cortical thickness in the left precentral, caudal middle frontal, rostral middle frontal, superior frontal, middle temporal, transverse temporal, insula, bilateral pars opercularis, and superior temporal regions was found in participants in the WML-VaD group compared with participants in the HC group (P < 0.05). The reductions in the cortical thickness of the above gyri were positively correlated with executive function in patients with WMLs.

**Clinical Implications:** These cross-sectional results suggest that decreased cortex thickness in certain gyri in patients with WMLs might lead to cognitive decline. These findings have implications that could improve the present understanding of the relationship among WMLs, cortical morphology, and possible concomitant cognitive impairment. The study highlights the potential of cortical thickness as an imaging marker for cognitive decline in patients with WMLs.