The association between cerebral dirty-appearing white matter and progression of small vessel disease in community-dwelling older adults

Motivation: Dirty-appearing white matter (DAWM) might be an early marker of cerebral small vessel disease (SVD) progression. Goal(s): To investigate whether dirty-appearing white matter (DAWM) on brain MRI is related to long-term progression of SVD markers in a cohort of community-dwelling older adults. Approach: We visually rated DAWM volume fraction on baseline FLAIR images (n=2506) and related this to progression of multiple SVD MRI markers at the 5.2-year follow-up. Results: Global and occipital DAWM is associated with an increase in global white matter hyperintensity (WMH) volume at follow-up. This suggests that DAWM is an early marker of SVD, preceding WMH. Impact: The presence of DAWM on MRI might help in early risk stratification of older adults at risk for cognitive decline due to SVD, and in that way allow for selection of individuals for preventive lifestyle interventions and treatment trials.