T1w/FLAIR-ratio as a predictor for cognition in a large population cohort: Findings from The Maastricht Study

Motivation: Myelin can be a useful predictor of disease progression and cognitive decline, however it requires dedicated MRI sequences. The T1w/FLAIR-ratio, which is more readily available, has previously been introduced as a proxy for the myelin content. Goal(s): To assess whether the T1w/FLAIR myelin proxy is a better predictor for cognition compared to other established MRI markers (i.e. grey matter volume, white matter hyperintensity load and fractional anisotropy). Approach: The T1w/FLAIR-ratio is calculated in a large (n=4525) population sample, and predictive value is assessed using linear regression models. Results: The T1w/FLAIR-ratio is a better predictor of cognitive decline compared to other established MRI-markers. Impact: The T1w/FLAIR-ratio can be used as a proxy for the myelin content. Here, we showed in a large population-based sample, that the T1w/FLAIR-ratio is a better predictor for cognition compared to atrophy, white matter lesion burden and microstructure.