The Role of White Matter Disease in Impaired Insight Among Individuals with Cognitive Impairment: Exploring Subtypes and Cognitive Pathways

The findings suggest DWMH impairs insight indirectly through its impact on judgment, a critical cognitive domain. While dementia severity (FAST) strongly predicts insight, the persistence of the DWMH-judgment relationship implicates structural brain changes driving cognitive deficits that impair insight. As the prefrontal lobes are known to subserve insight, we hypothesize that the disruption of the frontal-subcortical circuits by DWM lesions could explain the results. Our study highlights the need for clinicians to anticipate potential challenges in judgment and insight among individuals with significant DWMH.