Relationship between cerebral perfusion and cognition in white matter hyperintensities of presumed vascular origin: A prospective 3D-pCASL study

White matter hyperintensities of presumed vascular origin (WMH) are known imaging markers of cerebral small vessel disease and have been associated with future stroke risk, cognitive decline, and other adverse outcomes. However, the pathogenesis of WMH and its correlation with cerebral perfusion and cognitive impairment remain unclear. In this prospective study, we included 128 participants, each of whom underwent cognitive assessments and a three-dimensional pseudo-continuous arterial spin labeling sequence, using post-labeling delay values of 1525 and 2525 ms. The magnetic resonance imaging results of all participants were categorized into 4 groups based on the Fazekas visual rating scale. Variance analyses were conducted among the 4 groups of cerebral blood flow (CBF), and partial correlation analyses were performed between CBF and cognitive function. No clusters with a CBF1525ms difference were identified among the 4 groups. Three clusters with the CBF2525ms differences were identified among the 4 groups. The CBF2525ms of the brain regions with perfusion differences among the 4 groups showed an increasing trend with increasing Fazekas grades. A negative correlation was observed between CBF2525ms in the left lenticular nucleus and the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores (r = -0.306, P < .001, and r = -0.269, P = .002). The CBF2525ms of the right lenticular nucleus was negatively correlated with the MMSE and MoCA scores (r = -0.177, P = .047, and r = -0.179, P = .045). The CBF2525ms of the left thalamus/hippocampus was negatively correlated with the MMSE and MoCA scores (r = -0.226, P = .011, and r = -0.220, P = .013). This indicates that more severe WMH may increase perfusion through collateral circulation in certain brain regions, and their CBF is negatively correlated with cognitive function. This study further unveiled mechanisms behind WMH-related cognitive decline, which has a positive effect on the prevention and treatment of cognitive impairment in patients with WMH.