# Correlation of White Matter Hyperintensities and Perivascular Spaces With Montreal Cognitive Assessment (MoCA) Scores in Patients Evaluated for Anti-amyloid Therapy

## TL;DR

This study found that brain imaging features like white matter hyperintensities are linked to lower cognitive scores in patients suspected of having Alzheimer's disease.

## Contribution

The study identifies white matter hyperintensities as a potential imaging marker for cognitive decline in Alzheimer's disease suspects.

## Key findings

- Higher white matter hyperintensities (WMH) were negatively associated with Montreal Cognitive Assessment (MoCA) scores.
- Perivascular spaces (PVS) did not show a significant correlation with MoCA scores.
- Age was not significantly correlated with MoCA scores in the patient group.

## Abstract

Objective

This study aimed to investigate the relationship between white matter hyperintensities (WMH) and perivascular spaces (PVS) on magnetic resonance imaging (MRI) with Montreal Cognitive Assessment (MoCA) scores in patients referred for possible lecanemab therapy based on clinical suspicion of Alzheimer’s disease (AD) prior to biomarker confirmation.

Materials and methods

In this retrospective review, 149 consecutive patients with suspected AD between November 2023 and June 2024 who were evaluated for possible lecanemab therapy were identified. All underwent brain MRI and had valid MoCA scores. WMH were graded using the Fazekas scale (0-3). PVS were visually graded (1-4) in the basal ganglia and centrum semiovale on T2-weighted images. Generalized linear models assessed the association between imaging markers and MoCA, adjusting for age, sex, hypertension (HTN), hyperlipidemia (HLD), and diabetes mellitus (DM).

Results

The mean MoCA score was 19.56, reflecting mild to moderate cognitive impairment. The mean Fazekas score was 1.37, indicating mild to moderate WMH burden, while the mean PVS scores for basal ganglia and centrum semiovale were 1.99 and 2.37, respectively. There is no significant correlation between age and MoCA scores in our patient population. A negative association of -0.1 between the Fazekas score and MoCA score was observed after controlling for the effects of PVS. In contrast, PVS did not significantly correlate with MoCA score.

Conclusion

In patients evaluated for possible lecanemab therapy, a higher WMH burden was negatively associated with global cognition, whereas PVS demonstrated no significant relationship with MoCA scores. These findings suggest that WMH may be an imaging marker of vascular pathology in those suspected of AD.