# White matter hyperintensities and late-life cognition: an analysis of moderation effects of mild behavioral impairment

## TL;DR

This study explores how mild behavioral impairment may worsen cognitive decline in older adults with brain vessel disease and white matter damage.

## Contribution

The study reveals that mild behavioral impairment moderates the effect of white matter hyperintensities on late-life cognition in patients with cerebral small vessel disease.

## Key findings

- Mild behavioral impairment is linked to increased white matter hyperintensities and cognitive impairment.
- MBI moderates the relationship between white matter hyperintensities and cognitive decline in patients with aCSVD.
- High white matter burden is independently associated with cognitive impairment and MBI.

## Abstract

Mild behavioral impairment (MBI) is recognized as a potential early marker for dementia and may be indicative of the increased risk in the predementia stage. This study investigated whether MBI could moderate the impact of white matter hyperintensities (WMHs) on late-life cognitive function in patients with arteriosclerotic cerebral small vessel disease (aCSVD).

Patients were categorized into two groups based on Fazekas scores: low WMH burden (LWMH, scores 1–2; n = 119) and high WMH burden (HWMH, scores 3–6; n = 110). Logistic regression analysis was used to assess the associations among WMH, MBI, and screen-positive cognitive impairment. Moderation analysis was conducted to evaluate whether the presence of MBI could influence the relationship between WMH and cognitive outcomes.

WMH was associated with MBI (p < 0.001) and screen-positive cognitive impairment (MoCA: p = 0.003; MMSE: p = 0.025), and MBI was correlated with screen-positive cognitive impairment (p = 0.010 and 0.007, respectively). HWMH was independently correlated with screen-positive cognitive impairment and MBI (p = 0.001; p < 0.001; p = 0.031). Compared with cases in the non-MBI group, those in the MBI group had more WMHs in the occipital lobes (p = 0.016) and subcortical structures (p = 0.042). Furthermore, MBI significantly moderated the association between WMH and screen-positive cognitive impairment (β = −0.10, p < 0.014; β = −0.06, p < 0.041).

The presence of MBI may exacerbate the cognitive decline associated with WMH in patients with aCSVD. These findings highlight the importance of early identification and monitoring of MBI in cases with WMH to better assess dementia risk and to develop interventional strategies.