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A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia
Bocti C, Swartz RH, Gao FQ, Sahlas DJ, Behl P, Black SE.. Stroke, 2005-09-22
Topic: Risk, prevention and care in population studies
Background and purpose One possible mechanism of cognitive decline in individuals with subcortical vascular disease is disruption of cholinergic fibers by ischemic lesions, such as strategically located white matter hyperintensities (WMH). The authors applied a new MRI visual rating scale to assess WMH within cholinergic pathways in patients with Alzheimer Disease (AD) and subcortical ischemic microvascular disease. Methods Subjects included 60 AD patients with and without WMH, matched for age, as well as 15 control subjects. A visual rating scale was developed based on published immunohistochemical tracings of the cholinergic pathways in humans. On 4 selected axial images, the severity of WMH in the cholinergic pathways was rated on a 3-point scale for ten regions, identified with major anatomical landmarks. A published, consensus-derived, general WMH scale was also applied. All subjects underwent standardized neuropsychological testing. Results The Cholinergic Pathways HyperIntensities Scale showed reliability and was validated with volumetry of strategic WMH. After accounting for age and education in a multiple linear regression model, The Cholinergic Pathways HyperIntensities Scale ratings were associated with impaired performance on the Mattis Dementia Rating Scale (r=0.40; P=0.02) and accounted for 12% of the variance (corrected r2). A similar model was not significant for general WMH scores. Conclusions The new MRI rating scale for WMH in cholinergic pathways is reliable and shows stronger correlations with cognitive performance than a general WMH rating scale in AD with WMH. This new rating scale provides indirect evidence that localization of WMH within neurotransmitter systems may contribute to cognitive decline.
Key findings
- Results The Cholinergic Pathways HyperIntensities Scale showed reliability and was validated with volumetry of strategic WMH.
- After accounting for age and education in a multiple linear regression model, The Cholinergic Pathways HyperIntensities Scale ratings were associated with impaired performance on the Mattis Dementia Rating Scale (r=0.40; P=0.02) and accounted for 12% of the variance (corrected r2).
- A similar model was not significant for general WMH scores.
Why it matters
A new rating scale for white matter hyperintensities within cholinergic pathways was reliable and was associated with impaired performance on the Mattis Dementia Rating Scale, accounting for 12% of the variance. A similar model was not significant for general white matter hyperintensity scores.
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Study details
- Participants60
- Evidence strengthLow
How this study scored 48/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Stroke) |
| Journal's citation record | 3 / 4 | Stroke: journal h-index 455 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2005 — older than 20 years, still counted |
| Sample size | 1 / 4 | 60 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 183 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 8.0 citations a year over 23 year(s) since 2005 |
| Impact for its field and year | 3 / 6 | Cited 3.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 8 other studies in this library |
| Still being cited | 1 / 4 | Cited 14 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Sandra E. Black: h-index 132 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | McGill University: institution h-index 1,373 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 16179569) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 48 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Bocti, C., Swartz, R. H., Gao, F. Q., Sahlas, D. J., Behl, P., & Black, S. E. (2005). A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia. Stroke. https://doi.org/10.1161/01.str.0000183615.07936.b6
Vancouver
Bocti C, Swartz RH, Gao FQ, Sahlas DJ, Behl P, Black SE. A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia. Stroke. 2005. doi:10.1161/01.str.0000183615.07936.b6. PMID: 16179569.
BibTeX
@article{bocti2005-16179569,
author = {Bocti, C. and Swartz, R. H. and Gao, F. Q. and Sahlas, D. J. and Behl, P. and Black, S. E.},
title = {{A new visual rating scale to assess strategic white matter hyperintensities within cholinergic pathways in dementia}},
journal = {Stroke},
year = {2005},
doi = {10.1161/01.str.0000183615.07936.b6},
pmid = {16179569},
url = {https://doi.org/10.1161/01.str.0000183615.07936.b6}
}
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