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The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis
Stéphanie Debette, Hugh Stephen Markus. BMJ, 2010-07-26
Topic: Brain proteins, microglia and lab models
OBJECTIVES: To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed from 1966 to 23 November 2009. STUDY SELECTION: Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death. DATA EXTRACTION: Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome. DATA SYNTHESIS: 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested. CONCLUSION: White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Debette, S., & Markus, H. S. (2010). The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. https://doi.org/10.1136/bmj.c3666
Vancouver
Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2010. doi:10.1136/bmj.c3666. PMID: 20660506.
BibTeX
@article{debette2010-20660506,
author = {Debette, Stéphanie and Markus, Hugh Stephen},
title = {{The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis}},
journal = {BMJ},
year = {2010},
doi = {10.1136/bmj.c3666},
pmid = {20660506},
url = {https://doi.org/10.1136/bmj.c3666}
}
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.
Why it matters
This review of 46 long-term studies found that white matter hyperintensities seen on brain magnetic resonance imaging were associated with an increased risk of stroke, dementia, and death. The authors say finding them should prompt detailed screening for risk factors of stroke and dementia.
How this study scored 56/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it. We have no data on strength of evidence, so that was left out: it earned 53 of the 95 points we could judge it on, which is 56 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (BMJ) |
| Journal's citation record | 4 / 4 | BMJ: journal h-index 608 (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 | — / 5 | No evidence rating recorded — left out of this score |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2010 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 2,328 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 129.3 citations a year over 18 year(s) since 2010 |
| Impact for its field and year | 3 / 6 | Cited 8.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 4 / 4 | Cited 490 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Hugh Stephen Markus: h-index 137 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Boston University: institution h-index 1,456 (OpenAlex) |
| Multicenter collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 20660506) |
| Free to read | 2 / 2 | Free to read |
| Points | 53 / 95 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 53 of the 95 points we could judge it on is 56 out of 100. |
| Total | 56 / 100 | — |
What each of these 20 components measures, and what this score is not →
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