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White matter hyperintensities, cognitive impairment and dementia: an update
Prins ND, Scheltens P.. Nature reviews. Neurology, 2015-02-17
Topic: Risk, prevention and care in population studies
White matter hyperintensities (WMHs) in the brain are the consequence of cerebral small vessel disease, and can easily be detected on MRI. Over the past three decades, research has shown that the presence and extent of white matter hyperintense signals on MRI are important for clinical outcome, in terms of cognitive and functional impairment. Large, longitudinal population-based and hospital-based studies have confirmed a dose-dependent relationship between WMHs and clinical outcome, and have demonstrated a causal link between large confluent WMHs and dementia and disability. Adequate differential diagnostic assessment and management is of the utmost importance in any patient, but most notably those with incipient cognitive impairment. Novel imaging techniques such as diffusion tensor imaging might reveal subtle damage before it is visible on standard MRI. Even in Alzheimer disease, which is thought to be primarily caused by amyloid, vascular pathology, such as small vessel disease, may be of greater importance than amyloid itself in terms of influencing the disease course, especially in older individuals. Modification of risk factors for small vessel disease could be an important therapeutic goal, although evidence for effective interventions is still lacking. Here, we provide a timely Review on WMHs, including their relationship with cognitive decline and dementia.
Key findings
- Over the past three decades, research has shown that the presence and extent of white matter hyperintense signals on MRI are important for clinical outcome, in terms of cognitive and functional impairment.
- Large, longitudinal population-based and hospital-based studies have confirmed a dose-dependent relationship between WMHs and clinical outcome, and have demonstrated a causal link between large confluent WMHs and dementia and disability.
Why it matters
This 2015 review says the white matter hyperintensities that small vessel disease leaves on MRI track with cognitive and functional decline in a dose-dependent way, and that large studies "have demonstrated a causal link between large confluent WMHs and dementia and disability." It stresses careful diagnostic assessment, "most notably" in people with early cognitive impairment, and suggests that even in Alzheimer's disease this vascular damage "may be of greater importance than amyloid itself", especially in older people. Treating small-vessel risk factors "could be an important therapeutic goal, although evidence for effective interventions is still lacking", and the review reports no new data and no treatment that prevents or cures dementia.
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Study details
- Study designlongitudinal study
- Evidence strengthModerate
How this study scored 63/100
Published in a peer-reviewed journal, and it is a longitudinal study following the same people over time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Nature reviews. Neurology) |
| Journal's citation record | 3 / 4 | Nature Reviews Neurology: journal h-index 269 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — 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) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 1,287 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 99.0 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 4 / 6 | Cited 13.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 69 other studies in this library |
| Still being cited | 4 / 4 | Cited 462 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Philip Scheltens: h-index 181 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Amsterdam UMC Location Vrije Universiteit Amsterdam: institution h-index 938 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 25686760) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 63 / 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
Prins, N. D., & Scheltens, P. (2015). White matter hyperintensities, cognitive impairment and dementia: an update. Nature reviews. Neurology. https://doi.org/10.1038/nrneurol.2015.10
Vancouver
Prins ND, Scheltens P. White matter hyperintensities, cognitive impairment and dementia: an update. Nature reviews. Neurology. 2015. doi:10.1038/nrneurol.2015.10. PMID: 25686760.
BibTeX
@article{prins2015-25686760,
author = {Prins, N. D. and Scheltens, P.},
title = {{White matter hyperintensities, cognitive impairment and dementia: an update}},
journal = {Nature reviews. Neurology},
year = {2015},
doi = {10.1038/nrneurol.2015.10},
pmid = {25686760},
url = {https://doi.org/10.1038/nrneurol.2015.10}
}
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