Objective: We aimed to assess the significance of white matter hyperintensities (WMHs) in dementia with Lewy bodies (DLB) and their contribution to phenotype of the disease.

Background: Cerebrovascular pathology often found on MRI and autopsy in DLB patients. The importance of WMHs in DLB remains poorly understood. Some authors reported that WMHs have an additive effect on cognitive decline in dementia, whereas others could not confirm this association, on the contrary, considering inverse relationship. Apparently, a possible explanation for the inconsistent associations between WMHs and clinical symptoms would be heterogeneity of the WMHs.

Methods: We examined 17 patients that fulfilled clinical criteria for probable DLB. The clinical assessment included Montreal Cognitive Assessment scale (MoCA), Addenbrooke’s Cognitive Examination (ACE-R), Neuropsychiatric Inventory (NPI-4), University of Miami Parkinson’s disease Hallucinations Questionnaire (UM-PDHQ), the motor section of the Unified Parkinson’s disease rating scale (UPDRS), orthostatic hypotension test. Sleep-wake profile was assessed using a single-question screen for REM sleep behavior disorder (RBD1Q), the Epworth Sleepiness Scale (ESS). All subjects were performed 1,5 T brain MRI. MRI revealed moderate to severe WMHs in 10 participants. Patients were performed ultrasound assessment of endothelial-dependent and endothelial-independent flow-mediated vasodilation of the brachial artery using reactive hyperemia test. Willebrand factor and lipid profile were also evaluated.

Results: The presence of WMHs was associated with a later onset of disease, clinically significant orthostatic hypotension, more severe neuropsychiatric features (р<0,05). No relationship between the parkinsonism, presence and severity of coexistent cerebrovascular lesions was seen in this cohorts of patients. DLB without WMHs frequently had excessive daytime sleepiness and RBD, worse cognitive performance (р<0,005). There was significant decline of vessel reactivity in patients with WMHs. But it was not correlated with the serum parameters, thereby suggesting different mechanisms of endothelial dysfunction. 

Conclusions: We found association of WMHs with age, cognitive, sleep, neuropsychiatric and autonomic disturbances, endothelial dysfunction. Larger prospective longitudinal studies are warranted to confirm the utility of many imaging techniques in evaluating of cerebrovascular lesions in early DLB stages.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/white-matter-lesions-and-peripheral-vessel-reactivity-in-dementia-with-lewy-bodies/