Objective: Cerebral atrophy and white matter lesions (WMLs) are common in older people with common risk factors, but it is unclear if they are related. We investigated whether and to what degree they are related in deep and superficial structures using both volumetric and visual ratings.
Methods: The intracranial, total brain tissue (TBV), cerebrospinal fluid (CSF), ventricular superficial subarachnoid space (SSS), grey matter, normal-appearing white matter, WMLs, and combined CSF, venous sinuses and dural volumes were measured. WMLs were also rated using the Fazekas scale.
Results: Amongst 672 adults (mean age 73 ± 1 years), WMLs were associated with global brain atrophy (TBV, β = -0.43 mm(3), P < 0.01) and specifically with deep (ventricular enlargement, β = 0.10 mm(3), P = 0.03) rather than superficial (SSS, β = 0.09 mm(3), P = 0.55) atrophy. A 1 mm(3) increase in WML volume was associated with a 0.43 mm(3) decrease in TBV and 0.10 mm(3) increase in ventricular volume. WMLs were associated with combined CSF + Venous Sinuses + Meninges volumes, but not CSF volume alone. Some of the associations were attenuated after correcting for vascular risk factors. The associations were similar for visually scored WMLs.
Conclusion: WMLs are associated with brain atrophy, primarily with deep brain structures. Measures of brain atrophy should include all intracranial structures when assessing brain shrinkage.