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Abstract
Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5701) and classified into (i) stroke/transient ischemic attack (TIA), (ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or (iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. The prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3%). Bandung Indonesia showed the highest prevalence of WML, adjusted for age, sex, education, disease groups, and imaging modality. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. WML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia, and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.
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1 The Chinese University of Hong Kong, Division of Neurology, Department of Medicine and Therapeutics, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482); The Chinese University of Hong Kong, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482); The Chinese University of Hong Kong, Shenzhen Research Institute, Shenzhen, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482)
2 The Chinese University of Hong Kong, Division of Neurology, Department of Medicine and Therapeutics, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482); The Chinese University of Hong Kong, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482)
3 University of Santo Tomas, Department of Neuroscience and Behavioural Medicine, Faculty of Medicine and Surgery, Manila, Philippines (GRID:grid.412775.2) (ISNI:0000 0004 1937 1119); St. Luke’s Medical Centre, Institute for Neurosciences, Quezon City, Philippines (GRID:grid.412775.2)
4 National University Health System, Memory Aging and Cognition Center, Singapore, Singapore (GRID:grid.410759.e) (ISNI:0000 0004 0451 6143); National University of Singapore, Department of Pharmacology, Singapore, Singapore (GRID:grid.4280.e) (ISNI:0000 0001 2180 6431)
5 Achmad Yani University, Department of Neurology, Cimahi, Indonesia (GRID:grid.4280.e)
6 St. Luke’s Medical Centre, Institute for Neurosciences, Quezon City, Philippines (GRID:grid.4280.e)
7 National Institute of Mental Health and Neuro Sciences, Department of Neurology, Bengaluru, India (GRID:grid.416861.c) (ISNI:0000 0001 1516 2246)
8 National University Health System, Memory Aging and Cognition Center, Singapore, Singapore (GRID:grid.410759.e) (ISNI:0000 0004 0451 6143); National University of Singapore, Department of Pharmacology, Singapore, Singapore (GRID:grid.4280.e) (ISNI:0000 0001 2180 6431); National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore, Singapore (GRID:grid.4280.e) (ISNI:0000 0001 2180 6431)
9 National Neuroscience Institute, Department of Neurology, Singapore, Singapore (GRID:grid.276809.2) (ISNI:0000 0004 0636 696X)
10 Seoul National University Bundang Hospital, Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea (GRID:grid.412480.b) (ISNI:0000 0004 0647 3378)
11 Seoul National University College of Medicine, Department of Psychiatry, SMG-SNU Boramae Medical Centre, Seoul, South Korea (GRID:grid.31501.36) (ISNI:0000 0004 0470 5905)
12 Hasan Sadikin Hospital, Department of Neurology, Bandung, Indonesia (GRID:grid.452407.0) (ISNI:0000 0004 0512 9612)
13 Mahidol University, Department of Medicine At, Bangkok, Thailand (GRID:grid.10223.32) (ISNI:0000 0004 1937 0490)
14 Peking University Institute of Mental Health, Dementia Care and Research Centre, Beijing, China (GRID:grid.11135.37) (ISNI:0000 0001 2256 9319)
15 Kaohsiung Medical University, Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital and Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
16 The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482)
17 The Chinese University of Hong Kong, Division of Neurology, Department of Medicine and Therapeutics, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482); The Chinese University of Hong Kong, Therese Pei Fong Chow Research Centre for Prevention of Dementia and Margaret Kam Ling Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482); The Chinese University of Hong Kong, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Hong Kong SAR, China (GRID:grid.10784.3a) (ISNI:0000 0004 1937 0482)