Neuropsychiatric Symptoms and White Matter Hyperintensities in Older Cognitively Unimpaired Men Versus Women

Objectives

We aimed to examine association patterns of white matter hyperintensities (WMH) with neuropsychiatric symptoms (NPS) in men versus women.

Methods

We performed a cross-sectional analysis of data acquired from the National Alzheimer's Coordinating Center database. Cognitively unimpaired participants aged ≥ 50 years with data on WMH severity were studied. Using Cardiovascular Health Study scores, WMH were coded as no to mild (score: 0–4), moderate (score: 5–6) or extensive (score: 7–8). NPS were quantified on the Neuropsychiatric Inventory Questionnaire. For the purposes of the main analysis, participants were dichotomized for presence of each NPS (0: absent; 1: present). Adjusted binary logistic regression models estimated the odds of having each of 12 NPS by sex-WMH status. To confirm the validity of our findings, the correlations between NPS severity and WMH burden were also separately explored in men and women.

Results

Among 4617 participants with normal cognition, there were 1502 men and 2685 women with no to mild WMH changes, 102 men and 274 women with moderate WMH changes and 19 men and 35 women with extensive WMH changes. Greater WMH burden (especially extensive changes) was related to increased odds of lability symptoms (agitation, disinhibition, irritability) and apathy in men but not women. Elation and appetite disorders followed the same trend but failed to achieve statistical significance. The exploratory analysis revealed positive correlations between these symptoms' severity with WMH burden in men but not in women.

Conclusions

WMH burden was differentially associated with NPS in older men versus women with normal cognition.