Justin H Wong,1 Anna Gan,1 Keao Kawaakoa,2 Claudia Seiler,2 Bailey Wong,2 Meliza Roman,1 Chathura Siriwardhana,1 Enrique Carrazana,1 Kore Kai Liow1,2
1 John A. Burns School of Medicine, University of Hawaiʻi, Honolulu, HI
2 Hawaii Pacific Neuroscience Memory Disorders Center and Alzheimer’s Research Unit, Honolulu, HI
White matter hyperintensities (WMHs) and cortical atrophy are imaging markers of neurodegeneration. This study aimed to identify risk factors associated with extensive WMHs and cortical atrophy in a diverse Alzheimer Disease (AD) population. We retrospectively reviewed 452 AD patients from a single center in Hawaii (2018–2024) with available MRI or CT imaging. Variables included age, race, marital status, vascular comorbidities, alcohol use, Fazekas scores, and Global Cortical Atrophy (GCA) scores. Among 411 patients with reported race, Asians had the highest rate of extensive WMHs (28.9%), followed by NHPIs (21.0%) and Whites (13.8%) (P = 0.037). Risk factors for extensive WMHs included age ≥80, widowed status, prediabetes, diabetes, hyperlipidemia, hypercholesterolemia, and prior stroke or TIA (all P < 0.05). Alcohol use was associated with lower WMH burden (P = 0.04). WMH severity correlated with higher GCA scores (P < 0.001). GCA severity was also associated with age ≥80, widowed status, prediabetes, and diabetes. Diabetic medication use was linked to lower rates of severe GCA (P = 0.037). These findings highlight vascular comorbidities as key contributors to WMH and cortical atrophy in AD, with racial differences potentially reflecting disparities in vascular health.
