The relation between white-matter lesions and cognition

PURPOSE OF REVIEW: To summarize recent findings and developments in the field of the relation between white-matter lesions and cognition. RECENT FINDINGS: Recent studies have provided further evidence that white-matter lesions exert a detrimental effect on cognitive profile. New magnetic-resonance techniques may help in clarifying the meaning and extent of this effect. Evidence is also increasing about lesion progression occuring over time, at least in patients with severe white-matter lesions, and this progression is one of the factors related to cognitive decline in the elderly. The need to delay or halt the progression of white-matter lesions has led to clarification of the role of some risk factors and to performance of therapeutic trials where white-matter lesions are used as a surrogate marker for the end point of small-vessel disease. In addition to cognitive effects, white-matter lesions have a role in the decline of other functional performances, and this places individuals with higher-grade lesions at increased risk of developing disability. SUMMARY: White-matter lesions cannot be considered as mere incidental findings, at least in patients who show severe lesions. The pathogenesis of white-matter lesions must be clarified further and strategies found to delay their progression.