Brain Changes Linked to Cognitive Decline and Recovery in Stroke Patients

Researchers from the Row Fogo Centre for Research into Ageing and the Brain found that the regression of WMH might be associated with improved executive function (the ability to use cognitive skills to manage daily tasks) and preserved overall cognition, while the progression of WMH correlates with cognitive decline.

WMH, which appear as bright spots on brain MRIs, are one of the most common markers of cerebral small vessel disease. These abnormalities are a major contributor to cognitive decline and vascular dementia, and typically worsen over time. However, emerging evidence shows that WMH can also decrease in size—a phenomenon called “regression”. 

The research team followed 198 patients who had experienced minor, non-disabling strokes. Participants underwent cognitive tests and brain scans shortly after their strokes and one year later to assess changes in WMH volume and cognitive performance. The researchers categorised participants based on whether their WMH volume had progressed, remained stable, or regressed over the study period. 

Firstly, researchers found that participants with the most WMH regression showed better executive functioning, measured by an improved score on the Trail Making Test (a measure of mental flexibility and processing speed).

Secondly, the researchers found that participants with the greatest increase in WMH volume exhibited declines in global cognition, as measured by the Montreal Cognitive Assessment.

Finally, the research team found that participants with regressing WMH did not suffer the decline in global cognition expected in this population, suggesting that regression interrupted this decline.

The findings highlight that WMH-affected brain tissue can potentially recover, providing an opportunity to improve cognitive outcomes in patients with SVD. These results suggest that slowing or reversing WMH progression could be a valuable target for future treatments .

Dr Susana Muñoz Maniega, Research Fellow in Diffusion Tensor MRI Imaging at the University of Edinburgh said: “SVD progression in older age is relentless, causing irreversible damage to brain tissue that can impact all aspects of cognition. As the population continues to age, finding treatments and interventions to slow or even reverse the effects of SVD is more critical than ever.” 

Dr Muñoz Maniega added: “The discovery that WMH can regress, and that this recovery may lead to cognitive benefits, is a significant breakthrough in SVD research. Although further studies are needed to replicate these findings before they can be integrated into clinical practice, they offer real hope for developing targeted therapies that could preserve cognitive function and improve quality of life for those affected by SVD.”

For those affected with SVD  and their families, this research provides hope that brain tissue repair is possible, with interventions targeting WMH regression offering a promising avenue for improving cognitive ageing.

Click here to read the full paper: https://pubmed.ncbi.nlm.nih.gov/39899790/ 

Click here to read the editorial “Progression in the Understanding of Cerebral Small Vessel Disease Regression” in Neurology: https://www.neurology.org/doi/abs/10.1212/WNL.0000000000213391 

Full citation: 

Jochems, A. C. C., Muñoz Maniega, S., Clancy, U., Arteaga-Reyes, C., Jaime Garcia, D., Chappell, F. M., Hamilton, O. K. L., Backhouse, E. V., Barclay, G., Jardine, C., McIntyre, D., Hamilton, I., Sakka, E., Valdés Hernández, M. D. C., Wiseman, S., Bastin, M. E., Stringer, M. S., Thrippleton, M., Doubal, F., & Wardlaw, J. M. (2025). Longitudinal Cognitive Changes in Cerebral Small Vessel Disease: The Effect of White Matter Hyperintensity Regression and Progression. Neurology, 104(4), e213323-. https://doi.org/10.1212/WNL.0000000000213323