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Joint trajectories of brain atrophy, white matter hyperintensities and cognition quantify brain maintenance.
Menze, I. (First author)DZNE* ; Bernal, J.DZNE* ; Kievit, R. A. ; Tripathi, K. P. ; Kaleck, T. ; Yakupov, R.DZNE* ; Altenstein, S.DZNE* ; Bartels, C. ; Buerger, K.DZNE* ; Butryn, M.DZNE* ; Dechent, P. ; Ewers, M.DZNE* ; Fliessbach, K.DZNE* ; Frommann, I.DZNE* ; Gemenetzi, M.DZNE* ; Glanz, W.DZNE* ; Gref, D.Extern* ; Hellmann-Regen, J. D. N.DZNE* ; Hetzer, S. ; Incesoy, E. I.DZNE* ; Janowitz, D.DZNE* ; Kilimann, I.DZNE* ; Kleineidam, L.DZNE* ; Kronmüller, M. T.DZNE* ; Laske, C.DZNE* ; van Lent, D. M. ; Lüsebrink, F.DZNE* ; Perneczky, R.DZNE* ; Peters, O.DZNE* ; Preis, L.Extern* ; Priller, J.DZNE* ; Rauchmann, B. S.Extern* ; Rostamzadeh, A. ; Roeske, S.DZNE* ; Scheffler, K. ; Schott, B.-H.DZNE* ; Schneider, A.DZNE* ; Sodenkamp, S.DZNE* ; Spottke, A.DZNE* ; Spruth, E. J.DZNE* ; Stark, M.DZNE* ; Teipel, S.DZNE* ; Wagner, M.DZNE* ; Wiltfang, J.DZNE* ; Jessen, F.DZNE* ; Ramirez, A.DZNE* ; Schreiber, S.DZNE* ; Düzel, E.DZNE* ; Ziegler, G. (Last author)DZNE*
2026
Springer Nature
[London]
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Please use a persistent id in citations: doi:10.1038/s41467-026-74957-2
Abstract: Brain maintenance - the preservation of brain structure or function relevant to cognitive performance - remains challenging to quantify. Here, we propose a domain-general brain maintenance index derived by jointly modelling the longitudinal co-evolution of ageing-related atrophy (via medial temporal lobe to ventricle ratio, MTLV-ratio), white matter hyperintensities (WMH), and global cognition assessed by the preclinical Alzheimer's cognitive composite (PACC5) using latent growth curve modelling. We demonstrate its utility in 543 cognitively unimpaired older adults from the DELCODE cohort, followed annually over four years. We show that changes in MTLV-ratio and WMH additively predict cognitive change. We further show that higher neuroticism, depressive symptoms, lower openness, and faster biological ageing are related to unfavourable domain-specific trajectories and poorer brain maintenance. Our findings highlight the combined relevance of WMH and ageing-related atrophy dynamics for brain maintenance. Maintaining cerebrovascular and mental health alongside cognitive engagement could promote brain maintenance, delay cognitive decline and dementia.
Keyword(s): Humans (MeSH) ; White Matter: pathology (MeSH) ; White Matter: diagnostic imaging (MeSH) ; Atrophy: pathology (MeSH) ; Cognition: physiology (MeSH) ; Brain: pathology (MeSH) ; Brain: diagnostic imaging (MeSH) ; Aging: pathology (MeSH) ; Aging: physiology (MeSH) ; Magnetic Resonance Imaging (MeSH) ; Female (MeSH) ; Male (MeSH) ; Aged (MeSH) ; Aged, 80 and over (MeSH) ; Cognitive Dysfunction: pathology (MeSH)
Contributing Institute(s):
- Clinical Neurophysiology and Memory (AG Düzel)
- Translational Neuropsychiatry (AG Priller)
- Clinical Research (Munich) (Clinical Research (Munich))
- Patient Studies (Bonn) (Patient Studies (Bonn))
- Neuropsychology (AG Wagner)
- Interdisciplinary Dementia Research (AG Endres)
- Clinical Dementia Research (Rostock /Greifswald) (AG Teipel)
- Parkinson Genetics (AG Gasser)
- Clinical Research Platform (CRP) (AG Spottke)
- Clinical Research Platform (CRP) (Clinical Research Platform (CRP))
- Vascular Cognitive Impairment & Post-Stroke Dementia (AG Dichgans)
- Biomarker-Assisted Early Detection of Dementias (AG Peters)
- Epigenetics and Systems Medicine in Neurodegenerative Diseases (AG Fischer)
- Translational Dementia Research (Bonn) (AG Schneider)
- Core ICRU (ICRU)
- Molecular biomarkers for predictive diagnostics of neurodegenerative diseases (AG Wiltfang)
- Clinical Alzheimer’s Disease Research (AG Jessen)
- Mixed Cerebral Pathologies and Cognitive Aging (AG Schreiber)
Research Program(s):
- 353 - Clinical and Health Care Research (POF4-353) (POF4-353)
- 352 - Disease Mechanisms (POF4-352) (POF4-352)
Appears in the scientific report
2026
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