Lifestyle Changes Reduced Estimated White Matter Hyperintensities Based on Retinal Image Analysis

Abstract

This study evaluates if there is an association between lifestyle changes and the risk of small vessel disease (SVD) as measured by cerebral white matter hyperintensities (WMH) estimated by the automatic retinal image analysis (ARIA) method. We recruited 274 individuals into a community cohort study. Subjects were assessed at baseline and annually with the Health-Promoting Lifestyle Profile II Questionnaire (HPLP-II) and underwent a simple physical assessment. Retinal images were taken using a non-mydriatic digital fundus camera to evaluate the level of WMH estimated by ARIA (ARIA-WMH) to measure the risk of small vessel disease. We calculated the changes from baseline to one year for the six domains of HPLP-II and analysed the relationship with the ARIA-WMH change. A total of 193 (70%) participants completed both the HPLP-II and ARIA-WMH assessments. The mean age was 59.1 ± 9.4 years, and 76.2% (147) were women. HPLP-II was moderate (Baseline, 138.96 ± 20.93; One-year, 141.97 ± 21.85). We observed a significant difference in ARIA-WMH change between diabetes and non-diabetes subjects (0.03 vs. −0.008, respectively, p = 0.03). A multivariate analysis model showed a significant interaction between the health responsibility (HR) domain and diabetes (p = 0.005). For non-diabetes subgroups, those with improvement in the HR domain had significantly decreased in ARIA-WMH than those without HR improvement (−0.04 vs. 0.02, respectively, p = 0.003). The physical activity domain was negatively related to the change in ARIA-WMH (p = 0.02). In conclusion, this study confirms that there is a significant association between lifestyle changes and ARIA-WMH. Furthermore, increasing health responsibility for non-diabetes subjects reduces the risk of having severe white matter hyperintensities.