ASA: White Matter Hyperintensity Burden Tied to Future Decline in Older Adults” Driving Ability

MONDAY, Feb. 2, 2026 (HealthDay News) — White matter hyperintensity (WMH) burden predicts functional decline in real-world driving among older adults, according to a study scheduled to be presented at the annual American Stroke Association International Stroke Conference, held from Feb. 4 to 6 in New Orleans.

Chia-Ling Phuah, M.D., from the Barrow Neurological Institute in Phoenix, and colleagues examined the relationship between WMH burden (quantified using deep learning-based magnetic resonance imaging segmentation) and longitudinal real-world driving behavior. The analysis included 220 community-dwelling adults aged 65 years and older without dementia at baseline.

The researchers found that greater WMH burden was associated with reduced driving frequency, trip diversity, and adaptability at baseline and with faster decline in these outcomes over time. During a mean follow-up of 5.6 years, 17 percent of participants with greater WMH burden developed cognitive impairment. WMH burden predicted more crashes and hard braking, with posterior WMH growth conferring the highest crash risk (β = 0.59). The association between WMH and risky driving was attenuated by antihypertensive use (β = −0.18), especially angiotensin-converting enzyme (ACE) inhibitors. These findings persisted independent of Alzheimer disease (AD) biomarkers, suggesting an additive role of cerebral small vessel disease independent of AD pathology.

“One especially promising finding was that people taking blood pressure medications, particularly ACE inhibitors, tended to maintain safer driving habits even when their brain scans revealed more damage,” Phuah said in a statement. “This effect was observed regardless of whether their blood pressure levels were at target levels. This suggests that these medications may help support brain health as we age.”

One author disclosed ties to the pharmaceutical industry.

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