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We assessed the associations of CHIPS with regional brain atrophy, Alzheimer’s disease co-pathology and clinical phenotype. Additionally, we compared its diagnostic performance to that of other manual and automated evaluation methods. We included 82 individuals (41 patients in the Lewy body continuum with either probable dementia with Lewy bodies or mild cognitive impairment with Lewy bo Keywords: dementia with Lewy bodies; cholinergic white matter pathways; CHIPS; white matter signal abnormalities Author: Cene Jerele Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Fri May 16 14:56:12 2025 CEST ModDate: Sat May 17 07:02:15 2025 CEST Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: AcroForm JavaScript: no Pages: 16 Encrypted: no Page size: 612.283 x 790.866 pts Page rot: 0 File size: 6002818 bytes Optimized: yes PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- BWTFMF+GillSansMTStd-Medium Type 1C Custom yes yes yes 1430 0 EEZVBJ+GillSansMTStd-Bold Type 1C Custom yes yes yes 1433 0 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false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: OneColumn PageMode: UseOutlines Language: en Outlines: Item: Title: Cerebrovascular co-pathology and cholinergic white matter pathways along the Lewy body continuum Destination: head1 Children: Item: Title: Introduction Destination: secfcaf173-s1 Item: Title: Methods Destination: secfcaf173-s2 Children: Item: Title: Study population Destination: secfcaf173-s2.1 Item: Title: MRI scanning Destination: secfcaf173-s2.2 Item: Title: Global and regional manual measures of WMSA Destination: secfcaf173-s2.3 Item: Title: Automated segmentation of global WMSA assessed with FreeSurfer Destination: secfcaf173-s2.4 Item: Title: Tractography analysis of cholinergic white matter pathways Destination: secfcaf173-s2.5 Item: Title: Measures of regional brain atrophy Destination: secfcaf173-s2.6 Item: Title: CSF biomarkers Destination: secfcaf173-s2.7 Item: Title: Statistical analysis Destination: secfcaf173-s2.8 Item: Title: Results Destination: secfcaf173-s3 Children: Item: Title: Cohort characteristics Destination: secfcaf173-s3.1 Item: Title: Interrater agreement Destination: secfcaf173-s3.2 Item: Title: Associations with age, sex, and education for selection of covariates Destination: secfcaf173-s3.3 Item: Title: Aim 1 part 1 group differences in WMSA markers and white matter cholinergic pathways (tractography) Destination: secfcaf173-s3.4 Item: Title: Aim 1 part 2 associations among WMSA markers and white matter cholinergic pathways (tractography) Destination: secfcaf173-s3.5 Item: Title: Aim 1 part 3 diagnostic performance of CHIPS and other MRI markers for discriminating LB patients from controls Destination: secfcaf173-s3.6 Item: Title: Aim 2 part 1 associations with regional brain atrophy Destination: secfcaf173-s3.7 Item: Title: Aim 2 part 2 associations with CSF biomarkers, clinical features, and cognitive performance Destination: secfcaf173-s3.8 Item: Title: Discussion Destination: secfcaf173-s4 Item: Title: Conclusion Destination: secfcaf173-s5 Item: Title: Supplementary material Destination: secfcaf173-s6 Item: Title: Funding Destination: secfcaf173-s7 Item: Title: Competing interests Destination: secfcaf173-s8 Item: Title: Data availability Destination: secfcaf173-s9 Item: Title: References Destination: reflist Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 933 ImageHeight: 1096 BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1066 ImageHeight: 640 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 583 ImageHeight: 439 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: 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Kramberger Daniel Ferreira DOI: 10.1093/braincomms/fcaf173; Brain Communications, 7, 3, 2025-05-06.; Abstract: Dementia with Lewy bodies often presents with cholinergic degeneration and varying degrees of cerebrovascular disease. There is a lack of radiological methods for evaluating cholinergic degeneration in dementia with Lewy bodies. We investigated the potential of the Cholinergic Pathway Hyperintensities Scale (CHIPS) in identifying cerebrovascular disease–related disruptions in cholinergic white matter pathways, offering a practical and accessible method for assessing cholinergic integrity in neurodegenerative diseases. We assessed the associations of CHIPS with regional brain atrophy, Alzheimer’s disease co-pathology and clinical phenotype. Additionally, we compared its diagnostic performance to that of other manual and automated evaluation methods. We included 82 individuals (41 patients in the Lewy body continuum with either probable dementia with Lewy bodies or mild cognitive impairment with Lewy bo © The Author(s) 2025. Published by Oxford University Press on behalf of the Guarantors of Brain. dementia with Lewy bodies cholinergic white matter pathways CHIPS white matter signal abnormalities Journal Brain Communications © The Author(s) 2025. 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