High-Convexity Sulcal Tightness on Brain MRI Tied to Threefold Cognitive Decline Risk

Tightness of the brain's high-convexity sulci on baseline MRI was linked to a nearly threefold higher risk of cognitive decline over five to seven years in 2,133 older adults; participants with both this finding and enlarged Sylvian fissures were 83% more likely to decline.

• The association held in participants who were cognitively normal at baseline, suggesting possible value for early risk stratification before symptoms appear.
• Combining tight high-convexity sulci with enlarged Sylvian fissures was tied to an 83% higher likelihood of long-term cognitive decline; complete disproportionately enlarged subarachnoid-space hydrocephalus (DESH) was rare (1.7%), while incomplete DESH was common (46.3%).

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