165 General Discussion 8 studies are rare, but can give crucial insights linking findings on MRI images to histological staining in the same areas. Combined WMH shape and histology studies could help to confirm and explain the differences in pathology of SVD subtypes that the findings in Chapter 3 are pointing towards. A questions to be raised in future studies could be; What are the exact histopathological differences between WMH with a different shape? 8.4 POTENTIAL FOR TRANSLATION INTO CLINICAL PRACTICE Often there is a large gap between techniques that are developed and used in research compared to clinical practice. Many elegant and advanced techniques and applications may never translate into clinical practice. There are several challenges when attempting to move “from bench to bedside”. An important question that remains is, therefore, how the novel techniques presented in this thesis can eventually be of benefit to patients. Oftentimes scientific findings obtained in large populationbased studies, enable us to understand associations between different pathologies and risk factors on a group level. However, the results found in such studies are usually not easily translatable to an individual patient. One of the reasons for this is that in a research setting different factors are prioritized compared to clinical practice. For instance, disease prognosis is frequently investigated in research, but is a lot less commonly used in dementia patients in daily clinical practice. Since many diseases, such as vascular dementia, are most effectively modifiable at early stages, disease prognosis may shift towards a more important role also in clinical practice in the future. Clinicians require tools that are easy to use, deliver clear output, and which can help to make the diagnosis more specific and accurate. Some types of SVD, such as cerebral amyloid angiopathy (CAA) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) have a more defined imaging pattern and definition. On the other hand, sporadic types of SVD are highly heterogenous and lack such a clear definition. It is unlikely that a single brain MRI marker will provide enough precision and information to make individual clinical decisions in such heterogenous disease cases. Models with combined SVD markers (e.g. WMH shape, atrophy, microbleeds) will, therefore, become increasingly relevant. Multimodal data can be used to build large prediction models with which we could categorize patients according to their predicted prognosis regarding disease progression. We aimed to perform the first steps into this direction in Chapter 6. A next step could be that the software using MRI images could be combined with
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