Differences in brain cholesterol metabolism and insulin in two subgroups of patients with different CSF biomarkers but similar white matter lesions suggest different pathogenic mechanisms

► This study investigates the pathogenesis of WMHs in elderly with memory complaints. ► Combined quantitative metabolic analysis and brain MRIs. ► The median of the combination of CSF Aβ42 and T-tau levels defines group belonging. ► The two study groups have similar appearance on FLAIR images. ► Correlation between WMHs and cholesterol-insulin metabolism differ in the groups.