Aortic Atherosclerosis at Middle Age Predicts Cerebral White Matter Lesions in the Elderly

Abstract

Background and Purpose-MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions. Methods-We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life. Results-The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions Ϸ20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions. Conclusions-The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable. (Stroke. 2000;31:425-429.)

Subcortical Hyperintensities Are Associated With Cognitive Decline in Patients With Mild Cognitive Impairment

“…Indeed, PVH and subcortical or deep white matter lesions (ie, WMH) have been associated with different clinical conditions. 1,43,44 Vascular risk factors were shown to be correlated more strongly with PVH than with WMH, 45 but this is unlikely to be the only explanation for our results, as they remained unchanged after adjustment for vascular risk factors. It has been suggested that lesions affecting the periventricular area may impair cognitive functioning more easily than lesions affecting the subcortical area.…”

Aspirin Attenuates the Incidence of Silent Brain Lesions in Patients With Nonvalvular Atrial Fibrillation

“…Because the deep white matter is an arterial border zone already marginally perfused under physiologic circumstances, it is vulnerable to a decrease in cerebral blood flow. 30 Reduced cardiac output in patients with AF may induce ischemia of the deep white matter, causing lesions. 31 We have already reported that an irregular heart rate blunts nitric oxide (NO) synthesis and increases p-selectin expression on platelets, ultimately increasing the risk for silent BI.…”

Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

“…A history of cerebrovascular disease (51), the presence of aortic atherosclerosis during midlife (52), and the presence of carotid atherosclerosis (14) were preferentially associated with PVWML. High serum carotenoid level which had been reported to be protective for carotid atherosclerosis was related to decreased PVWMLs but not to DWMLs (53).…”