Cognitive correlates of white matter lesion load and brain atrophy

Dong, Chuanhui; Nabizadeh, Nooshin; Caunca, Michelle R.; Cheung, Ying Kuen; Rundek, Tatjana; Elkind, Mitchell S.V.; DeCarli, Charles; Sacco, Ralph L.; Stern, Yaakov; Wright, Clinton B.

doi:10.1212/wnl.0000000000001716

Cited by 75 publications

(67 citation statements)

References 41 publications

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“…Processing of MRI scans to calculate total intracranial volume (ICV), cerebral volume, and white matter hyperintensity volumes (WMHV), has been previously described 20. Semiautomated measurements of pixel distributions using mathematical modeling of pixel‐intensity histograms for cerebrospinal fluid and brain white and gray matter were used to identify the optimal pixel‐intensity threshold to distinguish cerebrospinal fluid from brain matter, using a custom‐designed image analysis package (QUANTA 6.2 using a Sun Microsystems Ultra 5 workstation).…”

Section: Methodsmentioning

confidence: 99%

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Gardener

Caunca

Dong

et al. 2018

JAHA

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BackgroundThe American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume.Methods and ResultsA subsample of stroke‐free participants from the population‐based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=−0.047; P=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72–0.97) and positively associated with cerebral volume (beta per factor=0.300; P=0.002).ConclusionsAn increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.

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Section: Methodsmentioning

confidence: 99%

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Gardener

Caunca

Dong

et al. 2018

JAHA

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“…Total cerebral volume was computed as the sum of whole brain volume voxels from the T1 segmentation process, and white matter hyperintensity volume was calculated as the sum of voxels ≥3.5 SDs above the mean image intensity multiplied by pixel dimensions and section thickness using axial FLAIR images. 21 For this study, percentage of atrophy was obtained using the formula ((TIV - total cerebral volume)/TIV *100). 22 …”

Section: Methodsmentioning

confidence: 99%

Brain Perivascular Spaces as Biomarkers of Vascular Risk: Results from the Northern Manhattan Study

Gutierrez¹,

Elkind

Dong

et al. 2017

AJNR Am J Neuroradiol

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Background Dilated perivascular spaces (PVS) in the brain are associated with greater arterial pulsatility. We hypothesized that PVS identify individuals at higher risk of systemic and cerebral vascular events. Methods Stroke-free participants in the population-based Northern Manhattan Study had brain MRI performed, and were followed for myocardial infarction, any stroke, and death. Imaging analyses distinguished PVS from lesions presumably ischemic (LPI). PVS were further subdivided into lesions with diameter of ≤ 3 mm (small PVS) and > 3 mm (large PVS). We calculated relative rates of events with Poisson models, and hazard ratios (HR) with Cox proportional models. Results NOMAS participants who had MRI data available for review (n=1228; 59% women, 65% Hispanic, mean age 71 ± 9 years) were followed for an average of 9 ± 2 years. Participants in the highest tertile of the small PVS score had higher relative rate of all death (1.38, 1.01–1.91), vascular death (1.87, 1.12–3.14), myocardial infarction (2.08, 1.01–4.31), any stroke (1.79, 1.03–3.11), and any vascular event (1.74, 1.18–2.56). After adjusting for confounders there was a higher risk of vascular death (HR 1.06, 1.01–1.11), myocardial infarction (HR 2.22, 1.12–4.42), and any vascular events (HR 1.04, 1.01–1.08) with a higher small PVS scores. Conclusions In this multi-ethnic, population-based study, participants with a high burden of SPVS had increased risk of vascular events. By gaining pathophysiological insight into the mechanism of PVS dilatation, we may be able to propose novel therapies to better prevent vascular disorders in the population.

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“…In a community-based sample of older adults free of clinical stroke, Dong et al found a negative relationship between WMI burden and cognitive performance, irrespective of brain atrophy (Dong et al, 2015). Chaudhari et al demonstrated that, in addition to poor educational background, location of infarct, and baseline stroke severity, WMI load is also an independent predictor for post-stroke cognitive dysfunction (Chaudhari et al, 2014).…”

Section: Clinical Manifestationsmentioning

confidence: 99%

White matter injury in ischemic stroke

Wang

Liu

Hong

et al. 2016

Progress in Neurobiology

213

206

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Stroke is one of the major causes of disability and mortality worldwide. It is well known that ischemic stroke can cause gray matter injury. However, stroke also elicits profound white matter injury, a risk factor for higher stroke incidence and poor neurological outcomes. The majority of damage caused by stroke is located in subcortical regions and, remarkably, white matter occupies nearly half of the average infarct volume. Indeed, white matter is exquisitely vulnerable to ischemia and is often injured more severely than gray matter. Clinical symptoms related to white matter injury include cognitive dysfunction, emotional disorders, sensorimotor impairments, as well as urinary incontinence and pain, all of which are closely associated with destruction and remodeling of white matter connectivity. White matter injury can be noninvasively detected by MRI, which provides a three-dimensional assessment of its morphology, metabolism, and function. There is an urgent need for novel white matter therapies, as currently available strategies are limited to preclinical animal studies. Optimal protection against ischemic stroke will need to encompass the fortification of both gray and white matter. In this review, we discuss white matter injury after ischemic stroke, focusing on clinical features and tools, such as imaging, manifestation, and potential treatments. We also briefly discuss the pathophysiology of WMI and future research directions.

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Cognitive correlates of white matter lesion load and brain atrophy

Abstract: In this racially/ethnically diverse, community-based sample, white matter lesion load was inversely associated with cognitive performance, independent of brain atrophy. Lateral ventricular, hippocampal, and lobar GM volumes explained domain-specific variability in cognitive performance.

Cited by 75 publications

References 41 publications

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Brain Perivascular Spaces as Biomarkers of Vascular Risk: Results from the Northern Manhattan Study

White matter injury in ischemic stroke

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