Large-vessel correlates of cerebral small-vessel disease

Abstract

Objective: Our aim was to investigate the relationship of carotid structure and function with MRI markers of cerebral ischemic small-vessel disease.Methods: The study comprised 1,800 participants (aged 72.5 6 4.1 years, 59.4% women) from the 3C-Dijon Study, a population-based, prospective cohort study, who had undergone quantitative brain MRI and carotid ultrasound. We used multivariable logistic and linear regression adjusted for age, sex, and vascular risk factors.Results: Presence of carotid plaque and increasing carotid lumen diameter (but not common carotid artery intima-media thickness) were associated with higher prevalence of lacunar infarcts: odds ratio ( Conclusions: In addition to and independently of carotid plaque, increasing carotid lumen diameter and markers of carotid stiffness were associated with increasing prevalence of lacunar infarcts and increasing WMHV, respectively. Neurology â 2013;80:662-669 GLOSSARY BI 5 brain infarct; CCA 5 common carotid artery; CI 5 confidence interval; IMT 5 intima-media thickness; LI 5 lacunar infarct; L-WMHV 5 large white matter hyperintensity volume; OR 5 odds ratio; SVD 5 small-vessel disease; WMH 5 white matter hyperintensity; WMHV 5 white matter hyperintensity volume.Brain imaging studies have shown that the impact of ischemic brain injury, a major cause of disability, dementia, and mortality in adults, 1 extends much beyond that of acute clinical events such as stroke. Vascular lesions, including MRI-defined brain infarcts (BIs) and white matter hyperintensities (WMH), are frequently observed in older community-dwelling individuals. The prevalence of BIs ranges between 8% and 28% 2,3

Arterial stiffness and progression of structural brain changes

“…The cross-sectional findings are largely in agreement with previous studies in the general population, which reported that higher aortic or carotid stiffness was associated with larger WML volume, 12,16,19,20 and that increased carotid stiffness was associated with smaller total and gray and white matter volume. 12 However, in previous studies the association between aortic stiffness and lacunar or silent subcortical brain infarcts was inconsistent, and no association was found with cortical infarcts.…”

“…12 However, in previous studies the association between aortic stiffness and lacunar or silent subcortical brain infarcts was inconsistent, and no association was found with cortical infarcts. 12,16,19,20 In our study, the associations were stronger in older patients, in patients with uncontrolled hypertension, and in patients with larger CIMT. Since these are factors related to endothelial dysfunction and atherosclerosis, 35 it suggests that, together with arterial stiffness, these are among the conditions that may aggravate brain damage.…”

“…12 Also, stiffness of the large arteries may impair cerebral autoregulation, predisposing to hypoperfusion during hypotension, subsequently leading to ischemia. 13 Several cross-sectional studies relating arterial stiffness to the subclinical markers of dementia showed a relation between increased arterial stiffness and larger white matter lesion (WML) volumes, [14][15][16][17][18][19][20] more lacunar infarcts, 14,20,21 more brain atrophy, 12,20 and lower cerebral perfusion. 22 However, it is unknown whether arterial stiffness contributes to an increased development of ischemic and degenerative brain changes over time.…”

Associations between arterial stiffness, depressive symptoms and cerebral small vessel disease: cross-sectional findings from the AGES-Reykjavik Study

“…7,10,11 Previous studies have shown associations of CFPWV or local carotid stiffness with various manifestations of cerebral small vessel disease, including WMHV 6,12,17 and subcortical or lacunar infarcts. 6,12,17 In addition, previous studies have shown an association between depression and WMHV 19,38 and lacunar infarcts. 38,39 Furthermore, a population-based study 4 has shown that higher CFPWV and local carotid stiffness were associated with depression.…”

Pulse wave velocity is associated with β-amyloid deposition in the brains of very elderly adults

“…7 Arterial stiffness is a well-established risk factor for subclinical cerebrovascular disease and WMH, 8 independent of other cardiovascular risk factors. 9,10 Yet the relationship between arterial stiffness and Ab deposition is unknown. Therefore, in this observational study of very elderly adults without dementia, we evaluated the relationship of arterial stiffness with measures of brain structure, including cerebral fibrillar Ab deposition and WMH volume, considered separately and jointly.…”