Progression of Magnetic Resonance Imaging-Defined Brain Vascular Disease Predicts Vascular Events in Elderly

Longstreth, W. T.; Arnold, Alice M.; Kuller, Lewis H.; Bernick, Charles; Lefkowitz, David; Beauchamp, Norman J.

doi:10.1161/strokeaha.111.622977

Cited by 12 publications

(17 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Dolichoectasia, characterized by tortuous, dilated vessels causing bidirectional blood flow, stasis, and thrombus formation, has been associated with lacunar stroke in the general population 33 . White matter hyperintensities, often indicative of cerebral hypoperfusion and axon demyelination, have been correlated with cognitive decline 34 , and future stroke 35 . The presence of these lesions in children with SCT may herald future cerebrovascular events.…”

Section: Discussionmentioning

confidence: 99%

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Caughey

Loehr

Key

et al. 2014

Stroke

View full text Add to dashboard Cite

Background and Purpose Numerous case reports describe stroke in individuals with sickle cell trait (SCT) in the absence of traditional risk factors for cerebrovascular disease. To date, no prospective epidemiological studies have investigated this association. Methods A population-based sample of African Americans (N=3,497, mean age=54, female=62%) was followed from 1987–2011 in the Atherosclerosis Risk in Communities Study (ARIC), contributing a total of 65,371 person-years. Hazard ratios and incidence rate differences for ischemic stroke were estimated, contrasting SCT to homozygous hemoglobin A (HbAA). Models were adjusted for age, sex, smoking, diabetes, hypertension, total cholesterol, atrial fibrillation, and coronary heart disease. Results SCT was identified in 223 (6.4%) participants. Over a median follow up of 22 years, 401 subjects experienced incident stroke (89% ischemic). Incident ischemic stroke was more frequent among those with SCT (13%) than HbAA (10%). SCT was associated with an ischemic stroke hazard ratio of 1.4 (1.0 – 2.0), and an incidence rate difference amounting to 1.9 (0.4 – 3.8) extra strokes per 1000 person-years. Conclusion We observed an increased risk of ischemic stroke in African Americans with SCT. Further investigation of the incidence and pathophysiology of stroke in SCT patients is warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Caughey

Loehr

Key

et al. 2014

Stroke

View full text Add to dashboard Cite

show abstract

“…An obvious limitation of our study is the lack of a physical measure of subclinical disease (carotid atherosclerosis, ankle brachial index or white matter changes on MRI brain) which have been used in other studies [28,29,30,31,32,33]. We could not measure covert stroke, which requires magnetic resonance imaging (MRI) of brain or cognitive function testing.…”

Section: Discussionmentioning

confidence: 99%

Vascular Risk Factors, Cardiovascular Disease and Functional Impairment in Community-Dwelling Adults

et al. 2014

View full text Add to dashboard Cite

Background: Older adults report preservation of functional independence as one of the most important constructs of successful ageing. Vascular risk factors may increase the risk of functional impairment due to clinical and subclinical vascular disease. Objective: To describe the association between vascular risk factors and impaired ability to perform daily living activities, independent of established cardiovascular disease. Methods: We conducted an analysis of the Clarity Cohort, which is a cross-sectional study of 9,816 community-dwelling Irish adults. Of the total cohort, 3,499 completed standardized self-reported health questionnaires, which included questions on activities of daily living. Functional impairment was defined as self-reported impairment in self-care, mobility or household tasks. Using logistic regression analyses, we determined the association between vascular risk factors and functional impairment, independent of demographics, prior coronary artery disease, stroke, congestive heart failure, and peripheral vascular disease. Results: Functional impairment was reported in 40.4% (n = 1,413) of the cohort overall and in 23% of those with established cardiovascular disease. The mean age was 66.2 ± 10.3 years, 52% of the cohort were aged over 65 and 45.6% were male. Some difficulty with instrumental activities of daily living was reported by 35.4% (n = 1,240) while 29.4% (n = 1,029) reported some difficulty with basic activities of daily living. On multivariable analysis, older age [OR 1.03 (1.02, 1.04) per year], current smoking [OR 1.43 (1.08, 1.89)], atrial fibrillation [OR 1.68 (1.07, 2.65)], former alcohol use [OR 1.87 (1.36, 2.57)] and prior stroke [OR 1.91 (1.24, 2.93)] were associated with an increased risk of functional impairment. Older age leaving education [OR 0.96 (0.94, 0.99)], non-use of alcohol [OR 0.76 (0.61, 0.93)] and increased high-density lipoprotein levels [OR 0.70 (0.56, 0.88)] were associated with reduced risk of functional impairment. Conclusions: Independent of established cardiovascular disease, some vascular risk factors are associated with functional impairment. Modification of these risk factors is expected to have a large impact on preservation of functional independence through prevention of overt and covert vascular disease.

show abstract

“…Silent infarcts are at least 5 times as prevalent as clinical strokes, 30 share the same risk factors as clinical strokes, 31, 32 accumulate over time in the absence of clinical strokes, 33 and are associated with stroke and cognitive impairment. 34, 35 Asymptomatic brain MRI abnormalities, including white matter hyperintensities and infarcts, have been associated with functional impairment cross-sectionally, 36 at 3 months, 37 and over 4 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Trajectory of Functional Decline Before and After Ischemic Stroke

Dhamoon

Moon

Paik

et al. 2012

Stroke

View full text Add to dashboard Cite

Background and Purpose-Previous research in our cohort showed a delayed decline in functional status after first ischemic stroke. We compared the long-term trajectory of functional status before and after ischemic stroke. Methods-The Northern Manhattan Study contains a prospective, population-based study of stroke-free individuals age Ն40 years, followed for a median of 11 years. The Barthel index (BI), a commonly used measure of activities of daily living, was assessed annually. Generalized estimating equations were used to assess functional decline over time before stroke and beginning 6 months after stroke. Follow-up was censored at the time of recurrent stroke. Results-Among 3298 participants, 210 participants had an ischemic stroke during follow-up and had poststroke BI assessed. Mean age (ϮSD) was 77Ϯ9 years, 38% were men, 52% were Hispanic, 37% had diabetes, and 31% had coronary artery disease. There was no difference in rate of functional decline over time before and after stroke (Pϭ0.51), with a decline of 0.96 BI points per year before stroke (PϽ0.0001) and 1.24 BI points after stroke (Pϭ0.001). However, when stratified by insurance status, among those with Medicaid or no insurance, in a fully adjusted model, there was a difference in slope before and after stroke (Pϭ0.04), with a decline of 0.58 BI points per year before stroke (Pϭ0.02) and 1.94 BI points after stroke (Pϭ0.001). Conclusions-In this large, prospective, population-based study with long-term follow-up, there was a significantly steeper decline in functional status after ischemic stroke compared with before stroke among those with Medicaid or no insurance, after adjusting for confounders. (Stroke. 2012;43:2180-2184.)

show abstract

Progression of Magnetic Resonance Imaging-Defined Brain Vascular Disease Predicts Vascular Events in Elderly

Cited by 12 publications

References 7 publications

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Sickle Cell Trait and Incident Ischemic Stroke in the Atherosclerosis Risk in Communities Study

Vascular Risk Factors, Cardiovascular Disease and Functional Impairment in Community-Dwelling Adults

Trajectory of Functional Decline Before and After Ischemic Stroke

Contact Info

Product

Resources

About