Silent Brain Infarction on Magnetic Resonance Imaging and Neurological Abnormalities in Community-Dwelling Older Adults

Price, Thomas R.; Manolio, Teri A.; Kronmal, Richard A.; Kittner, Steven J.; Yue, Nancy Chang; Robbins, John A.; Anton‐Culver, Hoda; O’Leary, Daniel H.

doi:10.1161/01.str.28.6.1158

Cited by 276 publications

(240 citation statements)

References 25 publications

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“…MRI infarcts and infarct-like lesions were classified without reference to clinical signs or symptoms; their relationship to symptoms and clinically recognized stroke has been reported previously. 12 Cerebral ventricular size was assessed on a scale of 0 to 9 by comparison with a series of 8 studies with successively increasing ventricular size ranging from small (grade 1) to severe enlargement (grade 8). Studies considered to have ventricles smaller than those in grade 1 received grade 0, and worse than grade 8 received grade 9.…”

Section: Cerebral Mrimentioning

confidence: 99%

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

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182

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Abstract-Cerebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. While these findings are generally believed to be related to ischemia and atherosclerosis, their relationship to atherosclerosis in the carotid arteries remains to be explored. Study subjects were part of the multicenter Cardiovascular Health Study, a cross-sectional study of 3502 women and men Ն65 years of age undergoing cranial MRI and carotid ultrasonography. MRI infarcts were detected in 1068 participants (29.3%) and measurable carotid plaque in 2745 (75.3%). MRI infarcts, ventricular and sulcal widening, and white matter score were strongly associated with carotid intimal-medial thickness (IMT) and stenosis degree after adjustment for age and sex (all PϽ0.01). Associations with plaque characteristics were less strong and less consistent; MRI infarcts were weakly associated only with surface irregularity, and ventricular size was weakly associated only with lesion density (both PϽ0.04). In contrast, sulcal widening was strongly related to plaque characteristics, with scores being higher in those with heterogeneous and irregular plaque (both PϽ0.009 Key Words: stroke Ⅲ cerebrovascular disorders Ⅲ carotid arteries Ⅲ atherosclerosis Ⅲ aged Ⅲ epidemiology Ⅲ risk factors C erebral magnetic resonance imaging (MRI) has demonstrated a high prevalence of infarct-like lesions, white matter hyperintensities, and evidence of cerebral atrophy in older adults. 1-3 While these findings are related to standard risk factors for cardiovascular disease and are believed to be consequences of ischemia, 4 -6 their relationship to atherosclerosis in the carotid arteries has not been widely explored.Because the carotid arteries provide the majority of the brain's blood supply, detailed information on extent, severity, and characteristics of carotid atherosclerosis can be used to explore its relationships to cerebral MRI findings. Lesion characteristics such as increased density, heterogeneity, and surface irregularity have been shown to relate to prevalent clinically defined transient ischemic attack and stroke, 6 but these associations have not been examined for cerebral MRI findings.The Cardiovascular Health Study (CHS) cohort represents a large, multicenter sample of older men and women examined by both carotid ultrasonography and cerebral MRI. Cross-sectional data from these examinations were analyzed (1) to describe prevalences of MRI-defined infarcts, infarctlike lesions, and gray and white matter changes by quintile of common and internal carotid intimal-medial thickness (IMT); degree of carotid stenosis; and characteristics of carotid plaque; (2) to determine independence of carotid atherosclerosis/MRI abnormality associations from known clinical and subclinical cardiovascular disease and cardiovascular disease risk factors; and (3) to define relationships of MRI infarcts and ipsilateral carotid artery disease. MethodsCHS participants ...

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Section: Cerebral Mrimentioning

confidence: 99%

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Manolio

Burke

O’Leary

et al. 1999

ATVB

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182

160

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“…White matter lesions (WMLs) have been reported to be a predictive factor in vascular dementia [1][2][3][4] and stroke, [5][6][7] and are generally regarded as chronic ischemic lesions of the brain. Prior attempts to attribute their cause to general arteriosclerosis have been inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Augmentation index is related to white matter lesions

et al. 2012

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The augmentation index (AIx) is a measure of pulse wave reflection from peripheral muscular conduit arteries, and is assumed to increase with stiffened arteries. A white matter lesion (WML) is generally regarded as a chronic ischemic lesion, which is associated with cerebral small-vessel arteriosclerosis. The aim of this study is to elucidate the effect of pulse wave reflection on the brain. Carotid AIx was measured in a total of 205 neurologically normal adults. The correlations between AIx and WML were investigated. Two categories of WML were evaluated, periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH). On univariate analysis, AIx was significantly correlated with the grades of PVH and DSWMH (P¼0.0001, respectively). On multivariate analysis, AIx was correlated with PVH and DSWMH, independent of other risk factors such as age or blood pressure. Pulse wave reflection from small vessels may influence the genesis of WML. Keywords: augmentation index; endothelial dysfunction; pulse wave velocity; white matter lesion INTRODUCTION White matter lesions (WMLs) have been reported to be a predictive factor in vascular dementia 1-4 and stroke, 5-7 and are generally regarded as chronic ischemic lesions of the brain. Prior attempts to attribute their cause to general arteriosclerosis have been inconclusive. Some reports analyzed the presence of an association between WML and pulse wave velocity (PWV), which is the velocity at which a pulse wave travels between two arterial points and is considered to reflect an advanced stage of arteriosclerosis, but the results were controversial. [8][9][10] Henskens emphasized that an important methodological limitation is the lack of information on carotid wave reflection, and it is difficult to interpret hemodynamic profile from the PWV alone, while the carotid augmentation index (AIx) should be determined as an index of the effect of arterial stiffening on cerebral blood flow. 9 AIx is represented as the ratio of the late systolic component, which consists mainly of the pressure wave reflected back from the peripheral arteries, to the early systolic component in the pulse, and is thought to detect a degree of functional arterial stiffening in the distal muscular conduit arteries. 11-14 Thus, it is hypothesized that the AIx of the carotid artery includes information related to intracranial vascular changes. Based on this hypothesis, we investigated the association between WML and AIx in order to elucidate the effect of pulse wave reflection as an early marker of arterial stiffening on the brain.

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“…However, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. [7][8][9][10][11] With regard to SBI, the North Manhattan Study found that male sex was independently associated with SBI on a multivariable logistic regression model. 7 Although the Rotterdam Scan Study reported a higher prevalence of SBI among women than men, the sex difference was no longer statistically significant when adjusted for other risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…9 In contrast, sex was not independently associated with an increased risk of SBI in the Cardiovascular Health Study and Framingham Offspring Study. 10,11 In this study, we conducted a population-based, cross-sectional analysis of brain MRI findings to examine the relationship between sex differences in the risk profile and SBI.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

et al. 2010

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Although brain infarction is more common in men, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. This study was to examine the relationship between sex differences in the risk profile and SBI. We conducted a population-based, cross-sectional analysis of cardiovascular risk factors and SBI on MRI. We asked all the female participants about the age at natural menopause and parity. SBI was detected in 77 (11.3%) of 680 participants (266 men and 414 women) with a mean age of 64.5 (range 40-93) years. In the logistic analysis, age (odds ratio (OR)¼2.760/10 years, 95% confidence interval (CI)¼2.037-3.738), hypertension (OR¼3.465, 95% CI¼1.991-6.031), alcohol intake (OR¼2.494, 95% CI¼1.392-4.466) and smoking (OR¼2.302, 95% CI¼1.161-4.565) were significant factors concerning SBI. Although SBI was more prevalent among men, this sex difference disappeared on the multivariate model after adjustment for other confounders. In 215 women aged 60 years or older, age at natural menopause, early menopause, duration of menopause, number of children and age at the last parity were not significantly associated with SBI after adjustment for age. Hypertension and age were considered to be the major risk factors for SBI in community-dwelling people. Male predominance in SBI was largely due to higher prevalence of alcohol habit and smoking in men than in women in our population.

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Silent Brain Infarction on Magnetic Resonance Imaging and Neurological Abnormalities in Community-Dwelling Older Adults

Abstract: MRI evidence of brain infarction is common in older men and women without a clinical history of stroke. Their strong associations with impaired cognition and neurological deficits suggest that they are neither silent nor innocuous.

Cited by 276 publications

References 25 publications

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Relationships of Cerebral MRI Findings to Ultrasonographic Carotid Atherosclerosis in Older Adults

Augmentation index is related to white matter lesions

Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study

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