The Prevalence of White-Matter Lesions on Computed Tomography of the Brain in Demented and Nondemented 85-Year-Olds

Skoog, Ingmar; Palmertz, Bo; Andreasson, Lars-Arne

doi:10.1177/089198879400700308

Cited by 78 publications

(72 citation statements)

References 44 publications

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“…Cross-sectional associations between WMLs and depression have been shown repeatedly, especially for MRI and mainly from clinical studies (Greenwald et al, 1998;Ikram et al, 2010;Kumar et al, 2000;Kumar et al, 2002), although not all studies support this association (Rainer et al, 2006;Skoog et al, 1994). Our finding that WMLs preceded major depression is in agreement with three previous longitudinal studies using MRI (Godin et al, 2008;Steffens et al, 2002;Teodorczuk et al, 2007).…”

Section: Discussionsupporting

confidence: 90%

“…The Gothenburg scale was used to rate WMLs (Skoog et al, 1994). According to this scale, WMLs are defined as periventricular or subcortical areas of decreased attenuation below that expected for normal white matter.…”

Section: Ct Scan Rating Methodsmentioning

confidence: 99%

“…The changes were always diffusely distributed within the white matter. The scale gives a global measure of WMLs in the brain, and has been used in our epidemiological studies since 1986 (Skoog et al, 1994). It is a 0-to 3-point scale that takes into account the severity of the hypodensity of WMLs, including 0 (absence of any attenuation), 1 (mild signal attenuation), 2 (moderate signal attenuation), and 3 (severe signal attenuation).…”

Section: Ct Scan Rating Methodsmentioning

confidence: 99%

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Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Olesen

Gustafson

Simoni

et al. 2010

Neuropsychopharmacol

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The influence of organic brain changes on the development of depression in the elderly is uncertain. Cross-sectional studies, most often from clinical samples, report associations with brain atrophy and cerebrovascular disease, while longitudinal population studies have given mixed results. Our aim was to investigate whether cortical atrophy and white matter lesions (WMLs) on computed tomography (CT) predict occurrence of depression in the elderly. This is a prospective population-based study with 5-year follow-up. The baseline sample included 525 elderly subjects, aged 70-86 years, without dementia or major depression, with a score on the Mini-Mental State Examination above 25, and without dementia at follow-up. Cortical atrophy and WMLs were evaluated at baseline using CT. The main outcome measure was development of major or minor depression at follow-up according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, as evaluated using neuropsychiatric examinations and hospital discharge registers. Logistic regression was used to estimate risk. Over the period of 5 years, 20 individuals developed major and 63 minor depression. Presence of temporal lobe atrophy (odds ratio (OR) ¼ 2.81, 95% confidence interval (CI) 1.04-7.62) and moderate-to-severe WMLs (OR ¼ 3.21, 95% CI 1.00-10.26) independently predicted major, but not minor, depression after controlling for various confounders. Other brain changes did not predict occurrence of depression. Our findings suggest that temporal lobe atrophy and WMLs represent relatively independent and complementary pathways to major depression in the elderly. This may have implications for prevention, as both neurodegeneration and cerebrovascular disease have been related to preventable factors.

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Section: Discussionsupporting

confidence: 90%

Section: Ct Scan Rating Methodsmentioning

confidence: 99%

Section: Ct Scan Rating Methodsmentioning

confidence: 99%

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Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Olesen

Gustafson

Simoni

et al. 2010

Neuropsychopharmacol

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“…Decreased density was rated as mild, moderate, or severe, in relation to the attenuation of normal white matter. 1 The same rating scale was used in 1992 and 2000. Interobserver agreement for rating the presence of WMLs between the 2 radiologists in 1992 was 84% (ϭ0.75; PϽ0.001), 1 and between the radiologist in 1992 and the neurologist in 2000 it was 65% (ϭ0.30; PϽ0.001).…”

Section: Brain Ct Scansmentioning

confidence: 99%

“…1,2 Individuals with WMLs are at increased risk for dementia, 1,3 depression, 4 stroke, 5,6 and gait disorders. 7 On histopathology, WMLs on CT represent ischemic demyelination with arteriolosclerosis, hyalinosis, and narrowing of the lumen of the small penetrating arteries in the white matter.…”

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confidence: 99%

Blood Pressure Components and Changes in Relation to White Matter Lesions

Guo

Pantoni²,

Simoni³

et al. 2009

Hypertension

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Abstract-This study aimed to examine the long-term effect of high blood pressure (systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure) on white matter lesions and to study changes in different blood pressure components in relation to white matter lesions. A representative population of women was examined in 1968 and re-examined in 1974, 1980, 1992, and 2000. The presence and severity of white matter lesions on computed tomography were rated by a visual rating scale in 1992 and 2000 in 539 women. Systolic and diastolic blood pressures were measured at all of the examinations. We found that presence and severity of white matter lesions in 1992/2000 were associated with higher diastolic blood pressure and mean arterial pressure at each examination but not with systolic blood pressure and pulse pressure. Odds ratios (95% CIs) for the presence of white matter lesions per 10-mm Hg increase in diastolic pressure were 1.4 (1.0 to 1.9) in 1968, 1.3 (1.0 to 1.8) in 1974, 1.4 (1.1 to 1.9) in 1980, and 1.3 (1.0 to 1.6) in 1992 after adjustment for confounders. The presence of white matter lesions was also associated with a 24-year increase in diastolic pressure (Ͼ10 mm Hg), systolic pressure (Ͼ40 mm Hg), pulse pressure (Ͼ24 Key Words: blood pressure Ⅲ white matter lesions Ⅲ longitudinal study C erebral white matter lesions (WMLs) are common findings on computed tomography (CT) and MRI in the elderly. 1,2 Individuals with WMLs are at increased risk for dementia, 1,3 depression, 4 stroke, 5,6 and gait disorders. 7 On histopathology, WMLs on CT represent ischemic demyelination with arteriolosclerosis, hyalinosis, and narrowing of the lumen of the small penetrating arteries in the white matter. 8 Cerebral ischemia and microangiopathy are suggested as the main causes of WMLs, 9 and hypertension is a widely reported risk factor for these lesions. 10 Higher blood pressure has been associated with an increased risk of WMLs in cross-sectional studies 11,12 and in 1 short-term longitudinal study. 13 However, long-term longitudinal studies on blood pressure and WMLs are few. Two such studies, 1 with 20-year follow-up in a general population 14 and 1 with 25-year follow-up in a male population, 15 reported an association between higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) and WMLs on MRI. An increase and decrease in DBP, as well as an increase in SBP, have also been related to higher risks of WMLs on MRI. 14,16 Other than SBP and DBP, blood pressure is also characterized by its steady and pulsatile components. The mean arterial pressure (MAP) is a steady component reflecting cardiac output and vascular resistance, as well as elasticity averaged over time 17,18 ; and pulse pressure (PP) is a pulsatile component mainly reflecting large artery stiffness and wave reflections. 18 Earlier epidemiological studies have reported that PP and MAP are predictors of cardiovascular disease and stroke. 17,19,20 However, it is not known how these components affect the risk of WMLs ...

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Apolipoprotein E in Cerebrospinal Fluid in 85-Year-Old Subjects

Skoog¹

1997

Arch Neurol

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Whether our finding of an association between low CSF levels of Apo E and dementia disorders (both degenerative, such as AD, and vascular, such as VAD) is related to the pathogenesis of these disorders or is a secondary consequence of the disease process remains to be established. Although statistical correlations do not give direct evidence of causal relations, the correlations between CSF level of Apo E and severity of dementia and cortical atrophy suggest that CSF level of Apo E follows the disease process.

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The Prevalence of White-Matter Lesions on Computed Tomography of the Brain in Demented and Nondemented 85-Year-Olds

Cited by 78 publications

References 44 publications

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Blood Pressure Components and Changes in Relation to White Matter Lesions

Apolipoprotein E in Cerebrospinal Fluid in 85-Year-Old Subjects

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