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Jansma A, de Bresser J, Schoones JW, van Heemst D, Akintola AA. Sporadic cerebral small vessel disease and cognitive decline in healthy older adults: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2024; 44:660-679. [PMID: 38415688 DOI: 10.1177/0271678x241235494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
We performed a systematic review and meta-analysis on prospective studies that provided risk estimates for the impact of 3 different MRI markers of small vessel disease (SVD), namely white matter hyperintensities (WMH), cerebral microbleeds (CMB) and lacunes, on cognitive decline in relatively healthy older adults without cognitive deficits at baseline. A total of 23 prospective studies comprising 11,486 participants were included for analysis. Extracted data was pooled, reviewed and meta-analysed separately for global cognition, executive function, memory and attention. The pooled effect size for the association between cerebral SVD and cognitive decline was for global cognition -0.10 [-0.14; -0.05], for executive functioning -0.18 [-0.24; - 0.11], for memory -0.12 [-0.17; -0.07], and for attention -0.17 [-0.23; -0.11]. Results for the association of individual MRI markers of cerebral SVD were statistically significant for WMH and global cognition -0.15 [-0.24; -0.06], WMH and executive function -0.23 [-0.33; -0.13], WMH and memory -0.19 [-0.29; -0.09], WMH and attention -0.24 [-0.39; -0.08], CMB and executive function -0.07 [-0.13; -0.02], CMB and memory -0.11 [-0.21; -0.02] and CMB and attention -0.13 [-0.25; -0.02]. In conclusion, presence of MRI markers of cerebral SVD were found to predict an increased risk of cognitive decline in relatively healthy older adults. While WMH were found to significantly affect all cognitive domains, CMB influenced decline in executive functioning over time as well as (in some studies) decline in memory and attention.
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Affiliation(s)
- Alexander Jansma
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Centre, Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abimbola A Akintola
- Department of Internal Medicine, Section Geriatrics and Gerontology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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Luo X, Hong H, Li K, Zeng Q, Liu X, Hong L, Li J, Zhang X, Zhong S, Xu X, Chen Y, Zhang M, Huang P. Association Between Small Vessel Disease and Financial Capacity: A Study Based on Cognitively Normal Older Adults. J Alzheimers Dis 2024; 98:897-906. [PMID: 38461505 DOI: 10.3233/jad-231089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Financial capacity is vital for the elderly, who possess a substantial share of global wealth but are vulnerable to financial fraud. Objective We explored the link between small vessel disease (SVD) and financial capacity in cognitively unimpaired (CU) older adults via both cross-sectional and longitudinal analyses. Methods 414 CU participants underwent MRI and completed the Financial Capacity Instrument-Short Form (FCI-SF). Subsequent longitudinal FCI-SF data were obtained from 104, 240, and 141 participants at one, two, and four years, respectively. SVD imaging markers, encompassing white matter hyperintensities (WMH), cerebral microbleeds (CMB), and lacune were evaluated. We used linear regression analyses to cross-sectionally explore the association between FCI-SF and SVD severity, and linear mixed models to assess how baseline SVD severity impacted longitudinal FCI-SF change. The false discovery rate method was used to adjust multiple comparisons. Results Cross-sectional analysis revealed a significant association between baseline WMH and Bank Statement (BANK, β=-0.194), as well as between lacune number and Financial Conceptual Knowledge (FC, β= -0.171). These associations were stronger in APOE ɛ4 carriers, with β= -0.282 for WMH and BANK, and β= -0.366 for lacune number and FC. Longitudinally, higher baseline SVD total score was associated with severe FCI-SF total score decrease (β= -0.335). Additionally, baseline WMH burden predicted future decreases in Single Checkbook/Register Task (SNG, β= -0.137) and FC (β= -0.052). Notably, the association between baseline WMH and SNG changes was amplified in APOE ɛ4 carriers (β= -0.187). Conclusions Severe SVD was associated with worse FCI-SF and could predict the decline of financial capacity in CU older adults.
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Affiliation(s)
- Xiao Luo
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Hong
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Kaicheng Li
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaocao Liu
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Luwei Hong
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jixuan Li
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Siyan Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaopei Xu
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology,The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Lekoubou A, Nguyen C, Kwon M, Nyalundja AD, Agrawal A. Post-stroke Everything. Curr Neurol Neurosci Rep 2023; 23:785-800. [PMID: 37837566 DOI: 10.1007/s11910-023-01308-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW This review aims at providing updates on selected post-stroke complications. We examined recent advances in diagnosing and treating the following post-stroke complications: cognitive impairment, epilepsy, depression, fatigue, tremors, dysphagia, and pain. RECENT FINDINGS Advances in understanding the mechanisms of post-stroke complications, in general, are needed despite advances made in understanding, treating, and preventing these complications. There are growing progresses in integrating new tools to diagnose post-stroke cognitive impairment. The potential role of acute stroke reperfusion treatment in post-stroke epilepsy and its impact on other stroke complications is getting more transparent. Post-stroke depression remains underestimated and new tools to diagnose depression after stroke are being developed. New promising pharmacological approaches to treating post-stroke pain are emerging. Tremors related to stroke are poorly understood and under-evaluated, while treatment towards post-stroke dysphagia has benefited from new non-pharmacological to pharmacological approaches. CONCLUSIONS An integrative approach to stroke complications and collaborations between providers across specialties are more likely to improve stroke outcomes.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Clever Nguyen
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Michelle Kwon
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of Congo
| | - Ankita Agrawal
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Zhang S, Hu Y, Yang H, Li Q, Chen J, Bai H. Value of white matter hyperintensity volume and total white matter volume for evaluating cognitive impairment in patients with cerebral small-vessel disease. Front Aging Neurosci 2023; 15:1096808. [PMID: 37065461 PMCID: PMC10102346 DOI: 10.3389/fnagi.2023.1096808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundWhite matter hyperintensities (WMH) are a key imaging feature of cerebral small-vessel disease (CSVD). However, there is a lack of standardized methods for determining WMH volume, and the value of total white matter (WM) volume in the assessment of cognitive impairment in patients with CSVD remains unknown.ObjectiveWe aimed to explore the correlations of WMH volume and WM volume with cognitive dysfunction and its components in patients with CSVD. We also aimed to compare the value of the Fazekas score, WMH volume, and ratio of WMH volume to total WM volume in the assessment of cognitive dysfunction.MethodsThe study included 99 patients with CSVD. Patients were categorized into following groups based on MoCA scores: patients with mild cognitive impairment and those without. Brain magnetic resonance images were processed to investigate differences in WMH and WM volumes between the groups. Logistic regression analysis was used to determine whether these two factors were independent risk factors for cognitive dysfunction. Correlation analysis was used to examine the relationships of WMH and WM volume with different types of cognitive impairment. Receiver operating characteristic curves were used to compare the effectiveness of the WMH score, WMH volume, and WMH to WM ratio for evaluating cognitive dysfunction.ResultsThere were significant differences in age, education level, WMH volume, and WM volume between the groups (P < 0.05). After adjusting for age and education, the multivariate logistic analysis indicated that both WMH volume and WM volume were independent risk factors for cognitive dysfunction. Correlation analysis indicated that WMH volume was mainly related to cognition involving the visual space and delayed recall. WM volume was not strongly associated with different types of cognitive dysfunction. The WMH to WM ratio was the strongest predictor, with an area under the curve value of 0.800 and a 95% confidence interval of 0.710–0.891.ConclusionIncreases in WMH volume may aggravate cognitive dysfunction in patients with CSVD, and a higher WM volume may reduce the effect of WMH volume on cognitive function to a certain extent. The ratio of WMH to total WM volume may reduce the impact of brain atrophy, allowing for more accurate evaluation of cognitive dysfunction in older adults with CSVD.
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Balzano RF, Mannatrizio D, Castorani G, Perri M, Pennelli AM, Izzo R, Popolizio T, Guglielmi G. Imaging of Cerebral Microbleeds: Primary Patterns and Differential Diagnosis. CURRENT RADIOLOGY REPORTS 2021. [DOI: 10.1007/s40134-021-00390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Melazzini L, Vitali P, Olivieri E, Bolchini M, Zanardo M, Savoldi F, Di Leo G, Griffanti L, Baselli G, Sardanelli F, Codari M. White Matter Hyperintensities Quantification in Healthy Adults: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2020; 53:1732-1743. [PMID: 33345393 DOI: 10.1002/jmri.27479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although white matter hyperintensities (WMH) volumetric assessment is now customary in research studies, inconsistent WMH measures among homogenous populations may prevent the clinical usability of this biomarker. PURPOSE To determine whether a point estimate and reference standard for WMH volume in the healthy aging population could be determined. STUDY TYPE Systematic review and meta-analysis. POPULATION In all, 9716 adult subjects from 38 studies reporting WMH volume were retrieved following a systematic search on EMBASE. FIELD STRENGTH/SEQUENCE 1.0T, 1.5T, or 3.0T/fluid-attenuated inversion recovery (FLAIR) and/or proton density/T2 -weighted fast spin echo sequences or gradient echo T1 -weighted sequences. ASSESSMENT After a literature search, sample size, demographics, magnetic field strength, MRI sequences, level of automation in WMH assessment, study population, and WMH volume were extracted. STATISTICAL TESTS The pooled WMH volume with 95% confidence interval (CI) was calculated using the random-effect model. The I2 statistic was calculated as a measure of heterogeneity across studies. Meta-regression analysis of WMH volume on age was performed. RESULTS Of the 38 studies analyzed, 17 reported WMH volume as the mean and standard deviation (SD) and were included in the meta-analysis. Mean and SD of age was 66.11 ± 10.92 years (percentage of men 50.45% ± 21.48%). Heterogeneity was very high (I2 = 99%). The pooled WMH volume was 4.70 cm3 (95% CI: 3.88-5.53 cm3 ). At meta-regression analysis, WMH volume was positively associated with subjects' age (β = 0.358 cm3 per year, P < 0.05, R2 = 0.27). DATA CONCLUSION The lack of standardization in the definition of WMH together with the high technical variability in assessment may explain a large component of the observed heterogeneity. Currently, volumes of WMH in healthy subjects are not comparable between studies and an estimate and reference interval could not be determined. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Olivieri
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milano, Italy
| | - Marco Bolchini
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiology, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Abstract
Sleep maintains the function of the entire body through homeostasis. Chronic sleep deprivation (CSD) is a prime health concern in the modern world. Previous reports have shown that CSD has profound negative effects on brain vasculature at both the cellular and molecular levels, and that this is a major cause of cognitive dysfunction and early vascular ageing. However, correlations among sleep deprivation (SD), brain vascular changes and ageing have barely been looked into. This review attempts to correlate the alterations in the levels of major neurotransmitters (acetylcholine, adrenaline, GABA and glutamate) and signalling molecules (Sirt1, PGC1α, FOXO, P66shc, PARP1) in SD and changes in brain vasculature, cognitive dysfunction and early ageing. It also aims to connect SD-induced loss in the number of dendritic spines and their effects on alterations in synaptic plasticity, cognitive disabilities and early vascular ageing based on data available in scientific literature. To the best of our knowledge, this is the first article providing a pathophysiological basis to link SD to brain vascular ageing.
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Abstract
Lacunes on magnetic resonance imaging (MRI) are considered as a key hallmark for evaluating the progression and severity of cerebral small vessel diseases. We aimed to review the MRI diagnostic criteria, frequency, predictors and clinical impact of incident lacunes in the largest longitudinal studies. Analyses were restricted to cohort studies of more than 50 individuals that investigated incident lacunes over a duration of at least one year. We observed that: (1) MRI parameters and definition of lacunes are inconsistent across studies, (2) the frequency of incident lacunes is strongly related to the previous clinical and MRI status at individual level, (3) both age and hypertension diagnosed at onset predict incident lacunes but the exact impact of blood pressure level during follow-up remains undetermined, (4) the clinical correlates of these lesions on cognition are repeatedly observed but the exact consequences on motor or gait performances are not always evaluated. Homogenization of imaging techniques, the use of strict diagnostic criteria and a broader clinical assessment considering motor and gait performances should be recommended in future longitudinal studies of incident lacunes including clinical trials testing preventative treatments in cerebral small vessel diseases.
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Affiliation(s)
- Yifeng Ling
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hugues Chabriat
- Department of Neurology, Groupe Hospitalier Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris (APHP), Université Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité (INSERM U1161), Paris, France
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Azeem F, Durrani R, Zerna C, Smith EE. Silent brain infarctions and cognition decline: systematic review and meta-analysis. J Neurol 2019; 267:502-512. [PMID: 31691021 DOI: 10.1007/s00415-019-09534-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Silent brain infarction (SBI) may be associated with cognitive decline in the general population. We systematically reviewed prior literature on: (1) SBI and cognition cross-sectionally; (2) baseline SBI and future cognitive decline and risk for cognitive disorders including dementia, and (3) incident SBI and the emergence of cognitive decline or cognitive disorders. METHODS The MEDLINE and EMBASE databases were searched for relevant studies. Data were independently extracted by two reviewers. Quality was assessed using the Newcastle Ottawa Scale. Data were pooled using a random effects model when more than two comparable estimates were found. RESULTS Thirty relevant studies were identified: 17 had a cross-sectional design, 10 evaluated the association of baseline SBI with future cognitive decline, and 5 evaluated the association of incident SBI with cognitive decline. Most cross-sectional studies reported lower cognitive performance in persons with SBI. The pooled risk for incident dementia in persons with SBI was 1.48 (95% CI 1.12-1.97), but there was significant heterogeneity (p = 0.009); removing one outlier eliminated the heterogeneity (p = 0.53), giving a lower but still significant estimate (hazard ratio 1.27, 95% CI 1.06-1.51). The pooled risk for incident MCI was not increased in persons with SBI (hazard ratio 0.83, 95% CI 0.40 to 1.72), but there was significant heterogeneity (p < 0.001). The appearance of new SBI was associated with steeper rate of cognitive decline and the appearance of dementia. CONCLUSIONS SBI are associated with worse cognition and increased risk for dementia. More standardization of cognitive assessment methods would facilitate future cross-study comparisons.
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Affiliation(s)
- Feeha Azeem
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Romella Durrani
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Charlotte Zerna
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Calgary Stroke Program, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Eric E Smith
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,Hotchkiss Brain Institute, Calgary, AB, Canada. .,Calgary Stroke Program, Calgary, AB, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Elmståhl S, Ellström K, Siennicki-Lantz A, Abul-Kasim K. Association between cerebral microbleeds and hypertension in the Swedish general population "Good Aging in Skåne" study. J Clin Hypertens (Greenwich) 2019; 21:1099-1107. [PMID: 31274244 PMCID: PMC6771849 DOI: 10.1111/jch.13606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/08/2019] [Accepted: 05/25/2019] [Indexed: 12/27/2022]
Abstract
Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population‐based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16‐18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.
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Affiliation(s)
- Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Katarina Ellström
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Arkadiusz Siennicki-Lantz
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Kasim Abul-Kasim
- Department of Clinical Sciences Lund, Division of Diagnostic Radiology, Skåne University Hospital, Lund University, Malmö, Sweden
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