Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly

• W.T. Longstreth

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Corinne Dulberg

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Teri A. Manolio

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Michael R. Lewis

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Norman J. Beauchamp

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Daniel O’Leary

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Jeff Carr

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

• Curt D. Furberg

  From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C....

書誌事項

タイトル別名

• The Cardiovascular Health Study

抄録

Background and Purpose— MRI-defined infarcts are common in the elderly. We sought to explore incidence, manifestations, and predictors of such infarcts. Methods— The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of 5888 people aged ≥65 years. Participants have had extensive baseline and follow-up evaluations; 1433 participants underwent 2 MRI scans separated by 5 years and had no infarcts on initial MRI. Results— On follow-up MRI, 254 participants (17.7%) had 1 or more infarcts. Most were single (75.6%), subcortical (79.9%), and small (3 to 20 mm in 87.0%). Only 11.4% of those with infarcts experienced a documented transient ischemic attack or stroke between the scans. Although participants were similar at initial MRI, those with MRI-defined infarcts on follow-up experienced greater decline than those without infarcts on the Modified Mini-Mental State Examination and Digit-Symbol Substitution test (both P <0.01). Severity of white matter changes on initial MRI was the strongest predictor of incident infarcts. When it was excluded from stepwise multivariable models, predictors were serum creatinine, age, and ankle-arm index. Conclusions— Incident MRI-defined infarcts commonly affect the elderly. Most are small, subcortical, and not associated with acute symptoms recognized as a transient ischemic attack or stroke. Nonetheless, they cannot be considered silent because of their association with subtle cognitive deficits. These covert infarcts are associated with white matter changes, which may share a common pathophysiology. Whether control of vascular risk factors, such as blood pressure, would reduce the risk of developing these infarcts and associated cognitive decline deserves further investigation.

収録刊行物

• Stroke

  Stroke 33 (10), 2376-2382, 2002-10

  Ovid Technologies (Wolters Kluwer Health)

キーワード

• Advanced and Specialized Nursing
• Cardiology and Cardiovascular Medicine
• Neurology (clinical)

詳細情報

• CRID: 1363388844309263616
• NII論文ID: 30022679577
• DOI: 10.1161/01.str.0000032241.58727.49
• ISSN: 15244628
• ISSN: 00392499
• ISSN: http://id.crossref.org/issn/00392499
• Web Site: https://www.ahajournals.org/doi/full/10.1161/01.STR.0000032241.58727.49
• データソース種別:
  • Crossref
  • CiNii Articles