Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly - The Cardiovascular Health Study
Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly - The Cardiovascular Health Study
复制标题
DOI：
10.1161/01.str.0000149625.99732.69
复制
发表时间：
2005-01-01
期刊：
影响因子：
8.3
通讯作者：
Furberg, CD
中科院分区：
文献类型：
--
作者：
Longstreth, WT;Arnold, AM;Furberg, CD
背景和目的--老年人的磁共振成像(MRI)扫描通常显示可能引起关注的白质发现。我们试图记录连续成像上白质分级恶化的发生率、表现和预测因素。方法-心血管健康研究是一项基于人群的纵向研究，涉及5888名65岁及以上的人，其中1919人进行了广泛的初始和随访评估，包括相隔5年的2次MRI扫描。在没有临床信息的情况下，以标准的并排方式读取扫描，以确定脑白质分级的恶化。结果：538名参与者(28%)的脑白质明显恶化，大多数(85%)为1级。虽然在初始扫描时相似，但与没有白质分级的参与者相比，在控制了潜在的混杂因素，包括短暂性脑缺血发作或两次扫描之间中风的发生后，白质分级恶化的参与者在改良的迷你智力状态检查和数字符号替换测试(均小于或等于0.001)上经历了更大的下降。白质分级恶化的独立预测因素包括首次扫描前吸烟和首次扫描时脑梗塞。此外，根据初始扫描时脑白质分级的不同，预测因素也有所不同。对于低初始分级，年龄增加、舒张压升高、高密度脂蛋白胆固醇升高和低密度脂蛋白胆固醇降低与恶化的风险增加相关。对于较高的初始分级，任何心血管疾病和较低的踝臂指数与恶化的风险降低相关，而利尿剂和他汀类药物的使用与风险的增加相关。结论：老年人连续MRI上的白质分级恶化是常见的，与认知能力下降有关，并与心血管危险因素有复杂的关系。
Background and Purpose-Magnetic resonance imaging (MRI) scans in the elderly commonly show white matter findings that may raise concerns. We sought to document incidence, manifestations, and predictors of worsening white matter grade on serial imaging.Methods-The Cardiovascular Health Study is a population-based, longitudinal study of 5888 people aged 65 years and older, of whom 1919 have had extensive initial and follow-up evaluations, including 2 MRI scans separated by 5 years. Scans were read without clinical information in standard side-by-side fashion to determine worsening white matter grade.Results-Worsening was evident in 538 participants (28%), mostly (85%) by 1 grade. Although similar at initial scan, participants with worsening white matter grade, compared with those without, experienced greater decline on modified Mini-Mental State examination and Digit-Symbol Substitution test (both Pless than or equal to0.001) after controlling for potential confounding factors, including occurrence of transient ischemic attack or stroke between scans. Independent predictors of worsening white matter grade included cigarette smoking before initial scan and infarct on initial scan. Otherwise, predictors differed according to white matter grade on initial scan. For low initial grade, increased age, increased diastolic blood pressure, increased high-density lipoprotein cholesterol, and decreased low-density lipoprotein cholesterol were associated with increased risk of worsening. For high initial grade, any cardiovascular disease and low ankle-arm index were associated with decreased risk of worsening, whereas use of diuretics and statins were associated with increased risk.Conclusion-Worsening white matter grade on serial MRI scans in elderly is common, is associated with cognitive decline, and has complex relations with cardiovascular risk factors.