The Clinical Significance of Incidental White Matter Lesions on MRI Amongst a Diverse Population with Cognitive Complaints (INDEED)

项目总结--总体 1986年在核磁共振检查中首次被确认为“…”临床意义不确定的偶发损害与 脑血管危险因素“，白质高信号(WMH)是衰老的常见后果 血管危险因素加重的过程。WMH也影响WMH ARE的认知和进化 与记忆和执行功能的下降有关，而广泛的WMH预测事件MCI， 中风和痴呆症。WMH和脑梗塞对独立或附加的认知也有负面影响 变成同时的淀粉样蛋白状态。WMH的影响与临床痴呆症是一种 多因素过程。WMH对痴呆症的影响也与痴呆症风险 量表强调血管风险在痴呆症预测中的作用。 随着美国人口日益老龄化和多样化，美国痴呆症患者的数量 预计将大幅上升，特别是对那些伴发血管疾病的人。重要的是，它的影响 血管疾病对痴呆症风险的影响可能会在非洲裔美国人和西班牙裔美国人中加剧，他们现在处于 血管疾病的风险更大，对他们来说，血管疾病可能在临床痴呆症中发挥更大的作用。 随着人们对痴呆症认识的提高，在临床上看到个人出现的情况越来越普遍。 有轻微认知障碍的评估。神经成像研究经常发现“偶发性”WMH， 通常被放射科医生归因于“微血管疾病”，引起了患者对大脑健康的担忧。 以及未来患痴呆症的风险。然而，到目前为止，我们还没有意识到有任何研究 综合分析脑白质损伤的单独和联合MRI措施的影响 不同的、非痴呆的、无卒中的认知障碍人群的认知表现 在较长的观察期内的投诉。为了解决科学知识中的这一重要差距， 我们提出以下目标： 目的1.确定影响认知和健康的脑白质损伤的程度和特征 结果 目的2.评估白质损伤进展对认知和健康结局的影响机制 瞄准。3.基于目标1和目标2的结果，构建并验证预测性风险模型，最终目标为 提高白人患者对精准医疗管理和规划的认识 物质损害，两者都需要护理，作为未来治疗研究的纳入标准。 影响：鉴于最近的数据显示，血管风险因素对痴呆症的影响可以通过以下方式进行修改 在晚年进行有效的治疗可能会减轻痴呆症的人口负担，制定 认识和准确治疗VCID对痴呆负担的贡献是公共卫生的当务之急。

PROJECT SUMMARY – Overall Initially identified on MRI in 1986 as “…incidental lesions of uncertain clinical significance associated with cerebrovascular risk factors”, white matter hyperintensities (WMH) are a common consequence of the aging process exacerbated by vascular risk factors. WMH also influence cognition and evolution of WMH are associated with declines in both memory and executive function while extensive WMH predict incident MCI, stroke and dementia. WMH and infarction also have a negative impact on cognition independent or in addition to concurrent amyloid status. The impact of WMH is consistent with evidence that clinical dementia is a multifactorial processes. The impact of WMH on dementia is also consistent with the fact that dementia risk scales emphasize the role of vascular risk in dementia prediction. As the US population becomes increasingly older and more diverse, the number of Americans with dementia is expected to rise substantially, particularly for those with concomitant vascular disease. Importantly, the impact of vascular disease on dementia risk may be exacerbated in African Americans and Hispanics, who are at greater risk for vascular disease and for whom vascular disease may play a larger role in clinical dementia. As awareness of dementia increases, it is becoming common to see individuals presenting for clinical assessment with minor cognitive complaints. Neuroimaging studies frequently identify “incidental” WMH, usually ascribed to “microvascular disease” by radiologists, raising patient concerns about their brain health and future risk for dementia. To date, however, we are not aware of any studies that have comprehensively examined the impact of individual and combined MRI measures of white matter injury on cognitive performance among a diverse, non-demented, stroke free population with cognitive complaints over an extended period of observation. To address this important gap in scientific knowledge, we propose the following aims: Aim 1. To identify the extent and characteristics of white matter injury that influence cognitive and health outcomes Aim 2. Evaluate Mechanisms of progression of White Matter (WM) Injury on Cognition and Health Outcomes Aim. 3. Based on findings from Aims 1 and 2, build and validate a predictive risk model with the ultimate goal of increasing the understanding of precision medical management and planning needed by patients with white matter lesions, both for need for care as was inclusion criteria for future therapeutic studies. Impact: Given recent data showing that the impact of vascular risk factors on dementia can be modified by effective treatment in later life potentially lessening population burden of dementia, developing strategies that recognize and precisely treat the contribution of VCID to dementia burden is a public health imperative.