Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: The framingham offspring study

Stéphanie Debette, Alexa Beiser, Charles DeCarli, Rhoda Au, Jayandra J. Himali, Margaret Kelly-Hayes, Jose R. Romero, Carlos S. Kase, Philip A. Wolf, Sudha Seshadri

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE-: White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort. METHODS-: A total of 2229 Framingham Offspring Study participants aged 62±9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender. RESULTS-: Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95% CI: 1.02 to 5.13; HR=2.84, 95% CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95% CI: 1.32 to 3.72; HR=3.97, 95% CI: 1.10 to 14.30; HR=6.12, 95% CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged ≥60 years only (OR=2.47, 95% CI: 1.31 to 4.66 and OR=1.49, 95% CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95% CI: 1.13 to 1.69; HR=2.27, 95% CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia. CONCLUSIONS-: In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events.

Original languageEnglish (US)
Pages (from-to)600-606
Number of pages7
JournalStroke
Volume41
Issue number4
DOIs
StatePublished - Apr 2010

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Cerebrovascular Trauma
Dementia
Stroke
Mortality
Brain
Cognitive Dysfunction
White Matter
Independent Living

Keywords

  • Cerebrovascular disease/stroke
  • Computerized tomography and magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality : The framingham offspring study. / Debette, Stéphanie; Beiser, Alexa; DeCarli, Charles; Au, Rhoda; Himali, Jayandra J.; Kelly-Hayes, Margaret; Romero, Jose R.; Kase, Carlos S.; Wolf, Philip A.; Seshadri, Sudha.

In: Stroke, Vol. 41, No. 4, 04.2010, p. 600-606.

Research output: Contribution to journalArticle

Debette, Stéphanie ; Beiser, Alexa ; DeCarli, Charles ; Au, Rhoda ; Himali, Jayandra J. ; Kelly-Hayes, Margaret ; Romero, Jose R. ; Kase, Carlos S. ; Wolf, Philip A. ; Seshadri, Sudha. / Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality : The framingham offspring study. In: Stroke. 2010 ; Vol. 41, No. 4. pp. 600-606.
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title = "Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: The framingham offspring study",
abstract = "BACKGROUND AND PURPOSE-: White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort. METHODS-: A total of 2229 Framingham Offspring Study participants aged 62±9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender. RESULTS-: Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95{\%} CI: 1.02 to 5.13; HR=2.84, 95{\%} CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95{\%} CI: 1.32 to 3.72; HR=3.97, 95{\%} CI: 1.10 to 14.30; HR=6.12, 95{\%} CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged ≥60 years only (OR=2.47, 95{\%} CI: 1.31 to 4.66 and OR=1.49, 95{\%} CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95{\%} CI: 1.13 to 1.69; HR=2.27, 95{\%} CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia. CONCLUSIONS-: In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events.",
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author = "St{\'e}phanie Debette and Alexa Beiser and Charles DeCarli and Rhoda Au and Himali, {Jayandra J.} and Margaret Kelly-Hayes and Romero, {Jose R.} and Kase, {Carlos S.} and Wolf, {Philip A.} and Sudha Seshadri",
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T1 - Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality

T2 - The framingham offspring study

AU - Debette, Stéphanie

AU - Beiser, Alexa

AU - DeCarli, Charles

AU - Au, Rhoda

AU - Himali, Jayandra J.

AU - Kelly-Hayes, Margaret

AU - Romero, Jose R.

AU - Kase, Carlos S.

AU - Wolf, Philip A.

AU - Seshadri, Sudha

PY - 2010/4

Y1 - 2010/4

N2 - BACKGROUND AND PURPOSE-: White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort. METHODS-: A total of 2229 Framingham Offspring Study participants aged 62±9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender. RESULTS-: Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95% CI: 1.02 to 5.13; HR=2.84, 95% CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95% CI: 1.32 to 3.72; HR=3.97, 95% CI: 1.10 to 14.30; HR=6.12, 95% CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged ≥60 years only (OR=2.47, 95% CI: 1.31 to 4.66 and OR=1.49, 95% CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95% CI: 1.13 to 1.69; HR=2.27, 95% CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia. CONCLUSIONS-: In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events.

AB - BACKGROUND AND PURPOSE-: White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort. METHODS-: A total of 2229 Framingham Offspring Study participants aged 62±9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender. RESULTS-: Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95% CI: 1.02 to 5.13; HR=2.84, 95% CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95% CI: 1.32 to 3.72; HR=3.97, 95% CI: 1.10 to 14.30; HR=6.12, 95% CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged ≥60 years only (OR=2.47, 95% CI: 1.31 to 4.66 and OR=1.49, 95% CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95% CI: 1.13 to 1.69; HR=2.27, 95% CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia. CONCLUSIONS-: In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events.

KW - Cerebrovascular disease/stroke

KW - Computerized tomography and magnetic resonance imaging

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U2 - 10.1161/STROKEAHA.109.570044

DO - 10.1161/STROKEAHA.109.570044

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JF - Stroke

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