Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly

The cardiovascular health study

W. T. Longstreth, Alice M. Arnold, Norman J. Beauchamp, Teri A. Manolio, David Lefkowitz, Charles Jungreis, Calvin H Hirsch, Daniel H. O'Leary, Curt D. Furberg

Research output: Contribution to journalArticle

310 Citations (Scopus)

Abstract

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 P≤0.001) 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.

Original languageEnglish (US)
Pages (from-to)56-61
Number of pages6
JournalStroke
Volume36
Issue number1
DOIs
StatePublished - Jan 2005

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Magnetic Resonance Imaging
Incidence
Health
Blood Pressure
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Transient Ischemic Attack
White Matter
Diuretics
Ankle
LDL Cholesterol
HDL Cholesterol
Longitudinal Studies
Arm
Cardiovascular Diseases
Smoking
Stroke
Population

Keywords

  • Incidence
  • Leukoaraiosis
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly : The cardiovascular health study. / Longstreth, W. T.; Arnold, Alice M.; Beauchamp, Norman J.; Manolio, Teri A.; Lefkowitz, David; Jungreis, Charles; Hirsch, Calvin H; O'Leary, Daniel H.; Furberg, Curt D.

In: Stroke, Vol. 36, No. 1, 01.2005, p. 56-61.

Research output: Contribution to journalArticle

Longstreth, W. T. ; Arnold, Alice M. ; Beauchamp, Norman J. ; Manolio, Teri A. ; Lefkowitz, David ; Jungreis, Charles ; Hirsch, Calvin H ; O'Leary, Daniel H. ; Furberg, Curt D. / Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly : The cardiovascular health study. In: Stroke. 2005 ; Vol. 36, No. 1. pp. 56-61.
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AB - 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 P≤0.001) 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.

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