(Stroke. 1997;28:1158-1164.)
© 1997 American Heart Association, Inc.
Articles |
Silent Brain Infarction on Magnetic Resonance Imaging and Neurological Abnormalities in Community-Dwelling Older Adults
The Cardiovascular Health Study
From the Department of Neurology, University of Maryland Medical Center, Baltimore (T.R.P., S.J.K.); Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Biostatistics, University of Washington, Seattle (R.A.K.); Department of Neuroradiology, Johns Hopkins University Hospital, Baltimore, Md (N.C.Y.); Department of Medicine, University of California at Davis, Sacramento (J.R.); Epidemiology Division, University of California at Irvine (H. A.-C.); and Department of Radiology, Tufts University Medical Center, Boston, Mass (D.H. O'L.).
Correspondence to Teri Manolio, MD, MHS, NHLBI/DECA, 6701 Rockledge Dr, Room 8160, Bethesda, MD 20892-7934.
Background and Purpose Infarctlike lesions are
frequently detected in symptomatic and
asymptomatic older persons undergoing cerebral MRI, but
their significance in older adults has not been examined. We determined
the prevalence of MRI infarcts in a population-based sample of men and
women aged 
65 years and related these findings to demographic,
cognitive, and neurological status.
Methods MRI scanning was performed in 3660
Cardiovascular Health Study (CHS) participants after
brief neurological examinations and tests of cognitive function. MRIs
were read centrally for the presence of an infarct 3 mm in
diameter or smaller infarctlike lesions.
Results MRI infarcts were detected in 1131 of 3647
participants with readable infarct information (31%) and in 961 of the
subgroup of 3397 participants (28%) without known prior stroke
("silent" MRI infarcts). Smaller infarctlike lesions were found
in 196 of 2516 participants who had no MRI infarcts 3 mm. MRI
infarcts were more common in participants who were older, had prior
stroke, impaired cognition, visual field deficits, slowed repetitive
finger tapping (all P<.0001), weakness on toe and heel
walking, and history of memory loss, coma, or migraine headaches.
Multivariate analysis in those without prior
stroke showed strong associations of silent MRI infarcts with older
age, history of migraines, lower digit symbol scores, and more
abnormalities on neurological examination.
Conclusions MRI evidence of brain infarction is common in older men and women without a clinical history of stroke. Their strong associations with impaired cognition and neurological deficits suggest that they are neither silent nor innocuous.
Key Words: cerebral infarction • cognition • elderly • epidemiology • magnetic resonance imaging
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