doi: 10.1161/01.STR.0000032241.58727.49
(Stroke. 2002;33:2376.)
© 2002 American Heart Association, Inc.
Original Contributions |
Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly
The Cardiovascular Health Study
From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (C.D.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Pathology, University of Vermont, Colchester (M.R.L.); Department of Radiology, Johns Hopkins University, Baltimore, Md (N.J.B.); Department of Radiology, Tufts–New England Medical Center, Boston, Mass (D.O.); and Departments of Radiology (J.C.) and Public Health Sciences (C.D.F.), Wake Forest University, Winston-Salem, NC.
Correspondence to W.T. Longstreth, Jr, MD, Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Ave, Seattle WA 98104-2499. E-mail wl{at}u.washington.edu
Background and Purpose— MRI-defined infarcts are common in the elderly. We sought to explore incidence, manifestations, and predictors of such infarcts.
Methods— The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of 5888 people aged 
65 years. Participants have had extensive baseline and follow-up evaluations; 1433 participants underwent 2 MRI scans separated by 5 years and had no infarcts on initial MRI.
Results— On follow-up MRI, 254 participants (17.7%) had 1 or more infarcts. Most were single (75.6%), subcortical (79.9%), and small (3 to 20 mm in 87.0%). Only 11.4% of those with infarcts experienced a documented transient ischemic attack or stroke between the scans. Although participants were similar at initial MRI, those with MRI-defined infarcts on follow-up experienced greater decline than those without infarcts on the Modified Mini-Mental State Examination and Digit-Symbol Substitution test (both P<0.01). Severity of white matter changes on initial MRI was the strongest predictor of incident infarcts. When it was excluded from stepwise multivariable models, predictors were serum creatinine, age, and ankle-arm index.
Conclusions— Incident MRI-defined infarcts commonly affect the elderly. Most are small, subcortical, and not associated with acute symptoms recognized as a transient ischemic attack or stroke. Nonetheless, they cannot be considered silent because of their association with subtle cognitive deficits. These covert infarcts are associated with white matter changes, which may share a common pathophysiology. Whether control of vascular risk factors, such as blood pressure, would reduce the risk of developing these infarcts and associated cognitive decline deserves further investigation.
Key Words: brain infarction • creatinine • incidence • leukoariosis • magnetic resonance imaging
This article has been cited by other articles:
 |
|
 |
|
  L. Minati, T. Edginton, M. Grazia Bruzzone, and G. Giaccone Reviews: Current Concepts in Alzheimer's Disease: A Multidisciplinary Review American Journal of Alzheimer's Disease and Other Dementias, April 1, 2009; 24(2): 95 - 121. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Viswanathan, W. A. Rocca, and C. Tzourio Vascular risk factors and dementia: How to move forward? Neurology, January 27, 2009; 72(4): 368 - 374. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Johnston The 2008 William M. Feinberg Lecture: Prioritizing Stroke Research Stroke, December 1, 2008; 39(12): 3431 - 3436. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. J. van Dijk, N. D. Prins, H. A. Vrooman, A. Hofman, P. J. Koudstaal, and M. M.B. Breteler Progression of Cerebral Small Vessel Disease in Relation to Risk Factors and Cognitive Consequences: Rotterdam Scan Study Stroke, October 1, 2008; 39(10): 2712 - 2719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Coutts, M. D. Hill, C. R. Campos, Y. B. Choi, S. Subramaniam, J. C. Kosior, A. M. Demchuk, and for the VISION study group Recurrent Events in Transient Ischemic Attack and Minor Stroke: What Events Are Happening and to Which Patients? Stroke, September 1, 2008; 39(9): 2461 - 2466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Virtanen, D. S. Siscovick, W. T. Longstreth Jr, L. H. Kuller, and D. Mozaffarian Fish consumption and risk of subclinical brain abnormalities on MRI in older adults Neurology, August 5, 2008; 71(6): 439 - 446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Fornage, Y. A. Chiang, E. S. O'Meara, B. M. Psaty, A. P. Reiner, D. S. Siscovick, R. P. Tracy, and W.T. Longstreth Jr Biomarkers of Inflammation and MRI-Defined Small Vessel Disease of the Brain: The Cardiovascular Health Study Stroke, July 1, 2008; 39(7): 1952 - 1959. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. B. Newman, R. M. Boudreau, B. L. Naydeck, L. F. Fried, and T. B. Harris A Physiologic Index of Comorbidity: Relationship to Mortality and Disability J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2008; 63(6): 603 - 609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Ikram, M. van Oijen, F. J. de Jong, J. A. Kors, P. J. Koudstaal, A. Hofman, J. C.M. Witteman, and M. M.B. Breteler Unrecognized Myocardial Infarction in Relation to Risk of Dementia and Cerebral Small Vessel Disease Stroke, May 1, 2008; 39(5): 1421 - 1426. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Steffens, H. Chung, K. R. R. Krishnan, W.T. Longstreth Jr, M. Carlson, and G. L. Burke Antidepressant Treatment and Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study Stroke, March 1, 2008; 39(3): 857 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Schneider, Z. Arvanitakis, W. Bang, and D. A. Bennett Mixed brain pathologies account for most dementia cases in community-dwelling older persons Neurology, December 11, 2007; 69(24): 2197 - 2204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Khatri, C. B. Wright, T. L. Nickolas, M. Yoshita, M. C. Paik, G. Kranwinkel, R. L. Sacco, and C. DeCarli Chronic Kidney Disease Is Associated With White Matter Hyperintensity Volume: The Northern Manhattan Study (NOMAS) Stroke, December 1, 2007; 38(12): 3121 - 3126. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Vernooij, M. A. Ikram, H. L. Tanghe, A. J.P.E. Vincent, A. Hofman, G. P. Krestin, W. J. Niessen, M. M.B. Breteler, and A. van der Lugt Incidental Findings on Brain MRI in the General Population N. Engl. J. Med., November 1, 2007; 357(18): 1821 - 1828. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]
|
|
|
|
 |
|
 W. Longstreth Jr., E. K. M. Larsen, R. Klein, T. Y. Wong, A. R. Sharrett, D. Lefkowitz, and T. A. Manolio Associations between Findings on Cranial Magnetic Resonance Imaging and Retinal Photography in the Elderly: The Cardiovascular Health Study Am. J. Epidemiol., January 1, 2007; 165(1): 78 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Hachinski, C. Iadecola, R. C. Petersen, M. M. Breteler, D. L. Nyenhuis, S. E. Black, W. J. Powers, C. DeCarli, J. G. Merino, R. N. Kalaria, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Stroke, September 1, 2006; 37(9): 2220 - 2241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Elkins, W. T. Longstreth Jr, T. A. Manolio, A. B. Newman, R. A. Bhadelia, and S. C. Johnston Education and the cognitive decline associated with MRI-defined brain infarct Neurology, August 8, 2006; 67(3): 435 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. N. Djaiani Aortic arch atheroma: stroke reduction in cardiac surgical patients. Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2006; 10(2): 143 - 157. [Abstract] [PDF]
|
|
|
|
 |
|
 D. S. Knopman Dementia and Cerebrovascular Disease Mayo Clin. Proc., February 1, 2006; 81(2): 223 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. G. Leblanc, J. F. Meschia, D. T. Stuss, and V. Hachinski Genetics of Vascular Cognitive Impairment: The Opportunity and the Challenges Stroke, January 1, 2006; 37(1): 248 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Seliger, W.T. Longstreth Jr, R. Katz, T. Manolio, L. F. Fried, M. Shlipak, C. O. Stehman-Breen, A. Newman, M. Sarnak, D. L. Gillen, et al. Cystatin C and Subclinical Brain Infarction J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3721 - 3727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.T. Longstreth Jr Brain Vascular Disease Overt and Covert Stroke, October 1, 2005; 36(10): 2062 - 2063. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Knopman, T. H. Mosley, D. J. Catellier, A. R. Sharrett, and for the Atherosclerosis Risk in Communities (ARIC) Cardiovascular risk factors and cerebral atrophy in a middle-aged cohort Neurology, September 27, 2005; 65(6): 876 - 881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Coutts, M. D. Hill, J. E. Simon, C. -H. Sohn, J. N. Scott, A. M. Demchuk, and for the VISION Study Group Silent ischemia in minor stroke and TIA patients identified on MR imaging Neurology, August 23, 2005; 65(4): 513 - 517. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Elkins, D. S. Knopman, K. Yaffe, and S. C. Johnston Cognitive function predicts first-time stroke and heart disease Neurology, May 24, 2005; 64(10): 1750 - 1755. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Kuller, O. L. Lopez, W. J. Jagust, J. T. Becker, S. T. DeKosky, C. Lyketsos, C. Kawas, J.C.S. Breitner, A. Fitzpatrick, and C. Dulberg Determinants of vascular dementia in the Cardiovascular Health Cognition Study Neurology, May 10, 2005; 64(9): 1548 - 1552. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Fox, H. A. Taylor Jr, E. J. Benjamin, J. Ding, P. R. Liebson, D. Arnett, E. M. Quin, and T. N. Skelton Left Ventricular Mass Indexed to Height and Prevalent MRI Cerebrovascular Disease in an African American Cohort: The Atherosclerotic Risk in Communities Study Stroke, March 1, 2005; 36(3): 546 - 550. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.T. Longstreth Jr, A. M. Arnold, N. J. Beauchamp Jr, T. A. Manolio, D. Lefkowitz, C. Jungreis, C. H. Hirsch, D. H. O'Leary, and C. D. Furberg Incidence, Manifestations, and Predictors of Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study Stroke, January 1, 2005; 36(1): 56 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Elkins and S. C. Johnston Twinning hearts and minds Neurology, December 28, 2004; 63(12): 2211 - 2212. [Full Text] [PDF]
|
|
|
|
|
|
J. S. Elkins, E. S. O'Meara, W. T. Longstreth Jr., M. C. Carlson, T. A. Manolio, and S. C. Johnston Stroke risk factors and loss of high cognitive function Neurology, September 14, 2004; 63(5): 793 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Shumaker, C. Legault, L. Kuller, S. R. Rapp, L. Thal, D. S. Lane, H. Fillit, M. L. Stefanick, S. L. Hendrix, C. E. Lewis, et al. Conjugated Equine Estrogens and Incidence of Probable Dementia and Mild Cognitive Impairment in Postmenopausal Women: Women's Health Initiative Memory Study JAMA, June 23, 2004; 291(24): 2947 - 2958. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Yousem, R. N. Bryan, N. J. Beauchamp Jr., and A. M. Arnold A National Neuroimaging Database: A Call to Action AJNR Am. J. Neuroradiol., June 1, 2004; 25(6): 908 - 909. [Full Text] [PDF]
|
|
|
|
 |
|
 W. T. Longstreth Jr, R. Katz, J. Olson, C. Bernick, J. J. Carr, M. R. Malinow, D. L. Hess, M. Cushman, and S. M. Schwartz Plasma Total Homocysteine Levels and Cranial Magnetic Resonance Imaging Findings in Elderly Persons: The Cardiovascular Health Study Arch Neurol, January 1, 2004; 61(1): 67 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Y. Streifler, M. Eliasziw, O. R. Benavente, S. Alamowitch, A. J. Fox, V. Hachinski, and H. J.M. Barnett Development and Progression of Leukoaraiosis in Patients With Brain Ischemia and Carotid Artery Disease Stroke, August 1, 2003; 34(8): 1913 - 1916. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. DeCarli White matter changes, creatinine, age, and ankle arm index predicted incident MRI defined infarctions in older adults Evid. Based Med., July 1, 2003; 8(4): 121 - 121. [Full Text] [PDF]
|
|