(Stroke. 1996;27:1269-1273.)
© 1996 American Heart Association, Inc.
Articles |
From UBOs to Binswanger's Disease
Impact of Magnetic Resonance Imaging on Vascular Dementia Research
the Division of Neurology, University of Texas at San Antonio.
Correspondence to Gustavo C. Roman, MD, 343 W Houston St, Suite 208, San Antonio, TX 78205.
Key Words: Binswanger's disease • dementia • lacunar infarction • leukoencephalopathy • magnetic resonance imaging • small-vessel disease
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Introduction |
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This issue of Stroke publishes the results of arguably the largest population-based MRI brain study on record: 3301 elderly participants in the Cardiovascular Health Study (CHS).1 In these times of budget reduction, the CHS may become—along with the Framingham study—a lasting monument to the scientific and public health benefits of the type of mega-scale epidemiological studies that only federally funded research can achieve.
The CHS provides a true random representation of the elderly US population, including African Americans. Because of its large sample size (5588 subjects), extensive baseline and follow-up evaluations, high rate of MRI studies (59%), and methodological carefulness, this study conclusively settles important issues regarding white matter changes in the elderly. The strong association of these lesions with advancing age and hypertension was confirmed. Also associated were silent strokes (in particular lacunes, observed in a third of the population), orthostatic hypotension, smoking history and its marker lower forced expiratory volume in 1 second (FEV1), and, somewhat unexpectedly, lower income—a probable surrogate for limited access to medical care, inadequate diet, and poor long-term blood pressure control. In contrast, diabetes, carotid artery disease, and fibrinogen values were not associated. In this analysis, white matter lesions in the elderly behaved as a continuous variable, following a continuum of lesions ranging from those barely detectable (grade 1) to extensive and confluent lesions (grade 9). Last, higher-grade lesions were clinically eloquent, as manifested by cognitive impairment and alterations of gait.
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Significance of White Matter Lesions in the Elderly |
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Brain imaging by CT and MR rediscovered long-forgotten pathologies of the senile
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