Association of Silent Cerebrovascular Disease Identified Using Natural Language Processing and Future Ischemic Stroke

Zhou

et al. 2022

Preprint

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Objective: To estimate the risk of dementia associated with incidentally-discovered covert cerebrovascular disease (CCD), including both covert brain infarction (CBI) and white matter disease (WMD). Patients and Methods: We included individuals aged ≥ 50 years enrolled in the Kaiser Permanente Southern California health system receiving a head CT or MRI for a non-stroke indication from January 1, 2009 and December 31, 2019, without prior ischemic stroke, transient ischemic attack, hemipelegia, hemiparesis, dementia/Alzheimer's disease or a visit reason / scan indication suggestive of cognitive decline. Using natural language processing (NLP), we identified the presence of CBI and WMD on the neuroimage report; WMD was characterized as mild, moderate, severe, or undetermined. Results: Among 241,050 qualified individuals, NLP identified 69,931 (29.0%) with WMD and 11,328 (4.7%) with CBI. The dementia incidence rates (per 1,000 person-years) were 23.5 (95% CI 22.90 to 24.0) for patients with WMD; 29.4 (95% CI 27.9 to 31.0) with CBI and 6.0 (5.8 to 6.2) without CCD. The effect of WMD on dementia risk was stronger in younger versus older patients and for CT- versus MRI-discovered lesions. For patients with versus without WMD on CT scan, the adjusted HR (aHR) was 2.87 (2.58 to 3.19) for those < age 70 and 1.87 (1.79 to 1.95) for those ≥ age 70. For patients with versus without WMD on MRI, the aHR for dementia risk was 2.28 (1.99 to 2.62) for patients < age 70 and 1.48 (1.32 to 1.66) for those ≥ age 70. The aHR associated with CBI was 2.02 (1.70 to 2.41) for patients age <70 and 1.22 (1.15 to 1.30) for patients age ≥ 70 for either modality. Dementia risk with WMD was strongly correlated with WMD severity. Conclusion: Incidentally-discovered CCD is common and identifies patients at high risk of dementia, representing an opportunity for prevention.

Section: Discussionsupporting

confidence: 88%

Association of Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia

Zhou

et al. 2022

Preprint

Self Cite

“…In previous work, we developed and validated natural language processing (NLP) algorithms to identify the presence of id‐CCD and severity of incidentally discovered WMD (id‐WMD) using neuroimaging reports and deployed these algorithms in a large integrated health system, 13 thereby permitting us to examine associations between exposures and rare outcomes in a cohort by using “big data.” We previously found that id‐CCD is strongly predictive of subsequent stroke 5 and dementia, 14 particularly in younger patients and in those with more severe WMD. In this study, we examined the association of id‐CBI and id‐WMD with a subsequent diagnosis of PD, using NLP of routinely obtained neuroimaging reports to identify these lesions.…”

Section: Introductionmentioning

confidence: 96%

Development of Parkinson Disease and Its Relationship with Incidentally Discovered White Matter Disease and Covert Brain Infarction in a Real‐World Cohort

Puttock

et al. 2022

Annals of Neurology

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Objective: This study aimed to examine the relationship between covert cerebrovascular disease, comprised of covert brain infarction and white matter disease, discovered incidentally in routine care, and subsequent Parkinson disease. Methods: Patients were ≥50 years and received neuroimaging for non-stroke indications in the Kaiser Permanente Southern California system from 2009 to 2019. Natural language processing identified incidentally discovered covert brain infarction and white matter disease and classified white matter disease severity. The Parkinson disease outcome was defined as 2 ICD diagnosis codes. Results: 230,062 patients were included (median follow-up 3.72 years). A total of 1,941 Parkinson disease cases were identified (median time-to-event 2.35 years). Natural language processing identified covert cerebrovascular disease in 70,592 (30.7%) patients, 10,622 (4.6%) with covert brain infarction and 65,814 (28.6%) with white matter disease. After adjustment for known risk factors, white matter disease was associated with Parkinson disease (hazard ratio 1.67 [95% CI, 1.44, 1.93] for patients <70 years and 1. 33 [1.18, 1.50] for those ≥70 years). Greater severity of white matter disease was associated with increased incidence of Parkinson disease(/1,000 person-years), from 1.52 (1.43, 1.61) in patients without white matter disease to 4.90 (3.86, 6.13) in those with severe disease. Findings were robust when more specific definitions of Parkinson disease were used. Covert brain infarction was not associated with Parkinson disease (adjusted hazard ratio = 1. 05 [0.88, 1.24]). Interpretation: Incidentally discovered white matter disease was associated with subsequent Parkinson disease, an association strengthened with younger age and increased white matter disease severity. Incidentally discovered covert brain infarction did not appear to be associated with subsequent Parkinson disease.

“…In previous work, we developed and validated natural language processing (NLP) algorithms to identify the presence of CCD and severity of WMD using neuroimaging reports and deployed these algorithms in a large integrated health system, 13 thereby permitting us to examine associations between exposures and rare outcomes in a cohort by using 'big data'. We previously found that CCD is strongly predictive of subsequent stroke 14 and dementia, 15 particularly in younger patients and in those with more severe WMD. In this study, we examined the association of CBI and WMD with a subsequent diagnosis of PD, using NLP of routinely obtained neuroimaging reports to identify these lesions.…”

Section: Introductionmentioning

confidence: 93%

Development of Parkinson’s disease and its relationship with incidentally-discovered white matter disease and covert brain infarction in a real world cohort

Puttock

et al. 2022

Preprint

Self Cite

Importance: While a link between cerebrovascular disease and cerebrovascular risk factors and subsequent development of Parkinson's disease has been suggested, the association between covert cerebrovascular disease and subsequent Parkinson's disease has not been rigorously examined. Objective: To examine the relationship between covert cerebrovascular disease, comprised of covert brain infarction and white matter disease, discovered incidentally in routine care and subsequent Parkinson's disease. Design: Enrollment in this observational cohort study occurred between 2009 and 2019. Setting: Kaiser Permanente Southern California health system. Participants: Patients were 50 years or older and received neuroimaging for a non-stroke indication. Exposure: Incidental covert brain infarction and white matter disease identified by natural language processing of neuroimaging reports. Natural language processing also classified white matter disease severity. Main Outcomes: Parkinson's disease. Results: 230,062 patients were included with a total of 980,772 person-years of follow-up and a median follow-up time of 3.72 years. 1,941 cases of Parkinson's disease were identified, with a median time-to-event of 2.35 (IQR 0.90 to 4.58) years. Covert cerebrovascular disease was identified in 70,592 (30.68%) patients, 10,622 (4.62%) with covert brain infarction and 65,814 (28.61%) with white matter disease. After adjustment for known risk factors, white matter disease was found to be associated with Parkinson's disease, with an adjusted hazard ratio of 1.67 (1.44, 1.93) for patients <70 years and 1.33 (1.18, 1.50) for those 70 years or older. Greater severity of white matter disease was associated with an increased incidence of Parkinson's disease per 1000 person-years, from 1.52 (1.43, 1.61) in patients without white matter disease to 4.90 (3.86, 6.13) in those with severe white matter disease. Findings were robust when more specific definitions of Parkinson's disease were used. Covert brain infarction was not associated with Parkinson's disease (adjusted hazard ratio=1.05 [0.88, 1.24]). Conclusions and Relevance: White matter disease was associated with subsequent Parkinson's disease, an association strengthened with younger age and increased white matter disease severity. Covert brain infarction did not appear to be associated with subsequent Parkinson's disease.