Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study

Abstract

ObjectivesThe objective was to develop and validate a risk model for the likelihood of extensive white matter lesions (extWML) to inform clinicians on whether to proceed with or forgo diagnostic MRI.DesignPopulation-based cohort study and multivariable prediction model.SettingTwo representative samples from France.ParticipantsPersons aged 60–80 years without dementia or stroke. Derivation sample n=1714; validation sample n=789.Primary and secondary outcome measuresVolume of extWML (log cm3) was obtained from T2-weighted images in a 1.5 T scanner. 20 candidate risk factors for extWML were evaluated with the C-statistic. Secondary outcomes in validation included incident stroke over 12 years follow-up.ResultsThe multivariable prediction model included six clinical risk factors (C-statistic=0.61). A cut-off of 7 points on the multivariable prediction model yielded the optimum balance in sensitivity 63.7% and specificity 54.0% and the negative predictive value was high (81.8%), but the positive predictive value was low (31.5%). In further validation, incident stroke risk was associated with continuous scores on the multivariable prediction model (HR 1.02; 95% CI 1.01 to 1.04, P=0.02) and dichotomised scores from the multivariable prediction model (HR 1.28; 95% CI 1.02 to 1.60, P=0.03).ConclusionsA simple clinical risk equation for WML constituted by six variables can inform decisions whether to proceed with or forgo brain MRI. The high-negative predictive value demonstrates potential to reduce unnecessary MRI in the population aged 60–80 years.

Impact of blood pressure variability and cerebral small vessel disease: A systematic review and meta-analysis

“…The pathogenesis of CSVD induced by increased BPV remains unclear. Excessive fluctuations in blood pressure may cause hemodynamic instability, leading to vascular wall destruction, vascular endothelial function impairment, brain tissue ischemia and hypoperfusion, and other factors [ [40] , [41] , [42] ].In our systematic review and meta-analysis, we found that SBPV and DBPV were closely related to the CSVD total burden score. This is consistent with the results of Tully et al 's meta-analysis, which showed that increased SBPV and DBPV can promote the occurrence of CSVD.…”

Development and validation of a predictive model for white matter lesions in young- and middle-aged people

“…Shinkawa et al ( 14) established a predictive model based on variables consisting of age, gender, PS, LDL, SBP, and administration of antihypertensive medication, which showed good accuracy to recognize risk probability for people with WML. Tully et al (12) developed and validated a predictive model of WML for people > 65 years based on the risk factors of DBP, medication to reduce blood pressure, psychotropic drug use, dependence on IADL, forgetfulness, and arithmetic difficulties. However, these studies have not focused on these young-and middle-aged people, who are also a large group, with nearly 50% of WML.…”

“…Some researchers have found several risk factors related to WML, such as age, female gender, high blood pressure, diabetes mellitus, hyperlipidemia, smoking status, and drinking habit (9,10). Previous studies have (11)(12)(13) analyzed some risk factors of WML in people over 60 years old. However, there are few studies on WML and its risk factors in young-and middle-aged people under 60 years old.…”

Identification of hippocampal volume as a mediator of the association between APOE4 and dementia

“…Siemens, Erlangen) and the same protocol. The three-dimensional (3D) high-resolution T1weighted brain volume and T2-weighted brain volume were acquired and processed as described elsewhere [19][20][21][22] . WMH variable was log-transformed to account for its non-normal distribution.…”