Different progression rates for deep white matter hyperintensities in elderly men and women

Heuvel, D.M.J. van den; Admiraal-Behloul, Faiza; Dam, V. Hester ten; Olofsen, Hans; Bollen, Edward L.E.M.; Murray, Heather; Blauw, Gerard J.; Westendorp, Rudi G. J.; Craen, Anton J. M. de; Buchem, Mark A. van

doi:10.1212/01.wnl.0000143058.40388.44

Cited by 95 publications

(87 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,8 This greater relative susceptibility to stroke than to coronary artery disease and the increased severity of stroke in women are unexplained, but could be due to a greater susceptibility to microvascular cerebral ischemia. Women have been reported to have a higher prevalence and severity of leukoaraiosis than men in some studies 9 -12 and a higher progression rate of leukoaraiosis by longitudinal MRI studies, 13,14 although not all studies have confirmed this difference. [15][16][17] To clarify whether leukoaraiosis is more prevalent or more severe in women than in men, or if the previously observed differences might be due to confounding by age, or be secondary to competing risk of earlier vascular death in men, we did a systematic review of the literature on leukoaraiosis and its association to sex,…”

Section: Discussionmentioning

confidence: 98%

Age- and sex-specific rates of leukoaraiosis in TIA and stroke patients

Simoni

Paul

et al. 2012

Neurology

View full text Add to dashboard Cite

Objective: To determine any sex differences in age-specific prevalence or severity of leukoaraiosis, a marker of white matter ischemia, in population-based and clinic cohorts of TIA/stroke and in a systematic review of the literature.Methods: Age-specific sex differences were calculated for both CT and MRI in the Oxford Vascular Study (OXVASC) and in an MRI-based clinic cohort. We pooled odds ratios (ORs) for leukoaraiosis in women vs men from published studies by fixed-effect meta-analysis, stratified by patient characteristics (stroke vs nonstroke) and CT vs MRI. Results:Among 10 stroke studies (all CT-based), leukoaraiosis was most frequent in women (OR ϭ 1.42, 95% confidence interval [CI] 1.27-1.57, p Ͻ 0.0001), with little heterogeneity between studies (p ϭ 0.28). However, no such excess was seen in 10 reports of nonstroke cohorts (0.91, 0.67-1.24, p ϭ 0.56). Moreover, excess leukoaraiosis in women on CT-imaging in OXVASC (1.38, 1.15-1.67, p ϭ 0.001) was explained by their older age (age-adjusted OR ϭ 1.01, 0.82-1.25, p ϭ 0.90). Leukoaraiosis was more severe in older (Ն75) women (CT-1.50, 1.14-1.97, p ϭ 0.004 in OXVASC; MRI-1.70, 1.17-2.48, p ϭ 0.006 in OXVASC and clinic cohort). However, leukoaraiosis was independently associated with early mortality (hazard ratio ϭ 1.46, 1.23-1.73, p Ͻ 0.0001), suggesting that comparisons in older age groups will be biased by prior premature death of men with leukoaraiosis. Sex differences in severity of leukoaraiosis were not addressed in previous studies. Conclusions:Previously reported excess leukoaraiosis in women with TIA/stroke is likely to be confounded by age and apparently greater severity in older women is likely to be biased by premature death in men with leukoaraiosis. Neurology Onset of coronary artery disease is delayed in women compared to men, 1,2 and women have a lower prevalence of peripheral and carotid artery disease, particularly before 75 years of age. 3 However, the overall age-specific incidence of stroke differs much less between the sexes, 4 the lifetime risk of stroke is similar in men and women, 5,6 and stroke in women appears to be more severe and to lead to more disability than in men. 7,8 This greater relative susceptibility to stroke than to coronary artery disease and the increased severity of stroke in women are unexplained, but could be due to a greater susceptibility to microvascular cerebral ischemia. Women have been reported to have a higher prevalence and severity of leukoaraiosis than men in some studies 9 -12 and a higher progression rate of leukoaraiosis by longitudinal MRI studies, 13,14 although not all studies have confirmed this difference. [15][16][17] To clarify whether leukoaraiosis is more prevalent or more severe in women than in men, or if the previously observed differences might be due to confounding by age, or be secondary to competing risk of earlier vascular death in men, we did a systematic review of the literature on leukoaraiosis and its association to sex,

show abstract

Section: Discussionmentioning

confidence: 98%

Age- and sex-specific rates of leukoaraiosis in TIA and stroke patients

Simoni

Paul

et al. 2012

Neurology

View full text Add to dashboard Cite

show abstract

“…45 Likewise, gender differences had also been proposed, with higher prevalence and greater progression of WMHs in women than in men, and a stronger association between IL-6 and WMHs in women than in men. 39,46,47 In summary, CRP and IL-6 are probably the most extensively studied inflammatory biomarkers in relation to cSVD presence and progression, although results are not consistent among all populations ( …”

Section: Inflammatory Biomarkersmentioning

confidence: 99%

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability

Vilar-Bergua

Riba‐Llena

Nafría

et al. 2015

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Vascular dementia is the second most common type of dementia after Alzheimer's disease (AD). Subcortical ischemic vascular disease refers to a form of vascular cognitive impairment characterized by the presence of diffuse white matter hyperintensities (WMHs) and multiple lacunar infarcts. These neuroimaging findings are mainly caused by cerebral smallvessel disease (cSVD) and relate to aging and cognitive impairment, but they can also be silent and highly prevalent in otherwise healthy individuals. We aimed to review studies on blood and cerebrospinal fluid (CSF) markers related to the presence of WMHs and lacunar infarcts that have been conducted in the past in large population-based studies and in high-risk selected patients (such as those with vascular risk factors, vascular cognitive impairment, or AD). Relevant associations with the presence and progression of cSVD have been described in the blood for markers related to inflammatory processes, endothelial damage and coagulation/fibrinolysis processes, etc. Also, different combinations of CSF markers might help to differentiate between etiologic types of dementia. In the future, to translate these findings into clinical practice and use biomarkers to early diagnosis and monitoring vascular cognitive impairment would require the replication of candidate markers in large-scale, multicenter, and prospectively designed studies.

show abstract

“…The extent and prevalence of white matter harms (WMHs) is much higher in women than in men of the same age [18,19] . Another 3-year longitudinal study of 554 elderly people (70~82 years old) had shown that, although the white matter were progressively harmed in both old men and women, the severity in the latter was two-fold higher [20] . The authors attributed this difference to increased sensitivity to ischemia in postmenopausal women because of the decline in estrogen levels [20] .…”

Section: Measurement Of Dwmh and Pvh Using Mri In All Age Subgroupsmentioning

confidence: 99%

“…Another 3-year longitudinal study of 554 elderly people (70~82 years old) had shown that, although the white matter were progressively harmed in both old men and women, the severity in the latter was two-fold higher [20] . The authors attributed this difference to increased sensitivity to ischemia in postmenopausal women because of the decline in estrogen levels [20] . The longitudinal study that compared the WMH between men and women of the same age better explained the important protective effect of estrogen on silent ischemic brain damage.…”

Section: Measurement Of Dwmh and Pvh Using Mri In All Age Subgroupsmentioning

confidence: 99%

Effects of hormone replacement therapy on magnetic resonance imaging of brain parenchyma hyperintensities in postmenopausal women

Liu

et al. 2009

Acta Pharmacol Sin

View full text Add to dashboard Cite

Aim: To apply 3.0 magnetic resonance imaging (MRI) to study the effects of long-term, low dose hormone replacement therapy (HRT) on the brain parenchyma of postmenopausal women. Methods: A total of 155 postmenopausal healthy female medical staff members from Peking Union Medical College Hospital were enrolled. The HRT group was composed of 71 subjects who had been given a low dose of HRT for over 4 years, while 84 women who had never been given HRT were enrolled in the control group. The Mini-Mental State Examination (MMSE) was used to evaluate mental state, and an Enzyme-Linked ImmunoSorbent Assay (ELISA) was used to detect plasma levels of sex hormones. In addition, all participants were subjected to an MRI, including axial T2 weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), T1 weighted imaging (T1WI, oblique coronal, vertical to the hippocampus, slice thickness 3 mm without gaps), and a 3D image of the whole brain. Results: The ELISA showed that the plasma level of estradiol in the HRT group was significantly higher than that in the control group (P<0.05). No differences were observed in the MMSE between the two groups. In participants older than 70 years of age, the number of deep white matter hyperintensities (DWMHs) in the control group was significantly higher than that in the HRT group (P=0.0013); however, in other age subgroups, no statistical differences were observed. Finally, no significant difference in periventricular hyperintensity (PVH) between the two groups was observed. Conclusion: We found that a high plasma level of estradiol in postmenopausal women receiving long-term HRT was correlated with the survival of brain parenchyma.

show abstract

Different progression rates for deep white matter hyperintensities in elderly men and women

Cited by 95 publications

References 11 publications

Age- and sex-specific rates of leukoaraiosis in TIA and stroke patients

Age- and sex-specific rates of leukoaraiosis in TIA and stroke patients

Blood and CSF biomarkers in brain subcortical ischemic vascular disease: Involved pathways and clinical applicability

Effects of hormone replacement therapy on magnetic resonance imaging of brain parenchyma hyperintensities in postmenopausal women

Contact Info

Product

Resources

About