Progression of Cerebral Small Vessel Disease in Relation to Risk Factors and Cognitive Consequences

Dijk, Ewoud J. van; Prins, Niels D.; Vrooman, Henri A.; Hofman, Albert; Koudstaal, Peter J.; Breteler, Monique M.B.

doi:10.1161/strokeaha.107.513176

Cited by 504 publications

(457 citation statements)

References 33 publications

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“…[21][22][23][24] On the basis of a less sensitive imaging tool (CT), we also found a differential effect of SBP and DBP on WML occurrence. It should also be noted that this differential effect was consistent across all 4 of the examinations from 1968 to 1992 in the present study.…”

Section: Discussionmentioning

confidence: 63%

“…Four previous prospective studies reported that higher baseline DBP, more than SBP, predicted WML progression in 2 to 5 years. [21][22][23][24] The present study aimed to examine the effects of SBP, DBP, PP, and MAP on WMLs in a population-based sample Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.…”

mentioning

confidence: 99%

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Blood Pressure Components and Changes in Relation to White Matter Lesions

Guo

Pantoni²,

Simoni³

et al. 2009

Hypertension

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Abstract-This study aimed to examine the long-term effect of high blood pressure (systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure) on white matter lesions and to study changes in different blood pressure components in relation to white matter lesions. A representative population of women was examined in 1968 and re-examined in 1974, 1980, 1992, and 2000. The presence and severity of white matter lesions on computed tomography were rated by a visual rating scale in 1992 and 2000 in 539 women. Systolic and diastolic blood pressures were measured at all of the examinations. We found that presence and severity of white matter lesions in 1992/2000 were associated with higher diastolic blood pressure and mean arterial pressure at each examination but not with systolic blood pressure and pulse pressure. Odds ratios (95% CIs) for the presence of white matter lesions per 10-mm Hg increase in diastolic pressure were 1.4 (1.0 to 1.9) in 1968, 1.3 (1.0 to 1.8) in 1974, 1.4 (1.1 to 1.9) in 1980, and 1.3 (1.0 to 1.6) in 1992 after adjustment for confounders. The presence of white matter lesions was also associated with a 24-year increase in diastolic pressure (Ͼ10 mm Hg), systolic pressure (Ͼ40 mm Hg), pulse pressure (Ͼ24 Key Words: blood pressure Ⅲ white matter lesions Ⅲ longitudinal study C erebral white matter lesions (WMLs) are common findings on computed tomography (CT) and MRI in the elderly. 1,2 Individuals with WMLs are at increased risk for dementia, 1,3 depression, 4 stroke, 5,6 and gait disorders. 7 On histopathology, WMLs on CT represent ischemic demyelination with arteriolosclerosis, hyalinosis, and narrowing of the lumen of the small penetrating arteries in the white matter. 8 Cerebral ischemia and microangiopathy are suggested as the main causes of WMLs, 9 and hypertension is a widely reported risk factor for these lesions. 10 Higher blood pressure has been associated with an increased risk of WMLs in cross-sectional studies 11,12 and in 1 short-term longitudinal study. 13 However, long-term longitudinal studies on blood pressure and WMLs are few. Two such studies, 1 with 20-year follow-up in a general population 14 and 1 with 25-year follow-up in a male population, 15 reported an association between higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) and WMLs on MRI. An increase and decrease in DBP, as well as an increase in SBP, have also been related to higher risks of WMLs on MRI. 14,16 Other than SBP and DBP, blood pressure is also characterized by its steady and pulsatile components. The mean arterial pressure (MAP) is a steady component reflecting cardiac output and vascular resistance, as well as elasticity averaged over time 17,18 ; and pulse pressure (PP) is a pulsatile component mainly reflecting large artery stiffness and wave reflections. 18 Earlier epidemiological studies have reported that PP and MAP are predictors of cardiovascular disease and stroke. 17,19,20 However, it is not known how these components affect the risk of WMLs ...

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Section: Discussionmentioning

confidence: 63%

mentioning

confidence: 99%

Blood Pressure Components and Changes in Relation to White Matter Lesions

Guo

Pantoni²,

Simoni³

et al. 2009

Hypertension

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“…Imaging‐detected infarcts included historical and/or silent stroke lesions that occurred in approximately 13% of participants (58 of the 459 participants with repeated MRI data); these were excluded from all tissue volumes. This incidence is approximately equal to the average incidence of infarcts in other large ageing cohorts [Schmidt et al, 2005; van Dijk et al, 2008]; we did not exclude these participants to ensure that our sample was as representative as possible of the wider population of older adults. Infarcts were identified by their cortical wedge‐shaped distribution in a typical arterial territory or, if subcortical, by their size larger than 2 cm indicating a striatocapsular aetiology.…”

Section: Methodsmentioning

confidence: 99%

Brain volumetric changes and cognitive ageing during the eighth decade of life

Ritchie

Dickie

Cox

et al. 2015

Human Brain Mapping

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Later‐life changes in brain tissue volumes—decreases in the volume of healthy grey and white matter and increases in the volume of white matter hyperintensities (WMH)—are strong candidates to explain some of the variation in ageing‐related cognitive decline. We assessed fluid intelligence, memory, processing speed, and brain volumes (from structural MRI) at mean age 73 years, and at mean age 76 in a narrow‐age sample of older individuals (n = 657 with brain volumetric data at the initial wave, n = 465 at follow‐up). We used latent variable modeling to extract error‐free cognitive levels and slopes. Initial levels of cognitive ability were predictive of subsequent brain tissue volume changes. Initial brain volumes were not predictive of subsequent cognitive changes. Brain volume changes, especially increases in WMH, were associated with declines in each of the cognitive abilities. All statistically significant results were modest in size (absolute r‐values ranged from 0.114 to 0.334). These results build a comprehensive picture of macrostructural brain volume changes and declines in important cognitive faculties during the eighth decade of life. Hum Brain Mapp 36:4910–4925, 2015. © 2015 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc

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“…Meanwhile, risk factors of atherosclerotic diseaseare largely shared by cerebral small vessel disease (CSVD) as well [2,3]. Visualized as white matter lesions (WMLs), lacunar infarcts, orcerebral microbleeds (CMBs) on magnetic resonance imaging (MRI), CSVD has been found closely related to cognitive impairment [4], one explanation for which is disruption of cholinergic fibers by strategically located white matter hyperintensities [5]. Nevertheless, the specific relationship between the vascular risk factors, CSVD associated cognitive decline and its underlying mechanisms is lacking.…”

Section: Introductionmentioning

confidence: 99%

Essen stroke risk score, cerebral cholinergic pathways and cognitive performances in patients with cerebral small vessel disease

Zhu¹,

Han²,

Fang³

et al. 2016

J Integr Syst Neurosci

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Background: Essen stroke risk score (ESRS) has been proposed for predicting recurrent risk of stroke caused by extra-and intra-cranial atherosclerotic disease. Nevertheless, the role of ESRS in cognition associated with cerebral small vessel disease (CSVD) has not been reported to our knowledge. We investigated the relationship between higher ESRS and impaired cognitive performances in patients with CSVD, with the hypothesis that cerebral cholinergic deafferentation may be one of the mechanisms.

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Progression of Cerebral Small Vessel Disease in Relation to Risk Factors and Cognitive Consequences

Cited by 504 publications

References 33 publications

Blood Pressure Components and Changes in Relation to White Matter Lesions

Blood Pressure Components and Changes in Relation to White Matter Lesions

Brain volumetric changes and cognitive ageing during the eighth decade of life

Essen stroke risk score, cerebral cholinergic pathways and cognitive performances in patients with cerebral small vessel disease

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