Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study

Bezerra, Daniel C.; Sharrett, A. Richey; Matsushita, Kunihiro; Gottesman, Rebecca F.; Shibata, Dean; Mosley, Thomas H.; Coresh, Josef; Szklo, Moysés; Carvalho, Marília Sá; Selvin, Elizabeth

doi:10.1212/wnl.0b013e31823efc42

Cited by 99 publications

(79 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…35 During the years, this may cause cerebral hypoperfusion, microinfarctions, and other signs of cerebral small vessel disease. 36 A relationship between BP and lesions in the cerebral whiter matter has been reported, 7,36 especially with midlife hypertension 37,38 and those with poorly controlled hypertension.…”

Section: Discussionmentioning

confidence: 99%

Temporal Evolution of Cognitive Changes in Incident Hypertension

et al. 2014

View full text Add to dashboard Cite

245I dentifying modifiable risk factors for cognitive decline and dementia is crucial to effective preventive strategies. Known risk factors include age, education, physical activity, diet, depression, and vascular disease.1 Although the dementia prevalence increases exponentially from 65 years of age, the risk builds up gradually with critical periods for some exposures across the life span. 2Cognitive decline from previous levels of functioning is a core criterion for the diagnosis of dementia.3 Findings from observational studies suggest that hypertension is a major risk factor for accelerated cognitive decline 4 and dementia. 5Hypertension predicts decline in the domains of memory, attention, 6 psychomotor speed, 7 and other fluid abilities. 8The effect of hypertension seems to be age dependent for the associations with cognitive decline and dementia 9 : Studies into midlife hypertension have generally found positive associations, 8,10,11 whereas studies into late life hypertension are more likely to show mixed results of a risk increasing, no, or even a protective effect. 8,12 Prospective studies with exceptionally long follow-up duration suggest an inverted U-shaped trajectory of blood pressure (BP) over time in people who later develop dementia (ie, an increase from midlife to late life and declining levels thereafter). 13,14 Understanding the effect of hypertension on cognitive decline and dementia is important because it opens the possibility of risk management using available interventions. 15,16 Observational studies have shown that individuals with pharmacologically controlled hypertension decline less than people with uncontrolled or untreated hypertension.4 Meta-analysis of randomized clinical trials found a significant dementia risk reduction in trials that prescribed diuretics or calcium channel blockers in the treatment arm, although no generic effect of hypertension medication was found. 17Most might be gained from timely interventions in newly diagnosed hypertension cases, but, to the best of our knowledge, no study has focused on the onset and course of cognitive decline in incident hypertension. One previous study of 49 healthy older adults used incident hypertension as a covariate when studying risk for white matter lesion progression on cognitive impairment (average follow-up, 5.6 years).18 ItAbstract-Midlife hypertension is a risk factor for dementia, but little is known about the cognitive trajectories of individuals with incident hypertension. This study follows the cognitive functioning in prevalent and incident hypertension for 12 years and in relation to age and treatment status. Cognitively intact adults aged 25 to 84 years (n=1805) were serially assessed at baseline, 6 years, and 12 years. Hypertension was defined by sphygmomanometry or antihypertensive medication use, and its association with cognitive decline was tested in random-effects models. At baseline, 638 (35.3%) participants had hypertension. They showed faster decline in memory (χ 2 test for homogeneity=35.75; df=2; P<0....

show abstract

Section: Discussionmentioning

confidence: 99%

Temporal Evolution of Cognitive Changes in Incident Hypertension

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Our findings agree with previous cross-sectional data in patients with CADASIL, 10 and active smoking has been reported to also increase the risk of stroke in sporadic SVD. 22 Smoking has multiple effects on the microvasculature, including altered nitric oxide signaling of calcium channels, 23 depletion of the free pool of tissue-type plasminogen activator 24 and enhanced free-radical production. 25 In this study, active smoking was also found to increase the risk of incident dementia independently of other potential risk factors, whereas a previous history of stroke did not change this risk.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Clinical Worsening in Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy

Chabriat

Hervé

Duering

et al. 2016

Stroke

103

View full text Add to dashboard Cite

Background and Purpose-Predictors of clinical worsening in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy remain unknown. This study aims to identify demographic, clinical, and magnetic resonance imaging predictors of incident strokes, incident dementia, clinical deterioration, and death in patients with this genetically proven disease. Methods-Two hundred ninety subjects (mean age, 50.6±11.4 years) were assessed at baseline and followed up for 36 months. Incident clinical events were recorded, and clinical scores included the Mini Mental State Examination, Mattis Dementia Rating Scale, modified Rankin Scale, and Barthel index. The number of lacunes and microbleeds, the volume of white-matter hyperintensities, and brain parenchymal fraction were assessed on baseline magnetic resonance imaging. Data were analyzed by ANCOVA, multivariable logistic regression, and Cox proportional hazard models. Results-Incident stroke occurred in 55 of 278 patients (19.8%). Moderate or severe disability developed in 19 of 210 (9%) nondisabled individuals, incident dementia in 49 of 231 (20%) nondemented subjects, and 4.8% of patients died. Active smoking, the number of lacunes, and brain parenchymal fraction independently predicted incident stroke during follow-up. Gait disturbance, dementia, and brain parenchymal fraction predicted progression toward moderate or severe disability. Active smoking, disability, and brain parenchymal fraction predicted incident dementia. Age was the only significant predictor of death. The clinical and imaging characteristics of CADASIL much resemble those of the most severe forms of sporadic SVD. We, thus, reasoned that information derived from a longitudinal study in CADASIL might offer insights relevant to SVD in general. Here, we report the final results of this study obtained in a large cohort of patients followed up for 3 years. Conclusions-Clinical Methods Study CohortSubjects were prospectively recruited between September 2003 and April 2011 through 2 major referral centers for CADASIL (University Hospital Lariboisière, Paris [n=178] and Ludwig Maximilians Universität, Munich [n=112]). They were included regardless of whether they had clinical manifestations of the disease if they were at least 18 years of age, had a documented mutation in the NOTCH3 gene, and were willing to be followed up. Details of the study protocol have been reported elsewhere.11 A follow-up interval of 3 years was chosen based on previous longitudinal data showing that significant changes in clinical scores can be detected within an interval of 2 years 8 when following up patients seen at major referral centers and to obtain a sufficient number of clinical events. In brief, clinical and demographic data were collected at study entry and included age, sex, years of education, and vascular risk factors (hypertension, diabetes mellitus, hypercholesteremia, smoking, and alcohol use). Blood pressure was measured at baseline and at follow-up.A history of transient ischemic attack...

show abstract

“…12 The false-negative rate is multifactorial and reflects a learning curve in LI CTP pattern identification 2,16,25 but also variability in the size of perfusion abnormality in the context of LI. 15 Traditionally, studies have focused on identifying larger hemispheric perfusion defects with or without concurrent deep abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…These results mirror a large community-based prospective cohort study of 15,792 middle-aged adults in whom both hypertension and diabetes were associated with smaller (but not large) infarcts. 25 The utility of CTP in the context of LI has been previously studied. 8,13,14 Early clinical deterioration occurs in 27%-62% of LI cases and is not reliably predicted clinically.…”

Section: Discussionmentioning

confidence: 99%