Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline

Vermeer, Sarah E.; Prins, Niels D.; Heijer, Tom den; Hofman, Albert; Koudstaal, Peter J.; Breteler, Monique M.B.

doi:10.1056/nejmoa022066

Cited by 2,055 publications

(1,503 citation statements)

References 31 publications

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“…Participants in the CARDIA (Coronary Artery Risk Development in Young Adults) brain MRI substudy who achieved more ideal CVH at ages 18 to 30 had larger brain volumes 25 years later, but they observed no associations with normal gray or white matter volume or abnormal white matter volume 24. WMHV, brain atrophy, and SBI are all important imaging biomarkers of brain aging and predictive of future risk of stroke and dementia across study populations 9, 10, 11. These brain changes have potential as brain health markers that can be used both clinically and in research studies as intermediate or surrogate outcomes to help identify at‐risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, although the AHA has now defined optimal brain health by the Life's Simple 7 metric, there is very limited evidence regarding its impact on biomarkers of subclinical brain aging. Subclinical brain aging biomarkers, including white matter hyperintensities, silent brain infarct (SBI), and brain atrophy, are common in the population and important risk factors for stroke as well as cognitive decline and dementia 9, 10, 11. The potential association of Life's Simple 7 and these important subclinical imaging biomarkers of brain aging is largely unknown and the motivation for the current analysis.…”

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confidence: 99%

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Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Gardener

Caunca

Dong

et al. 2018

JAHA

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BackgroundThe American Heart Association Life's Simple 7 metric defines ideal cardiovascular health (CVH) on 7 factors: smoking, diet, physical activity, body mass index, blood sugar, blood pressure, and cholesterol. This metric has been used to define optimal brain health, but data relative to subclinical imaging biomarkers of brain aging are lacking. This study examines the association between Life's Simple 7 with white matter hyperintensity volume, silent brain infarcts, and cerebral volume.Methods and ResultsA subsample of stroke‐free participants from the population‐based Northern Manhattan Study underwent brain magnetic resonance imaging an average of 7 years after baseline. Linear and logistic regression models were constructed to estimate associations between the number of ideal CVH metrics achieved with imaging biomarkers of brain aging, adjusting for sociodemographics. Among 1031 participants (mean age at magnetic resonance imaging=72±8, 40% men, 19% black, 16% white, and 65% Hispanic), no one had ideal status in all 7 factors, 1% had ideal status in 6 factors, 18% in 4 to 5 factors, 30% in 3 factors, 33% in 2 factors, and 18% in 0 to 1 factors. The number of ideal CVH factors achieved was inversely associated with white matter hyperintensity volume (beta per factor=−0.047; P=0.04) and silent brain infarct (odds ratio per factor=0.84; 95% confidence interval=0.72–0.97) and positively associated with cerebral volume (beta per factor=0.300; P=0.002).ConclusionsAn increasing ideal CVH score was associated with less white matter hyperintensity volume and silent brain infarcts and greater cerebral volumes, supporting the Life's Simple 7 metric as a useful measure to quantify optimal brain health. Monitoring and promoting achievement of Life's Simple 7 ideal CVH factors may improve subclinical and clinical brain health outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Gardener

Caunca

Dong

et al. 2018

JAHA

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“…1205 Nevertheless, there is a possibility of long-term sequelae, given the association between silent cerebral infarcts and an increased long-term risk of dementia. 1217 While further work remains, the amount of progress is striking and will benefit our patients in the long term.…”

Section: Section 10: Complicationsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,769

1,468

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“…Although the reported rates of clinically overt cerebrovascular events are relatively low (<2%),2, 4 58% of patients undergoing routine VT ablation procedures exhibit new brain emboli in postprocedural CMRI 5. Most of the CMRI‐detected ischemic lesions remained clinically silent, but recent studies have shown that these lesions might be associated with neurocognitive impairment and the development of dementia 19, 20…”

Section: Discussionmentioning

confidence: 99%

“…Although the relevance of clinically silent periprocedural embolic lesions is unknown, the long‐term consequences of these lesions might have negative neurocognitive effects such as premature dementia 5, 6, 20. Most endovascular electrophysiological procedures such as CA of atrial fibrillation and, particularly, VT are associated with fairly long procedure durations compared with other interventional procedures (eg, coronary angiography, LAA closure, TAVR, and mitral valve repair with the MitraClip).…”

Section: Discussionmentioning

confidence: 99%

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

Heeger

Metzner

Schlüter

et al. 2018

JAHA

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BackgroundCatheter ablation of ventricular tachycardia (VT) is associated with the risk of cerebral embolism. The origin of periprocedural brain embolism in the setting of VT ablation is often unknown and strategies to avoid it are sparse. The aim of this study was to assess the safety and feasibility of an endovascular 2‐filter‐based cerebral protection system (CPS) in left ventricular VT ablation procedures in patients with ischemic heart disease. Furthermore, histopathological correlates of periprocedural embolization were investigated.Methods and ResultsIn this pilot study, 11 patients with ischemic heart disease and sustained VT underwent left ventricular catheter ablation under CPS surveillance. The placement of the CPS was conducted before the ablation procedure via the right radial artery. The VT ablation procedure was performed via a combined transaortic and transseptal approach. All VTs were successfully ablated. Placement and retrieval of the CPS was successful and safe in all cases. No periprocedural complications related to the CPS were observed and no periprocedural transient ischemic attack or stroke occurred. Debris captured by the CPS was detected in all patients. Histology revealed that acute thrombus was the most common type of debris (91%), followed by arterial wall tissue (73%) and foreign material (55%). Less frequently found were myocardium (27%), calcification (9%), necrotic core (9%), and valve tissue (9%).ConclusionsCerebral protection during VT ablation seems to be safe and feasible. Ablation procedures of VT are associated with embolization of embolic debris, which was found in every patient.

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Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline

Abstract: Elderly people with silent brain infarcts have an increased risk of dementia and a steeper decline in cognitive function than those without such lesions.

Cited by 2,055 publications

References 31 publications

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

Ideal Cardiovascular Health and Biomarkers of Subclinical Brain Aging: The Northern Manhattan Study

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease

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