Small Vessel Disease on Neuroimaging in a 75-Year-Old Cohort (PIVUS): Comparison With Cognitive and Executive Tests

Abstract

Background and Purpose: Signs of small vessel disease (SVD) are commonly seen on magnetic resonance imaging (MRI) of the brain in cognitively healthy elderly individuals, and the clinical relevance of these are often unclear. We have previously described three different MRI manifestations of SVD as well as cerebral perfusion in a longitudinal study of non-demented 75-year-old subjects. The purpose of the present study was to evaluate the relationship of these findings to cognition and executive function at age 75 and changes after 5 years.Methods: In all, 406 subjects from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study were examined with MRI of the brain at age 75 years. Two-hundred and fifty of the subjects were re-examined 5 years later. White matter hyperintensities (WMHs) and lacunar infarcts (LIs) were assessed on both occasions, but microbleeds (MBs) and perfusion only at age 75. Cognitive function was screened by the Mini Mental State Examination (MMSE). Trail Making Test A and B (TMT-A and TMT-B) were performed at baseline and at follow-up at age 80.Results: At baseline, 93% performed >27 points in the MMSE. The TMT-B at age 75 was significantly related to WMH visual scoring after adjustment for sex, education and cerebrovascular disease risk factors (+80 s (95% CI 0.3–161 s), P < 0.05 for grade 2–3 vs. grade 0). Neither MMSE nor TMT-A was significantly related to WMH scoring. There was no relation between any test performance and WMH volume, white matter volume, number of MBs or brain perfusion at age 75. Subjects who had sustained a new LI (n = 26) showed a greater increase of the time to perform TMT-A at the 5-year follow-up (+25 s vs. +4 s in LI-free subjects, P = 0.003). Changes in MMSE or TMT-A and -B test performance between ages 75 and 80 were not related to changes in WMH scoring or volume during the 5 years follow-up, or to brain perfusion at age 75.Conclusion: In this cognitively healthy community-based population, moderate-severe WMHs and incident LIs on brain MRI in individuals aged 75–80 years were associated with a mild impairment of processing speed and executive function.

Association between cerebral microbleeds and hypertension in the Swedish general population “Good Aging in Skåne” study

“…Framingham Heart Study (8.8%, mean age: 66.5 years), 7 the AGES-Reykjavik study (11.1%-15.3%, mean age: 76 years), 5 the Swedish PIVUS (14%, mean age: 75 years), 21 and a recent Japanese population study of elderly people (23%). 22 Some of the differences could be attributed to a younger study population, selection bias with healthier participants, and MRI field strength used.…”

Incident cerebral lacunes: A review

“…48 In all other 16 studies, 1.5-T scanners were used. 17,31,34,36,37,40,42,43,50–52,54–56,58–60 The section thickness was thinner than 4 mm in 7 studies, 17,34,36,41,42,55,56,59 varied from 4 to 6 mm in 11 studies, 31,33,35,37,40,43,50–52,57,58,60 and was not stated in 1 study. 54 The in-plane resolution was described with the corresponding matrix in 11 studies 31,34,36,37,40,42,43,50–52,54,57,58 but was not detailed in 7 studies.…”

“…Incident lacunes were detected at individual level with a frequency ranging from 1.6% to 20.9% over 3.4 to 10.6 years of follow-up in eight population-based cohort studies (Table1). 17,31,33,34,36,37,40,55 The frequency of incident lacunes among community residents varied from 0.4% per year in the 477 individuals between 60 and 64 years included in the Austrian Stroke Prevention Study (ASPS) 36 to 4.0% per year in the 2612 independently living elderly individuals aged from 66 to 97 years included in the Age Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik) study from Iceland. 17 In three studies of individuals whose mean age was younger than 64 years, the estimated frequency ranged from 0.4% to 1.9% per year, 31,36,40 in five studies of subjects whose mean age was older than 70 years, this frequency ranged from 1.1% to 4.0% per year.…”

“…A single study was an international cohort study obtained in different countries, 26,35 5 studies were conducted in the Netherlands, [37][38][39]41,[43][44][45][46][47][48][57][58][59] 2 in Japan, [51][52][53] 2 in United States 18,19,[28][29][30][31][32][33] and 2 in United Kingdom. 42,54 A single study was performed in each of the following countries: Iceland, 17 France, 34 Australia, 36 Austria, 40 China, 49,50 Sweden 55,56 and Poland. 60…”

Sleep, brain vascular health and ageing

“…Lacunar infarcts and brain microbleeds increase with ageing. Higher cognitive functions like processing speed and executive functions are impaired with the progression of lacunar infarcts and microbleeds in population aged 75-80 years (Nylander et al 2018). Young population with long-term prevalence of small vessel diseases after stroke shows 10-20 years of preponement in brain ageing with increased vulnerability to vascular risks (Arntz et al 2016).…”