[White Matter Lesions As a Risk Factor for Stroke and Dementia. A Population-based Study in 85-year-olds]

Overview

Journal Nervenarzt

Specialty Neurology

Date 2004 Oct 27

PMID 15502905

Authors

M Liebetrau

G F Hamann

I Skoog

Affiliations

Soon will be listed here.

Abstract

Aim: This study was performed to determine whether white matter lesions on cranial computed tomography (cCT) are associated with increased prevalence and incidence of stroke, dementia, and mortality.

Methods: A representative sample of 239 85-year-olds living in Gothenburg, Sweden, was examined in a population-based study. Stroke was defined by information from patient reports, key informants, and an inpatient register system. Dementia was diagnosed according to DSM-III-R. White matter lesions (WML) and infarcts were determined by cCT. Follow-up examinations were performed 3 years later.

Results: White matter lesions doubled the odds of previous stroke (OR 1.8, 95% CI 1.03-3.3). Individuals with WML and stroke showed higher prevalence of dementia (OR 16.5, 95% CI 6.5-41.8) and mortality (OR 12.4, 95% CI 5.1-30.0) than those without WML and stroke.

Conclusion: White matter lesions are common in the elderly, and these changes have clinical consequences increasing the risk of stroke. Whether preventive mechanisms could lead to risk reduction should be clarified in further studies.

References

Vermeer S, Prins N, den Heijer T, Hofman A, Koudstaal P, Breteler M . Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med. 2003; 348(13):1215-22. DOI: 10.1056/NEJMoa022066. View

Alfredsson L, von Arbin M, de Faire U . Mortality from and incidence of stroke in Stockholm. Br Med J (Clin Res Ed). 1986; 292(6531):1299-303. PMC: 1340310. DOI: 10.1136/bmj.292.6531.1299. View

Launer L, Ross G, Petrovitch H, Masaki K, Foley D, White L . Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiol Aging. 2000; 21(1):49-55. DOI: 10.1016/s0197-4580(00)00096-8. View

Henon H, Vroylandt P, Durieu I, Pasquier F, Leys D . Leukoaraiosis more than dementia is a predictor of stroke recurrence. Stroke. 2003; 34(12):2935-40. DOI: 10.1161/01.STR.0000103747.58719.59. View

Liebetrau M, Steen B, Skoog I . Stroke in 85-year-olds: prevalence, incidence, risk factors, and relation to mortality and dementia. Stroke. 2003; 34(11):2617-22. DOI: 10.1161/01.STR.0000094420.80781.A9. View

De Champvallins M, Weber F, Collard M, RANCUREL G . Incidence and predictive factors of cerebrovascular events in 8,846 elderly treated hypertensive patients during a 3-year follow-up: the PRESAGE study. Eur Neurol. 2001; 45(2):89-96. DOI: 10.1159/000052101. View

Lechner H, Schmidt R, Bertha G, Justich E, Offenbacher H, Schneider G . Nuclear magnetic resonance image white matter lesions and risk factors for stroke in normal individuals. Stroke. 1988; 19(2):263-5. DOI: 10.1161/01.str.19.2.263. View

Smith C, Snowdon D, Wang H, Markesbery W . White matter volumes and periventricular white matter hyperintensities in aging and dementia. Neurology. 2000; 54(4):838-42. DOI: 10.1212/wnl.54.4.838. View

Aevarsson O, Skoog I . A population-based study on the incidence of dementia disorders between 85 and 88 years of age. J Am Geriatr Soc. 1996; 44(12):1455-60. DOI: 10.1111/j.1532-5415.1996.tb04070.x. View

10.

Fazekas F, Schmidt R, Kleinert R, Kapeller P, Roob G, Flooh E . The spectrum of age-associated brain abnormalities: their measurement and histopathological correlates. J Neural Transm Suppl. 1998; 53:31-9. DOI: 10.1007/978-3-7091-6467-9_4. View

11.

Asberg M, Montgomery S, Perris C, SCHALLING D, Sedvall G . A comprehensive psychopathological rating scale. Acta Psychiatr Scand Suppl. 1978; (271):5-27. DOI: 10.1111/j.1600-0447.1978.tb02357.x. View

12.

RINDER L, Roupe S, Steen B, Svanborg A . Seventy-year-old people in Gothenburg. A population study in an industrialized Swedish city. Acta Med Scand. 1975; 198(5):397-407. DOI: 10.1111/j.0954-6820.1975.tb19563.x. View

13.

Skoog I, Palmertz B, Andreasson L . The prevalence of white-matter lesions on computed tomography of the brain in demented and nondemented 85-year-olds. J Geriatr Psychiatry Neurol. 1994; 7(3):169-75. DOI: 10.1177/089198879400700308. View

14.

Ott B, Faberman R, Noto R, Rogg J, Hough T, Tung G . A SPECT imaging study of MRI white matter hyperintensity in patients with degenerative dementia. Dement Geriatr Cogn Disord. 1997; 8(6):348-54. DOI: 10.1159/000106654. View

15.

Liebetrau M, Steen B, Hamann G, Skoog I . Silent and symptomatic infarcts on cranial computerized tomography in relation to dementia and mortality: a population-based study in 85-year-old subjects. Stroke. 2004; 35(8):1816-20. DOI: 10.1161/01.STR.0000131928.47478.44. View

16.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

17.

Inzitari D, Cadelo M, Marranci M, Pracucci G, Pantoni L . Vascular deaths in elderly neurological patients with leukoaraiosis. J Neurol Neurosurg Psychiatry. 1997; 62(2):177-81. PMC: 486730. DOI: 10.1136/jnnp.62.2.177. View

18.

Hebert R, Brayne C . Epidemiology of vascular dementia. Neuroepidemiology. 1995; 14(5):240-57. DOI: 10.1159/000109800. View

19.

Tatemichi T, Desmond D, Mayeux R, Paik M, Stern Y, Sano M . Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalized cohort. Neurology. 1992; 42(6):1185-93. DOI: 10.1212/wnl.42.6.1185. View

20.

Lindenstrom E, Boysen G, Nyboe J, Appleyard M . Stroke incidence in Copenhagen, 1976-1988. Stroke. 1992; 23(1):28-32. DOI: 10.1161/01.str.23.1.28. View