Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA.
Stroke. 2010 Apr;41(4):600-6. doi: 10.1161/STROKEAHA.109.570044. Epub 2010 Feb 18.
White matter hyperintensities and MRI-defined brain infarcts (BIs) have individually been related to stroke, dementia, and mortality in population-based studies, mainly in older people. Their significance in middle-aged community-dwelling persons and the relative importance of these associations remain unclear. We simultaneously assessed the relation of white matter hyperintensities and BI with incident stroke, mild cognitive impairment, dementia, and mortality in a middle-aged community-based cohort.
A total of 2229 Framingham Offspring Study participants aged 62+/-9 years underwent volumetric brain MRI and neuropsychological testing (1999 to 2005). Incident stroke, dementia, and mortality were prospectively ascertained and for 1694 participants in whom a second neuropsychological assessment was performed (2005 to 2007), incident mild cognitive impairment was evaluated. All outcomes were related to white matter hyperintensities volume (WMHV), age-specific extensive WMHV and BI adjusting for age and gender.
Extensive WMHV and BI were associated with an increased risk of stroke (hazard ratio [HR]=2.28, 95% CI: 1.02 to 5.13; HR=2.84, 95% CI: 1.32 to 6.10). WMHV, extensive WMHV, and BI were associated with an increased risk of dementia (HR=2.22, 95% CI: 1.32 to 3.72; HR=3.97, 95% CI: 1.10 to 14.30; HR=6.12, 95% CI: 1.82 to 20.54) independently of vascular risk factors and interim stroke. WMHV and extensive WMHV were associated with incident amnestic mild cognitive impairment in participants aged > or = 60 years only (OR=2.47, 95% CI: 1.31 to 4.66 and OR=1.49, 95% CI: 1.14 to 1.97). WMHV and extensive WMHV were associated with an increased risk of death (HR=1.38, 95% CI: 1.13 to 1.69; HR=2.27, 95% CI: 1.41 to 3.65) independent of vascular risk factors and of interim stroke and dementia.
In a large community-based sample of middle-aged adults, BI predicted an increased risk of stroke and dementia independent of vascular risk factors. White matter hyperintensities portended an increased risk of stroke, amnestic mild cognitive impairment, dementia, and death independent of vascular risk factors and interim vascular events.
在基于人群的研究中，白质高信号和 MRI 定义的脑梗死（BI）分别与卒中、痴呆和死亡率相关，主要在老年人中。它们在中年社区居民中的意义以及这些关联的相对重要性尚不清楚。我们同时评估了白质高信号和 BI 与中年社区队列中卒中、轻度认知障碍、痴呆和死亡率的关系。
共有 2229 名弗雷明汉后代研究参与者年龄为 62+/-9 岁，接受了容积脑 MRI 和神经心理学测试（1999 年至 2005 年）。前瞻性确定卒中、痴呆和死亡率的发生情况，并对其中 1694 名参与者进行了第二次神经心理学评估（2005 年至 2007 年），评估了新发轻度认知障碍。所有结局均与白质高信号体积（WMHV）、年龄特异性广泛 WMHV 和 BI 相关，调整了年龄和性别。
广泛的 WMHV 和 BI 与卒中风险增加相关（风险比 [HR]=2.28，95%CI：1.02 至 5.13；HR=2.84，95%CI：1.32 至 6.10）。WMHV、广泛的 WMHV 和 BI 与痴呆风险增加相关（HR=2.22，95%CI：1.32 至 3.72；HR=3.97，95%CI：1.10 至 14.30；HR=6.12，95%CI：1.82 至 20.54），独立于血管危险因素和中期卒中。WMHV 和广泛的 WMHV 仅与年龄≥60 岁的参与者发生遗忘性轻度认知障碍有关（OR=2.47，95%CI：1.31 至 4.66 和 OR=1.49，95%CI：1.14 至 1.97）。WMHV 和广泛的 WMHV 与死亡风险增加相关（HR=1.38，95%CI：1.13 至 1.69；HR=2.27，95%CI：1.41 至 3.65），独立于血管危险因素和中期卒中及痴呆。
在一项大型基于社区的中年成年人样本中，BI 预测卒中和痴呆的风险增加，独立于血管危险因素。白质高信号预示着卒中、遗忘性轻度认知障碍、痴呆和死亡的风险增加，独立于血管危险因素和中期血管事件。
