Department of Radiology and Nuclear Medicine (S.H., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology (S.H., A.D., M.K.I., M.A.I., M.W.V.), Erasmus Medical Center, Rotterdam, the Netherlands.
Stroke. 2021 Mar;52(3):922-930. doi: 10.1161/STROKEAHA.120.032085. Epub 2021 Feb 4.
Cortical cerebral microinfarcts (CMIs) have been linked with dementia and impaired cognition in cross-sectional studies. However, the clinical relevance of CMIs in a large population-based setting is lacking. We examine the association of cortical CMIs detected on 1.5T magnetic resonance imaging with cardiovascular risk factors, cerebrovascular disease, and brain tissue volumes. We further explore the association between cortical CMIs with cognitive decline and risk of stroke, dementia, and mortality in the general population.
Two thousand one hundred fifty-six participants (age: 75.7±5.9 years, women: 55.6%) with clinical history and baseline magnetic resonance imaging (January 2009-December 2013) were included from the Rotterdam Study. Cortical CMIs were graded based on a previously validated method. Markers of cerebrovascular disease and brain tissue volumes were assessed on magnetic resonance imaging. Cognition was assessed using a detailed neuropsychological test at baseline and at 5 years of follow-up. Data on incident stroke, dementia, and mortality were included until January 2016.
Two hundred twenty-seven individuals (10.5%) had ≥1 cortical CMIs. The major risk factors of cortical CMIs were male sex, current smoking, history of heart disease, and stroke. Furthermore, presence of cortical CMIs was associated with infarcts and smaller brain volume. Persons with cortical CMIs showed cognitive decline in Stroop tests (color-naming and interference subtasks; β for color-naming, 0.18 [95% CI, 0.04-0.33], interaction ≤0.001 and β for interference subtask, 1.74, [95% CI, 0.66-2.82], interaction ≤0.001). During a mean follow-up of 5.2 years, 73 (4.3%) individuals developed incident stroke, 95 (5.1%) incident dementia, and 399 (19.2%) died. People with cortical CMIs were at an increased risk of stroke (hazard ratio, 1.18 [95% CI, 1.09-1.28]) and mortality (hazard ratio, 1.09 [95% CI, 1.00-1.19]).
Cortical CMIs are highly prevalent in a population-based setting and are associated with cardiovascular disease, cognitive decline, and increased risk of stroke and mortality. Future investigations will have to show whether cortical CMIs are a useful biomarker to intervene upon to reduce the burden of stroke.
皮质脑微梗死（CMIs）与横断面研究中的痴呆和认知障碍有关。然而，在大型基于人群的研究中，CMIs 的临床相关性尚不清楚。我们研究了在 1.5T 磁共振成像上检测到的皮质 CMIs 与心血管危险因素、脑血管疾病和脑组织体积之间的关系。我们进一步探讨了皮质 CMIs 与认知能力下降以及普通人群中风、痴呆和死亡风险之间的关系。
共纳入 2156 名参与者（年龄：75.7±5.9 岁，女性：55.6%），他们有临床病史和基线磁共振成像（2009 年 1 月至 2013 年 12 月），这些参与者来自鹿特丹研究。基于先前验证的方法对皮质 CMIs 进行分级。磁共振成像上评估了脑血管疾病和脑组织体积的标志物。使用详细的神经心理学测试在基线和 5 年随访时评估认知能力。将中风、痴呆和死亡的发病数据纳入至 2016 年 1 月。
227 人（10.5%）存在≥1 个皮质 CMIs。皮质 CMIs 的主要危险因素为男性、当前吸烟、心脏病和中风病史。此外，皮质 CMIs 的存在与梗死和较小的脑容量有关。皮质 CMIs 患者在 Stroop 测试（颜色命名和干扰子任务）中表现出认知能力下降（颜色命名的 β 值为 0.18[95%CI，0.04-0.33]，交互作用≤0.001，干扰子任务的 β 值为 1.74[95%CI，0.66-2.82]，交互作用≤0.001）。在平均 5.2 年的随访期间，73 人（4.3%）发生了新发中风，95 人（5.1%）发生了新发痴呆，399 人（19.2%）死亡。皮质 CMIs 患者发生中风的风险增加（风险比，1.18[95%CI，1.09-1.28]）和死亡率（风险比，1.09[95%CI，1.00-1.19]）。
皮质 CMIs 在基于人群的研究中非常普遍，与心血管疾病、认知能力下降以及中风和死亡率增加有关。未来的研究将必须表明皮质 CMIs 是否是一种有用的生物标志物，可以干预以减轻中风的负担。
