Cognitive impairment risk
- 14 July 2009
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 73 (2), 120-125
- https://doi.org/10.1212/wnl.0b013e3181ad53fd
Abstract
To determine whether white matter hyperintensity (WMH) progression rate is a better predictor of cognitive impairment risk than baseline WMH volume in healthy elderly individuals. Ninety-eight cognitively intact elderly subjects were followed in the Oregon Brain Aging Study. Forty-nine had at least 3 brain MRIs and annual cognitive and neurologic assessments until diagnosed with persistent cognitive impairment (PCI). Brain, ventricular CSF (vCSF), intracranial volume (ICV), hippocampus, total WMH, periventricular (PV) WMH, and subcortical WMH volumes were measured. Cox proportional hazards survival analyses were used to assess cognitive impairment risk. After adjusting for age, apolipoprotein E4 status, incident hypertension, ICV, entry Mini-Mental State Examination, baseline hippocampus, and both baseline vCSF volume and rate of vCSF volume change, increased progression of total WMH volume (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.3-2.7, p = 0.0007) and PV WMH volume (HR 1.94, 95% CI 1.3-3.1, p = 0.001) conferred higher risk of PCI, whereas baseline WMH volumes did not. Every 1 mL/y increase in PV WMH volume was associated with a 94% increased risk of PCI. Progression of total and periventricular (PV) white matter hyperintensity (WMH) volumes are better predictors of persistent cognitive impairment (PCI) than baseline WMH burden. Greater PV WMH burden progression is associated with the development of PCI, a potential precursor to Alzheimer or vascular dementia. Identification of factors that decrease WMH accumulation over time is needed to maintain cognitive health in our growing elderly population.Keywords
This publication has 39 references indexed in Scilit:
- Predicting the rate of cognitive decline in aging and early Alzheimer diseaseNeurology, 2004
- Links Between the Pathology of Alzheimer's Disease and Vascular DementiaNeurochemical Research, 2004
- Progression of cerebral white matter lesions: 6-year results of the Austrian Stroke Prevention StudyThe Lancet, 2003
- Cerebrovascular Pathology and Dementia in Autopsied Honolulu‐Asia Aging Study ParticipantsAnnals of the New York Academy of Sciences, 2002
- Independent predictors of cognitive decline in healthy elderly persons.Archives of Neurology, 2002
- The Clinical Dementia Rating (CDR)Neurology, 1993
- Neurologic function in the optimally healthy oldest oldNeurology, 1993
- Making the diagnosis of Alzheimer's disease. A primer for practicing pathologists.1993
- Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment CentersNeurology, 1992
- “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinicianJournal of Psychiatric Research, 1975