Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging-Detected Vascular Brain Injury

被引：9

作者：

Anand, Sonia S. ^{[1
,2
,3
]}

Friedrich, Matthias G. ^{[4
]}

Desai, Dipika ^{[3
]}

Schulze, Karleen M. ^{[1
,3
]}

Awadalla, Philip ^{[5
]}

Busseuil, David ^{[6
]}

Dummer, Trevor J. B. ^{[7
,8
]}

Jacquemont, Sebastien ^{[9
]}

Dick, Alexander ^{[10
]}

Kelton, David ^{[11
]}

Kirpalani, Anish ^{[12
]}

Lear, Scott A. ^{[13
]}

Leipsic, Jonathan ^{[14
]}

Noseworthy, Michael D. ^{[15
,16
]}

Parker, Louise ^{[17
]}

Parraga, Grace ^{[18
,19
]}

Poirier, Paul ^{[20
]}

Robson, Paula ^{[21
]}

Tardif, Jean-Claude ^{[6
]}

Teo, Koon ^{[1
,2
,3
]}

Vena, Jennifer ^{[22
]}

Yusuf, Salim ^{[1
,2
,3
]}

Moody, Alan R. ^{[23
]}

Black, Sandra E. ^{[24
,25
]}

Smith, Eric E. ^{[26
]}

机构：

[1] McMaster Univ, Dept Med, Hamilton, ON, Canada

[2] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[3] Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada

[4] McGill Univ, Dept Med & Diagnost Radiol, Montreal, PQ, Canada

[5] Univ Toronto, Ontario Inst Canc Res, Dept Mol Genet, Dept Elect & Comp Engn,Sch Biomed Engn, Toronto, ON, Canada

[6] Univ Montreal, Montreal Heart Inst, Res Ctr, Quebec City, PQ, Canada

[7] Univ British Columbia, Sch Populat & Publ Hlth, Vancouver, BC, Canada

[8] BC Canc Agcy, Vancouver, BC, Canada

[9] Univ Montreal, CHU St Justine, Dept Med & Pediat, Quebec City, PQ, Canada

[10] Univ Ottawa, Heart Inst, Div Cardiol, Ottawa, ON, Canada

[11] Brampton Civic Hosp, William Osler Hlth Syst, Diagnost Imaging, Brampton, ON, Canada

[12] Univ Toronto, St Michaels Hosp, Dept Med Imaging, Toronto, ON, Canada

[13] Simon Fraser Univ, Fac Hlth Sci, Burnaby, BC, Canada

[14] Univ British Columbia, St Pauls Hosp, Dept Radiol, Vancouver, BC, Canada

[15] McMaster Univ, Sch Biomed Engn, Dept Elect & Comp Engn, Hamilton, ON, Canada

[16] St Josephs Hlth Care, Diagnost Imaging, Hamilton, ON, Canada

[17] Dalhousie Univ, Dept Med, Halifax, NS, Canada

[18] Western Univ, Dept Med Biophys, London, ON, Canada

[19] Western Univ, Robarts Res Inst, London, ON, Canada

[20] Univ Laval, Inst Univ Cardiol & Pneumol Quebec, Laval, PQ, Canada

[21] Alberta Hlth Serv, Canc Control Alberta, Canc Res & Analyt, Edmonton, AB, Canada

[22] Alberta Hlth Serv, Richmond Rd Diagnost & Treatment Ctr, Canc Control Alberta, Canc Res & Analyt, Calgary, AB, Canada

[23] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med Imaging, Toronto, ON, Canada

[24] Univ Toronto, Dept Med Neurol, Toronto, ON, Canada

[25] Univ Toronto, Sunnybrook Hlth Sci Ctr, Hurvitz Brain Sci Res, Toronto, ON, Canada

[26] Univ Calgary, Dept Clin Neurosci, Hotchkiss Brain Inst, Calgary, AB, Canada

来源：

STROKE | 2020年 / 51卷 / 04期

基金：

加拿大健康研究院;

关键词：

brain; cardiovascular disease; cognition; infarction; risk factors; WHITE-MATTER HYPERINTENSITIES; SMALL VESSEL DISEASE; ATHEROSCLEROSIS RISK; GENERAL-POPULATION; INFARCTS; DEMENTIA; STROKE; VOLUME; PREVENTION; AGE;

D O I：

10.1161/STROKEAHA.119.028179

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods-Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results-The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (P<0.0001), INTERHEART risk score (P<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, -1.3 to -0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, -3.2 to -0.6) per high white matter hyperintensities, 3.5 (95% CI, -6.4 to -0.7) per nonlacunar stroke, and 6.8 (95% CI, -11.5 to -2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12-17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8-30), and MRI vascular brain injury accounted for 10% (95% CI, -3 to 22) of low test scores. Conclusions-Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.

引用

页码：1158 / 1165

页数：8

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