Coletados pelo Dr. Clayton Aguiar

Incidence, Manifestations, and Predictors of Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly
The Cardiovascular Health Study
W.T. Longstreth, Jr, MD, MPH; Alice M. Arnold, PhD; Norman J. Beauchamp, Jr, MD, MHS; Teri A. Manolio, MD, PhD; David Lefkowitz, MD; Charles Jungreis, MD; Calvin H. Hirsch, MD; Daniel H. O’Leary, MD; Curt D. Furberg, MD, PhD

From the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), Biostatistics (A.A.), and Radiology (N.J.B.), University of Washington, Seattle, Wash; the Division of Epidemiology and Clinical Applications (T.A.M.), National Heart, Lung, and Blood Institute, Bethesda, Md; the Neuroradiology Division, Departments of Radiology and Neurological Surgery (C.J.), University of Pittsburgh Medical Center, Pittsburgh, Pa; the Department of Medicine (C.H.H.), University of California at Davis, Sacramento, Calif; the Department of Radiology (D.H.O.), Tufts-New England Medical Center, Boston, Mass; and the Departments of Neurology (D.L.) and Public Health Sciences (C.D.F.), Wake Forest University, Winston-Salem, NC.

Correspondence to Dr W. T. Longstreth, Jr, Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Avenue, Seattle WA 98104-2420. E-mail wl@u.washington.edu

Background and Purpose— Magnetic resonance imaging (MRI) scans in the elderly commonly show white matter findings that may raise concerns. We sought to document incidence, manifestations, and predictors of worsening white matter grade on serial imaging.

Methods— The Cardiovascular Health Study is a population-based, longitudinal study of 5888 people aged 65 years and older, of whom 1919 have had extensive initial and follow-up evaluations, including 2 MRI scans separated by 5 years. Scans were read without clinical information in standard side-by-side fashion to determine worsening white matter grade.

Results— Worsening was evident in 538 participants (28%), mostly (85%) by 1 grade. Although similar at initial scan, participants with worsening white matter grade, compared with those without, experienced greater decline on modified Mini-Mental State examination and Digit-Symbol Substitution test (both P0.001) after controlling for potential confounding factors, including occurrence of transient ischemic attack or stroke between scans. Independent predictors of worsening white matter grade included cigarette smoking before initial scan and infarct on initial scan. Otherwise, predictors differed according to white matter grade on initial scan. For low initial grade, increased age, increased diastolic blood pressure, increased high-density lipoprotein cholestero l, and decreased low-density lipoprotein cholesterol were associated with increased risk of worsening. For high initial grade, any cardiovascular disease and low ankle–arm index were associated with decreased risk of worsening, whereas use of diuretics and statins were associated with increased risk.

Conclusion— Worsening white matter grade on serial MRI scans in elderly is common, is associated with cognitive decline, and has complex relations with cardiovascular risk factors.

Key Words: incidence • leukoaraiosis • magnetic resonance imaging

Fonte:Stroke. 2005;36:56

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