Related Experiment Videos
Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly
F E de Leeuw1, J C De Groot, M Oudkerk
1Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
Background And Purpose:
MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions.
Methods:
We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life.
Results:
The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions approximately 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions.
Conclusions:
The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.
Insights
Atherosclerosis in midlife is linked to periventricular white matter lesions in older age, suggesting early intervention is key for preventing cognitive decline.
Area of Science:
- Neurology
- Cardiovascular Health
- Aging Research
Background:
- White matter lesions are common in elderly brains and linked to cognitive impairment.
- Atherosclerosis, a gradual process starting early in life, has been anecdotally linked to white matter lesions.
Purpose of the Study:
- To investigate the longitudinal association between aortic atherosclerosis in midlife and late life and cerebral white matter lesions.
Main Methods:
- Utilized data from two population-based follow-up studies with baseline examinations in midlife (1975-1978) and late life (1990-1993).
- Assessed aortic atherosclerosis via abdominal radiographs in midlife (n=276) and late life (n=531).
- Evaluated cerebral white matter lesions (periventricular and subcortical) using 1.5-T MRI scans in 1995-1996.
Main Results:
- Midlife aortic atherosclerosis significantly predicted periventricular white matter lesions approximately 20 years later (aRR, 2.4; 95% CI, 1.2 to 5.0).
- A linear increase in risk was observed with greater aortic atherosclerosis severity.
- No significant association was found between midlife aortic atherosclerosis and subcortical lesions, nor between late-life aortic atherosclerosis and any white matter lesions.
Conclusions:
- The development of cerebral periventricular white matter lesions begins in midlife or earlier.
- Interventions targeting atherosclerosis prevention may need to occur well before clinical manifestation of white matter lesions to prevent cognitive consequences.