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Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment
Doeschka A Ferro1, Hilde van den Brink2, Lieza G Exalto2
1From the Department of Neurology (D.A.F., H.v.d.B., L.G.E., J.M.F.B., G.J.B.), Brain Center UMC Utrecht, University Medical Center Utrecht, Utrecht University; Department of Neurology (J.M.F.B.), Onze Lieve Vrouwe Gasthuis (OLVG) West; Department of Radiology & Nuclear Medicine (F.B.) Department of Neurology and Alzheimer Center Amsterdam (N.D.P., W.M.v.d.F.), Department of Epidemiology & Biostatistics (W.M.v.d.F.), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands; and Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK. d.a.ferro@umcutrecht.nl.
Objective:
To determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome.
Methods:
The TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46% female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal.
Results:
A total of 23 ACMIs were found in 16 of the 783 patients (2.0%). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.4-18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3-9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4-12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7-13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5-144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4-6.0, p = 0.005).
Conclusion:
In patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.
Insights
Acute cerebral microinfarcts (ACMIs) are rare in memory clinic patients but indicate active vascular brain injury. Their presence is linked to a higher risk of poor clinical outcomes and increased cerebrovascular disease burden.
Area of Science:
- Neurology
- Neuroimaging
- Vascular Dementia Research
Background:
- Vascular cognitive impairment (VCI) affects memory clinic populations.
- Acute cerebral microinfarcts (ACMIs) are small lesions that may indicate ongoing cerebrovascular disease.
- Understanding ACMI prevalence and impact is crucial for managing VCI.
Purpose of the Study:
- To determine the occurrence of ACMIs in memory clinic patients.
- To investigate the association of ACMIs with vascular risk factors, cognitive profiles, and CSF/neuroimaging markers.
- To evaluate the relationship between ACMIs and clinical outcomes in patients with possible VCI.
Main Methods:
- The TRACE-VCI study cohort included 783 patients with vascular brain injury on MRI.
- 3T diffusion-weighted imaging (DWI) was used to identify ACMIs (<5 mm supratentorial DWI hyperintensities).
- Associations with vascular risk, cognition, biomarkers, and clinical outcomes were analyzed.
Main Results:
- ACMIs were found in 2.0% of patients (16/783).
- ACMI presence was associated with a higher diagnosis of vascular dementia (OR 5.1) and increased cerebrovascular disease markers (e.g., microbleeds OR 18.9).
- Patients with ACMIs faced a 3-fold increased risk of poor clinical outcomes after a median 2.1-year follow-up.
Conclusions:
- ACMI presence in possible VCI patients signifies a substantial burden of cerebrovascular disease.
- ACMIs are associated with both small and large vessel disease.
- ACMIs may serve as a novel indicator of active vascular brain injury in VCI patients.
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