MRI markers of vascular brain injury found prognostically important

  • JAMA Neurol

  • curated by Susan London
  • Clinical Essentials
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Takeaway

  • Various MRI markers of covert vascular brain injury were associated with elevated risks for stroke, dementia, and death in community-dwelling older adults.

Why this matters

  • Markers are common incidental findings of unknown prognostic importance.
  • Establishing markers as risk factors might signal opportunity for preventive strategies.

Key results

  • Extensive white matter hyperintensities increased risks for:
    • Incident stroke (HR, 2.45; P<.001>
    • Ischemic stroke (HR, 2.39; P<.001>
    • Intracerebral hemorrhage (HR, 3.17; P=.002);
    • Dementia (HR, 1.84; P<.001>
    • Alzheimer’s disease (HR, 1.50; P<.001 and>
    • Death (HR, 2.00; P<.001>
  • MRI-defined brain infarcts increased risks for:
    • Incident stroke (HR, 2.38; P<.001>
    • Ischemic stroke (HR, 2.18; P<.001>
    • Intracerebral hemorrhage (HR, 3.81; P<.001 and>
    • Death (HR, 1.64; P<.001>
  • Cerebral microbleeds increased risks for:
    • Stroke (HR, 1.98; P<.001>
    • Ischemic stroke (HR, 1.92; P<.001>
    • Intracerebral hemorrhage (HR, 3.82; P<.001 and>
    • Death (HR, 1.53; P<.001>

Study design

  • Systematic review and meta-analysis: 94 prospective, longitudinal cohort studies among community-dwelling older adults.
  • Participants for analyses:
    • ≤14,529 for white matter hyperintensities of presumed vascular origin;
    • ≤16,012 for MRI-defined covert brain infarcts;
    • ≤15,693 for cerebral microbleeds;
    • ≤4587 for perivascular spaces.
  • Main outcomes: stroke, dementia, death.
  • Funding: None disclosed.

Limitations

  • Heterogeneous data.
  • Effect of longitudinal change in markers not assessable.
  • Insufficient data for perivascular spaces.

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