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Conference Paper: White matter hyperintensities, cerebral microbleeds, and medial temporal lobe atrophy in high-risk non-demented adults: prevalence and progression over 2 years

TitleWhite matter hyperintensities, cerebral microbleeds, and medial temporal lobe atrophy in high-risk non-demented adults: prevalence and progression over 2 years
Authors
Issue Date2016
PublisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/
Citation
The 21st Medical Research Conference (MRC 2016), Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 16 January 2016. In Hong Kong Medical Journal, v. 22 n. 1 suppl. 1, p. 42, abstract no. 66 How to Cite?
AbstractBackground: MRI markers of small vessel disease [white matter hyperintensities (WMH) and cerebral microbleeds (CMB)] and medial temporal lobe atrophy (MTLA) are frequent findings in patients with stroke and dementia. This was a hospital-based study to examine the prevalence of these MRI abnormalities amongst high-risk non-demented adults, and the risk factors for progression over 2 years. Methods: We analysed the data for 29 older non-demented adults (mean ± s.d. age was 73.8 ± 8.5 years, 66% male) with high baseline vascular risk. Each patient had undergone two brain MRI scans with a mean interval of 2 ± 0.9 years. 3T MRI brain images were retrospectively examined for the severity and location of WMH (Fazekas Score 0-3, >1 abnormal), CMB (Microbleed Anatomical Rating Scale 0-3, >0 abnormal) and MTLA (Scheltens Score 0-4, >1 abnormal). Comparisons were made between the first and second MRI for each patient. Results: Amongst our 29 participants, 38% were current/ex-smokers, 83% had hypertension, 35% had diabetes mellitus, 21% had coronary heart disease, 65% had previous stroke, 62% had hyperlipidaemia, and 7% had atrial fibrillation (AF). For medications, 35% were on statins, 69% on antiplatelet agents, and 10% on oral anticoagulants. MRI at baseline showed that 100% had subcortical WMH, 83% had periventricular WMH, 57% had CMB, and 38% had MTLA. During a mean interval of 2 years, 33% had progression of WMH, 32% had higher numbers of CMB (16% had worse CMB grades), and 38% had progression of MTLA. Patients with AF were more likely to experience WMH progression (p=.038), and patients with diabetes were more likely to experience MTLA progression (p=.01). Age, other vascular risk factors and prior antithrombotics and statin use were not significantly correlated with progression of MRI abnormalities. Multiple logistic regression analyses found no independent predictive factors. Conclusion: Amongst older non-demented adults with high cardiovascular risk, MRI markers of small vessel disease and MTLA are highly prevalent. One-in-three patients demonstrate rapid progression in WMH, CMB and MTLA within 2 years. AF and diabetes may exacerbate cerebral aging and progressive vascular damage, but their independent risks are unclear. Future trials should examine the effectiveness of vascular preventive interventions (e.g. use of non-vitamin K anticoagulants for AF) on cerebral protection.
Persistent Identifierhttp://hdl.handle.net/10722/225698
ISSN
2015 Impact Factor: 0.887
2015 SCImago Journal Rankings: 0.279

 

DC FieldValueLanguage
dc.contributor.authorKwan, SKJ-
dc.contributor.authorMak, SF-
dc.contributor.authorHar, WYA-
dc.contributor.authorAzman, R-
dc.contributor.authorMak, HKF-
dc.date.accessioned2016-05-20T08:10:13Z-
dc.date.available2016-05-20T08:10:13Z-
dc.date.issued2016-
dc.identifier.citationThe 21st Medical Research Conference (MRC 2016), Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, 16 January 2016. In Hong Kong Medical Journal, v. 22 n. 1 suppl. 1, p. 42, abstract no. 66-
dc.identifier.issn1024-2708-
dc.identifier.urihttp://hdl.handle.net/10722/225698-
dc.description.abstractBackground: MRI markers of small vessel disease [white matter hyperintensities (WMH) and cerebral microbleeds (CMB)] and medial temporal lobe atrophy (MTLA) are frequent findings in patients with stroke and dementia. This was a hospital-based study to examine the prevalence of these MRI abnormalities amongst high-risk non-demented adults, and the risk factors for progression over 2 years. Methods: We analysed the data for 29 older non-demented adults (mean ± s.d. age was 73.8 ± 8.5 years, 66% male) with high baseline vascular risk. Each patient had undergone two brain MRI scans with a mean interval of 2 ± 0.9 years. 3T MRI brain images were retrospectively examined for the severity and location of WMH (Fazekas Score 0-3, >1 abnormal), CMB (Microbleed Anatomical Rating Scale 0-3, >0 abnormal) and MTLA (Scheltens Score 0-4, >1 abnormal). Comparisons were made between the first and second MRI for each patient. Results: Amongst our 29 participants, 38% were current/ex-smokers, 83% had hypertension, 35% had diabetes mellitus, 21% had coronary heart disease, 65% had previous stroke, 62% had hyperlipidaemia, and 7% had atrial fibrillation (AF). For medications, 35% were on statins, 69% on antiplatelet agents, and 10% on oral anticoagulants. MRI at baseline showed that 100% had subcortical WMH, 83% had periventricular WMH, 57% had CMB, and 38% had MTLA. During a mean interval of 2 years, 33% had progression of WMH, 32% had higher numbers of CMB (16% had worse CMB grades), and 38% had progression of MTLA. Patients with AF were more likely to experience WMH progression (p=.038), and patients with diabetes were more likely to experience MTLA progression (p=.01). Age, other vascular risk factors and prior antithrombotics and statin use were not significantly correlated with progression of MRI abnormalities. Multiple logistic regression analyses found no independent predictive factors. Conclusion: Amongst older non-demented adults with high cardiovascular risk, MRI markers of small vessel disease and MTLA are highly prevalent. One-in-three patients demonstrate rapid progression in WMH, CMB and MTLA within 2 years. AF and diabetes may exacerbate cerebral aging and progressive vascular damage, but their independent risks are unclear. Future trials should examine the effectiveness of vascular preventive interventions (e.g. use of non-vitamin K anticoagulants for AF) on cerebral protection.-
dc.languageeng-
dc.publisherHong Kong Academy of Medicine Press. The Journal's web site is located at http://www.hkmj.org/-
dc.relation.ispartofHong Kong Medical Journal-
dc.rightsHong Kong Medical Journal. Copyright © Hong Kong Academy of Medicine Press.-
dc.titleWhite matter hyperintensities, cerebral microbleeds, and medial temporal lobe atrophy in high-risk non-demented adults: prevalence and progression over 2 years-
dc.typeConference_Paper-
dc.identifier.emailKwan, SKJ: jskkwan@hku.hk-
dc.identifier.emailHar, WYA: afifahar@hku.hk-
dc.identifier.emailMak, HKF: makkf@hkucc.hku.hk-
dc.identifier.authorityKwan, SKJ=rp01868-
dc.identifier.authorityMak, HKF=rp00533-
dc.identifier.hkuros257720-
dc.identifier.volume22-
dc.identifier.issue1 suppl. 1-
dc.identifier.spage42, abstract no. 66-
dc.identifier.epage42, abstract no. 66-
dc.publisher.placeHong Kong-

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