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Magnetic resonance imaging markers of cerebral small vessel disease in an elderly population – association with cardiovascular disease and cognitive function
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cerebral small vessel disease (SVD) is identifiable by clinical, neuroimaging, neuropathological and cognitive findings.

The aim of this thesis was to assess SVD and cerebral perfusion on magnetic resonance imaging (MRI) in a 75-year-old population and compare the findings with scars of myocardial infarctions, cardiovascular risk markers and cognitive function. In addition, the evolution of SVD over 5 years was studied.

The study population included subjects from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. The subjects had been chosen in a randomized manner from the register of the municipality. MRI of the brain and the heart, cognitive tests and blood tests for cardiovascular risk factors were performed in 406 subjects at age 75 years and 250 of them were re-examined 5 years later at the age of 80.

Paper 1 showed that unrecognized myocardial infarctions (UMIs) were found in 120 subjects (30%) and recognized myocardial infarctions (RMIs) in 21 (5%). Men with RMIs displayed an increased prevalence of cortical and lacunar cerebral infarctions, whereas women with UMIs more frequently had cortical cerebral infarctions.

Paper 2 showed that one or more brain infarcts were seen in 23% of the subjects (20% had only lacunar infarcts, 1% had only cortical infarcts and 2% had both). Hypertension and obesity were significantly associated with an increased risk of infarction.  The newer risk markers investigated were not significantly associated with brain infarcts.

Paper 3 showed that MRI manifestations of SVD progressed over 5 years. Relative cerebral blood flow (rCBF) was not associated with WMH volume or progression of WMH volume.

Paper 4 showed that moderate to severe WMHs and incident lacunar infarcts on brain MRI were associated with a mild impairment of executive function.

In conclusion, this longitudinal population based study compares MRI manifestations of SVD with clinical data, providing knowledge that may be used in further investigations of preventive interventions and for identification of disease in early stages.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , 55 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1327
Keyword [en]
Magnetic resonance imaging, cerebral perfusion, small vessel disease, cognitive function
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:uu:diva-319766ISBN: 978-91-554-9900-6 (print)OAI: oai:DiVA.org:uu-319766DiVA: diva2:1087718
Public defence
2017-06-02, Rosénsalen, Akademiska Barnsjukhuset, ing. 95-96, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2017-05-12 Created: 2017-04-10 Last updated: 2017-05-23
List of papers
1. Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes
Open this publication in new window or tab >>Prevalence of unrecognized myocardial infarction detected with magnetic resonance imaging and its relationship to cerebral ischemic lesions in both sexes
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2011 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 58, no 13, 1372-1377 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The purpose of this study was to investigate the prevalence of unrecognized myocardial infarction (UMI) detected with magnetic resonance imaging (MRI) and whether it is related to cerebral ischemic lesions on MRI in an elderly population-based cohort.

BACKGROUND: There is a correlation between stroke and recognized myocardial infarction (RMI) and between stroke and UMI detected with electrocardiography, whereas the prevalence of stroke in subjects with MRI-detected UMI is unknown.

METHODS: Cerebral MRI and cardiac late-enhancement MRI were performed on 394 randomly selected 75-year-old subjects (188 women, 206 men). Images were assessed for cerebral ischemic lesions and myocardial infarction (MI) scars. Medical records were scrutinized. Subjects with MI scars, with or without a hospital diagnosis of MI, were classified as RMI or UMI, respectively.

RESULTS: UMIs were found in 120 subjects (30%) and RMIs in 21 (5%). The prevalence of UMIs (p = 0.004) and RMIs (p = 0.02) was greater in men than in women. Men with RMI displayed an increased prevalence of cortical and lacunar cerebral infarctions, whereas women with UMI more frequently had cortical cerebral infarctions (p = 0.003).

CONCLUSIONS: MI scars are more frequent in men than in women at 75 years of age. The prevalence of RMI is related to that of cerebral infarctions.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160996 (URN)10.1016/j.jacc.2011.06.028 (DOI)21920267 (PubMedID)
Available from: 2011-11-04 Created: 2011-11-04 Last updated: 2017-04-10Bibliographically approved
2. Relation between Cardiovascular Disease Risk Markers and Brain Infarcts Detected by Magnetic Resonance Imaging in an Elderly Population
Open this publication in new window or tab >>Relation between Cardiovascular Disease Risk Markers and Brain Infarcts Detected by Magnetic Resonance Imaging in an Elderly Population
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2015 (English)In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 24, no 2, 312-318 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Established cardiovascular risk markers, such as hypertension, are associated with increased risk of brain infarcts. The newer markers N-terminal pro-brain natriuretic peptide, troponin I, C-reactive protein, and cystatin C may affect the risk of cardiovascular events and potentially, thereby, also stroke. We investigated the association between established and new risk markers for cardiovascular disease and brain infarcts detected by magnetic resonance imaging (MRI) at age 75.

METHODS:

Four hundred six randomly selected subjects from the Prospective Investigation of the Vasculature in Uppsala Seniors study were examined with MRI of the brain at age 75. Blood samples, measurements, and dedicated questionnaires at age 70 were used for analysis of risk markers. A history of diseases had been obtained at age 70 and 75. MRI was evaluated regarding lacunar and cortical infarcts. Univariate associations between outcomes and risk markers were assessed with logistic regression models.

RESULTS:

One or more infarcts were seen in 23% of the subjects (20% had only lacunar infarcts, 1% had only cortical infarcts, and 2% had both). Hypertension (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.4, 4.7) and obesity (OR 1.3; CI 1.0, 1.8) were significantly associated with increased risk of brain infarction. The newer risk markers were not significantly associated with the brain infarcts.

CONCLUSIONS:

The new markers were not associated with the predominantly lacunar infarcts in our 75-year-old population, why troponin I and NT-proBNP may be associated mainly with cardioembolic infarcts as shown recently.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-238456 (URN)10.1016/j.jstrokecerebrovasdis.2014.08.027 (DOI)000349177300010 ()25444032 (PubMedID)
Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2017-04-10Bibliographically approved
3. Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal study
Open this publication in new window or tab >>Quantitative and qualitative MRI evaluation of cerebral small vessel disease in an elderly population: a longitudinal study
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-319612 (URN)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-04-10
4. Small vessel disease on neuroimaging in elderly individuals: association with cognitive and executive tests
Open this publication in new window or tab >>Small vessel disease on neuroimaging in elderly individuals: association with cognitive and executive tests
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-319613 (URN)
Available from: 2017-04-06 Created: 2017-04-06 Last updated: 2017-04-10

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