Metabolic risks, white matter hyperintensities, and arterial stiffness in high-functioning healthy adults

Abstract Background Stroke is a serious complication in patients with type 2 diabetes (T2DM). Arterial stiffness may improve stroke prediction. We investigated the association between carotid-femoral pulse wave velocity [PWV] and the progression of cerebral white matter hyperintensities (WMH), a marker of stroke risk, in patients with T2DM and controls. Methods In a 5-year cohort study, data from 45 patients and 59 non-diabetic controls were available for analysis. At baseline, participants had a mean (± SD) age of 59 ± 10 years and patients had a median (range) diabetes duration of 1.8 (0.8–3.2) years. PWV was obtained by tonometry and WMH volume by an automated segmentation algorithm based on cerebral T2-FLAIR and T1 MRI (corrected by intracranial volume, cWMH). High PWV was defined above 8.94 m/s (corresponding to the reference of high PWV above 10 m/s using the standardized path length method). Results Patients with T2DM had a higher PWV than controls (8.8 ± 2.2 vs. 7.9 ± 1.4 m/s, p < 0.01). WMH progression were similar in the two groups (p = 0.5). One m/s increase in baseline PWV was associated with a 16% [95% CI 1–32%], p < 0.05) increase in cWMH volume at 5 years follow-up after adjustment for age, sex, diabetes, pulse pressure and smoking. High PWV was associated with cWMH progression in the combined cohort (p < 0.05). We found no interaction between diabetes and PWV on cWMH progression. Conclusions PWV is associated with cWMH progression in patients with type 2 diabetes and non-diabetic controls. Our results indicate that arterial stiffness may be involved early in the pathophysiology leading to cerebrovascular diseases.

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Cerebral Microbleeds and White Matter Hyperintensities in Cognitively Healthy Elderly: A Cross-Sectional Cohort Study Evaluating the Effect of Arterial Stiffness

Cerebrovascular Diseases Extra ◽

10.1159/000377710 ◽

2015 ◽

Vol 5 (2) ◽

pp. 41-51 ◽

Cited By ~ 21

Author(s):

Anna-Märta Gustavsson ◽

Erik Stomrud ◽

Kasim Abul-Kasim ◽

Lennart Minthon ◽

Peter M. Nilsson ◽

...

Keyword(s):

Cognitive Function ◽

White Matter ◽

Arterial Stiffness ◽

White Matter Hyperintensities ◽

Small Vessel Disease ◽

Cerebral Microbleeds ◽

Small Vessel ◽

Cognitive Tests ◽

Vessel Disease ◽

Healthy Elderly

Background: Arterial stiffness reflects the ageing processes in the vascular system, and studies have shown an association between reduced cognitive function and cerebral small vessel disease. Small vessel disease can be visualized as white matter hyperintensities (WMH) and lacunar infarcts but also as cerebral microbleeds on brain magnetic resonance imaging (MRI). We aimed to investigate if arterial stiffness influences the presence of microbleeds, WMH and cognitive function in a population of cognitively healthy elderly. Methods: The study population is part of the Swedish BioFinder study and consisted of 208 individuals without any symptoms of cognitive impairment, who scored >27 points on the Mini-Mental State Examination. The participants (mean age, 72 years; 59% women) underwent MRI of the brain with visual rating of microbleeds and WMH. Arterial stiffness was measured with carotid-femoral pulse wave velocity (cfPWV). Eight cognitive tests covering different cognitive domains were performed. Results: Microbleeds were detected in 12% and WMH in 31% of the participants. Mean (±standard deviation, SD) cfPWV was 10.0 (±2.0) m/s. There was no association between the presence of microbleeds and arterial stiffness. There was a positive association between arterial stiffness and WMH independent of age or sex (odds ratio, 1.58; 95% confidence interval, 1.04-2.40, p < 0.05), but the effect was attenuated when further adjustments for several cardiovascular risk factors were performed (p > 0.05). Cognitive performance was not associated with microbleeds, but individuals with WMH performed slightly worse than those without WMH on the Symbol Digit Modalities Test (mean ± SD, 35 ± 7.8 vs. 39 ± 8.1, p < 0.05). Linear regression revealed no direct associations between arterial stiffness and the results of the cognitive tests. Conclusions: Arterial stiffness was not associated with the presence of cerebral microbleeds or cognitive function in cognitively healthy elderly. However, arterial stiffness was related to the presence of WMH, but the association was attenuated when multiple adjustments were made. There was a weak negative association between WMH and performance in one specific test of attention. Longitudinal follow-up studies are needed to further assess the associations.

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Retinal image analytics detects white matter hyperintensities in healthy adults

Annals of Clinical and Translational Neurology ◽

10.1002/acn3.688 ◽

2018 ◽

Vol 6 (1) ◽

pp. 98-105 ◽

Cited By ~ 6

Author(s):

Alexander Y. Lau ◽

Vincent Mok ◽

Jack Lee ◽

Yuhua Fan ◽

Jinsheng Zeng ◽

...

Keyword(s):

White Matter ◽

Retinal Image ◽

White Matter Hyperintensities ◽

Healthy Adults

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P4-575: ARTERIAL STIFFNESS IS ASSOCIATED WITH GREATER WHITE MATTER BLOOD FLOW AND WHITE MATTER HYPERINTENSITIES REGARDLESS OF COGNITIVE STATUS

Alzheimer s & Dementia ◽

10.1016/j.jalz.2019.08.123 ◽

2019 ◽

Vol 15 ◽

pp. P1540-P1540

Author(s):

Youngkyoo Jung ◽

Timothy M. Hughes ◽

Samuel Lockhart ◽

Donghoon Kim ◽

Christopher T. Whitlow ◽

...

Keyword(s):

Blood Flow ◽

White Matter ◽

Arterial Stiffness ◽

White Matter Hyperintensities ◽

Cognitive Status

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White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness

Geriatrics and Gerontology International ◽

10.1111/ggi.12673 ◽

2015 ◽

Vol 15 ◽

pp. 17-25 ◽

Cited By ~ 9

Author(s):

Naoki Saji ◽

Noriko Ogama ◽

Kenji Toba ◽

Takashi Sakurai

Keyword(s):

White Matter ◽

Arterial Stiffness ◽

White Matter Hyperintensities ◽

Geriatric Syndrome

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Sex differences in interrelationships between arterial stiffness, carotid intima-media thickness, white matter hyperintensities, depression and cognition: A UK Biobank study

10.1101/755280 ◽

2019 ◽

Author(s):

Ruby S. M. Tsang ◽

John E. Gallacher ◽

Sarah Bauermeister

Keyword(s):

Sex Differences ◽

White Matter ◽

Arterial Stiffness ◽

White Matter Hyperintensities ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

List Type ◽

Media Thickness ◽

Microvascular Changes ◽

Vascular Ageing

AbstractObjectiveTo explore sex differences in the associations between arterial stiffness index, carotid intima-media thickness, white matter hyperintensities, depression and cognition.MethodsUK Biobank is a population-based cohort study of 502,664 healthy community dwelling adults aged 37-73 years. A select number of participants were recalled to participate in an online reassessment and imaging study, both of which included repeat cognitive assessments. A total of 7,394 volunteers aged 45-73 years (55% female) participated in the imaging visit and completed the self-report mental health questionnaire in the online follow-up were included in the analyses reported here. The main outcome measure of depression was measured using the PHQ-9 and cognition was assessed through measures of reaction time, verbal-numeric reasoning and visual memory. Pulse wave velocity (PWV) was assessed non-invasively using finger photoplethysmography, carotid intima-media thickness (CIMT) with automated ultrasound, and white matter hyperintensity volume with combined T1 and T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI).ResultsCross-sectionally, greater arterial stiffness was associated with greater depression in men but with better cognition in women. When white matter hyperintensities burden was added to the model, it mediated the relationships of carotid intima-media thickness with depression and cognition only in men.ConclusionsWe report sex differences in brain microvascular changes, depression and cognition in ageing, and suggest that they may be partly explained by sex-specific effects of vascular ageing.Summary boxesSection 1: What is already known on this topicArterial stiffness and carotid intima-media thickness are two non-invasive vascular ageing markers that have been shown to be associated with depression, cognitive impairment and dementia.Some studies report sex differences in arterial stiffness and carotid intima-media thickness.There is, however, a paucity of research on sex differences in the associations between these vascular ageing markers, white matter hyperintensities, depression and cognition.Section 2: What this study addsCross-sectionally, greater arterial stiffness was associated with greater depression in men but with better cognition in women. When white matter hyperintensities burden was added to the model, it mediated the relationships of carotid intima-media thickness with depression and cognition only in men.Our findings add to the existing evidence base of sex differences in brain microvascular changes, depression and cognition in ageing, and suggest that they may be partly explained by sex-specific effects of vascular ageing.

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