Abstract WP450: Cognitive Impairment and Asymptomatic Intracranial Atherosclerotic Stenosis in General Population

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
M.Fareed K. Suri ◽  
Jincheng Zhou ◽  
Ye Qiao ◽  
Haitao Chu ◽  
Adnan I Qureshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
African Americans ◽  
Previous History ◽  
Vascular Risk Factors ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: There is growing evidence suggesting that intracranial atherosclerosis is associated with cognitive impairment. We investigated the association between asymptomatic intracranial atherosclerosis and cognitive impairment in the bi-racial Atherosclerosis Risk in Communities (ARIC) cohort. Methods: ARIC participants who underwent high-resolution 3T magnetic resonance angiography, and a neuropsychology battery and neurological examination adjudicated by an expert panel, to detect mild cognitive impairment (MCI) and dementia. We adjusted for demographic and vascular risk factors in weighted logistic regression analysis, accounting for stratified sampling design and attrition, to determine the association of intracranial atherosclerotic stenosis (ICAS) with cognitive impairment. Results: In 1705 participants (mean age 76 ± 5.3, 41% men, 71% Whites and 29% African-Americans) with adequate imaging quality and no previous history of stroke, MCI was identified in 578 (34%) and dementia in 79 (4.6%). In white participants, after adjustment for demographic and vascular risk factors, ICAS ≥50% (vs no ICAS) was strongly associated with dementia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-10) and with any-cognitive impairment (OR 1.7, 95% CI 1.06 - 2.8). In contrast, no association was found between ICAS ≥50% and MCI or dementia in African-Americans, though sample size was limited and estimates were imprecise. Conclusion: Our results suggest asymptomatic ICAS is independently associated with cognitive impairment and dementia in Whites

scholarly journals Cognitive impairment and intracranial atherosclerotic stenosis in general population

Neurology ◽  
2018 ◽  
Vol 90 (14) ◽  
pp. e1240-e1247 ◽  
Author(s):  
M. Fareed K. Suri ◽  
Jincheng Zhou ◽  
Ye Qiao ◽  
Haitao Chu ◽  
Adnan I. Qureshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Expert Panel ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Atherosclerosis Risk ◽  
History Of

ObjectiveTo investigate the association between asymptomatic intracranial atherosclerosis and cognitive impairment in the Atherosclerosis Risk in Communities (ARIC) cohort.MethodsARIC participants underwent high-resolution 3T magnetic resonance angiography and a neuropsychology battery and neurologic examination adjudicated by an expert panel to detect mild cognitive impairment (MCI) and dementia. We adjusted for demographic and vascular risk factors in weighted logistic regression analysis, accounting for stratified sampling design and attrition, to determine the association of intracranial atherosclerotic stenosis (ICAS) with cognitive impairment.ResultsIn 1,701 participants (mean age 76 ± 5.3, 41% men, 71% whites, 29% blacks) with adequate imaging quality and no history of stroke, MCI was identified in 578 (34%) and dementia in 79 (4.6%). In white participants, after adjustment for demographic and vascular risk factors, ICAS ≥50% (vs no ICAS) was strongly associated with dementia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7–10.0) and with any cognitive impairment (OR 1.7, 95% CI 1.1–2.8). In contrast, no association was found between ICAS ≥50% and MCI or dementia in blacks, although the sample size was limited and estimates were imprecise.ConclusionOur results suggest that asymptomatic ICAS is independently associated with cognitive impairment and dementia in whites.

The Spectrum of Cerebrovascular Disease and Associated Cognitive Decline

2019 ◽  
pp. 574-599
Author(s):  
Victoria J. Williams ◽  
Steven E. Arnold ◽  
David H. Salat
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Structure And Function ◽  
Vascular Risk Factors ◽  
Vascular Health ◽  
Vascular Risk ◽  
And Function

Throughout the lifespan, common variations in systemic health and illness contribute to alterations in vasculature structure and function throughout the body, significantly increasing risk for cardiovascular and cerebrovascular disease (CVD). CVD is a prevalent cause of mortality in late life; it also promotes brain alterations, contributing to cognitive decline and, when severe, vascular dementia. Even prior to diseased states, individual variation in CVD risk is associated with structural and functional brain alterations. Yet, how cumulative asymptomatic alterations in vessel structure and function contribute to more subtle changes in brain tissue integrity and function that emerge in late life is unclear. Finally, vascular risk factors are associated with the clinical progression of neurodegenerative diseases such as Alzheimer’s disease (AD); however, recent theory posits that vascular degeneration may serve a contributory role in these conditions. This chapter reviews how lifespan changes in vascular health contribute to degenerative changes in neural tissue and the subsequent development of cognitive impairment and/or vascular dementia. It first discusses associations between vascular risk factors and cognition and also how declining vascular health may lead to cognitive impairment and dementia. Next, it identifies basic aspects of cerebrovascular anatomy and physiology sustaining tissue health and discusses how vulnerabilities of this system contribute to neurodegenerative changes. Finally, it reviews evidence of vascular contributions to AD and presents ideas for future research to better understand the full spectrum of cerebrovascular contributions to brain aging, cognitive decline, and dementia.

scholarly journals Vascular risk factors and cognitive impairment in a stroke-free cohort

Neurology ◽  
2011 ◽  
Vol 77 (19) ◽  
pp. 1729-1736 ◽  
Author(s):  
F. W. Unverzagt ◽  
L. A. McClure ◽  
V. G. Wadley ◽  
N. S. Jenny ◽  
R. C. Go ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Vascular Risk Factors ◽  
Vascular Risk

Abstract TP222: Frequency of Intracranial Arterial Imaging and its Yield in Consecutive Patients with Non-lacunar Cryptogenic Ischemic Stroke: ESUS Global Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kanjana S Perera ◽  
Balakumar Swaminathan ◽  
Jackie Bosch ◽  
Robert G Hart ◽  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Latin American ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Population ◽  
Atherosclerotic Stenosis ◽  
Index Stroke ◽  
Global Registry ◽  
Arterial Imaging

Background: Atherosclerotic stenosis of large IC arteries is an important cause of stroke. The prevalence of ICS in stroke population differs by ethnicity.We report the frequency of ICS among a global sample of patients with non-lacunar cryptogenic ischemic stroke (NLCIS) who did not have another identifiable cause for stroke i.e. cardioembolic, extracranial LAD, or other specific causes. Hypothesis: We hypothesized that the prevalence rates of ICS will differ according to global regions. Methods: Consecutive patients with recent ischemic stroke were retrospectively surveyed at 19 stroke centers in 19 countries to identify the frequency of IC imaging and its yield. Countries were grouped by World Bank regions. ICS was considered to be significant if there was >50% stenosis in the arteries proximal to the index stroke evidenced by MRA, CTA or TCD. Results: We identified a total of 2145 consecutive ischemic stroke patients among which 475 had NLCIS. IC arterial imaging was carried-out,on average, in 87% of patients. Of these 414 patients, 15% had stenosis proximal to the area of brain ischemia. The frequency of ICS among NLCIS patients was highest in East Asia (27%) and lowest in Pacific (4%). Patients with ICS in Latin America were significantly younger when compared to other 4 regions. Conclusion: IC arterial imaging is carried out in majority of stroke centers in patients with NLCIS, among whom the fraction of IS associated with ICS is substantial throughout the world, averaging about 15%. MRA / CTA had a higher yield than TCD. On average these patients have traditional vascular risk factors except for Latin American patients who are significantly younger with no vascular risk factors.

Abstract W P121: Patterns Of Vessel Involvement In Patients With Intracranial Atherosclerosis Across Ages

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tamara Strohm ◽  
Russell Cerejo ◽  
Jason Mathew ◽  
Irene Katzan ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Age Groups ◽  
Vascular Risk Factors ◽  
Posterior Circulation ◽  
Intracranial Stenosis ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Basilar Arteries ◽  
Vessel Involvement

Introduction: Intracranial atherosclerosis has been well studied in the aging population, much less is known about atherosclerotic stenosis in the young. Clinicians seek to control traditional vascular risk factors in this population, but differences in patterns of stenosis may call for varied treatment approaches. This study sought to compare age to the distribution of vessel involvement in patients with moderate-severe intracranial stenosis. Methods: This is a retrospective cohort study of patients with intracranial stenosis seen in the stroke clinic of a tertiary center from 2008-2013. Inclusion criteria were moderate-severe intracranial stenosis clinically felt to be due to atherosclerosis with ≥3 traditional vascular risk factors. Patients with other mechanisms of intracranial stenosis were excluded. Stenosis location and severity were based on cerebral angiography, CTA, or MRA. Patients were divided into young (< 50 yr), middle-age (51-64 yr), or older (≥ 65 yr). All 69 patients ≤50 yr were included; a random sample of 69 patients > 50 were selected for this analysis. Results: There were similar rates of vascular risk factors except HTN, which was less common in the young group (81.2% young, 100% middle, 96.8% older, p=0.0006). The location of stenoses varied by age category. Older patients had more posterior circulation involvement compared to the younger groups (p = 0.046), with more frequent involvement of vertebral and basilar arteries (p = 0.012) (Table). The occurrence of stenosis in the distal ICA and MCA vessels were similar among age groups. The frequency of ACA stenosis was highest in the young category (p = 0.026). Conclusion: There are differences in anatomic locations of presumed intracranial atherosclerosis across age groups with older patients (> 65 yrs) having a higher rate of posterior circulation disease. This suggests potential differences in pathophysiological mechanisms. These findings warrant further investigation.

Abstract WP116: Patterns of Vascular Calcification in Young Patients With Intracranial Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tamara Strohm ◽  
Irene Katzan ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Vascular Calcification ◽  
Young Patients ◽  
Vascular Risk Factors ◽  
Intracranial Stenosis ◽  
Intracranial Calcification ◽  
Vascular Risk ◽  
Atherosclerotic Stenosis ◽  
Significant Difference ◽  
Determine Mechanism

Introduction: Intravascular calcification is thought to be a marker of atherosclerosis in patients with stenosis and vascular risk factors. Little is known about the utility of quantifying intracranial calcification to help determine mechanism of stenosis. The objective of our study was to compare presence and patterns of intracranial calcification in patients with intracranial stenosis due to atherosclerosis and other etiologies. Methods: Retrospective cohort study of 89 patients < 50 years with diagnosis of intracranial stenosis who had undergone CT angiogram from 2008-2013; 44 had presumed atherosclerosis as etiology ( > 3 vascular risk factors with no other identified cause). CTAs were reviewed for presence and location of intracranial calcification. Results: Of patients with atherosclerotic stenosis, 28 (64%) had intravascular calcification compared to 16 (36%) of those with stenosis of other etiologies (P=0.0039). There was no significant difference in pattern or location of stenosis between groups. One-third had calcification outside the region of stenosis in both groups. Distal internal carotid artery and distal vertebral artery were the most common sites of intracranial calcification (Table). Conclusion: Intracranial calcification is more commonly seen in patients < 50 years old with stenosis secondary to atherosclerosis, but the pattern and location was similar between groups. More research is needed to determine the utility of using the presence of vascular calcification to help determine mechanism of intracranial stenosis in the young.

Abstract P230: Markers of Hyperglycemia and Intracranial Atherosclerotic Stenosis by Magnetic Resonance Angiography

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Akira Fujiyoshi ◽  
M.Fareed K Suri ◽  
Alvaro Alonso ◽  
Elizabeth Selvin ◽  
Haitao Chu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Atherosclerosis Risk In Communities ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
History Of ◽  
Diagnosed Diabetes ◽  
Aric Study

Introduction: Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke. Determinants of ICAS include conventional cardiovascular (CV) risk factors such as hypertension and dyslipidemia. The association of diabetes mellitus (DM) and/or hyperglycemia with ICAS, however, is less well documented. Hypothesis: In a community-based population, biomarkers of hyperglycemia will be cross-sectionally associated with prevalent ICAS independent of CV risk factors. Methods: Our analyses were conducted in a subsample of participants of the Atherosclerosis Risk in Communities (ARIC) Study who participated in the ARIC-Neurocognitive Study in 2011-13 with cerebrovascular magnetic resonance angiography and no history of stroke. For the present analyses, we grouped the participants into 3 categories based on the highest ICAS category among any of the intracranial arteries we assessed: “no stenosis”, “<50%”, or “≥50% (including occlusion)”. Diagnosed diabetes was defined as self-reported physician diagnosis or use of antidiabetic medication. Ordinal logistic regression provided odds ratios of prevalent ICAS according to quintile of glucose or glycated hemoglobin (HbA1c) adjusted for CV risk factors. Results (Table): There were 1,658 individuals included in our study (age 67-90 years, women 58%, Black 29%), 31% (514/1658) had diagnosed diabetes, 10% (165/1658) had ≥50 % stenosis at any of the intracerebral arteries. In crude analyses, those with higher glucose and HbA1c were more likely to have ICAS among the non-diabetes and the diabetes. In logistic regression, highest quintile of glucose, relative to the lowest, had odds ratio of 2.26 (95% confidence interval 1.48, 3.45) for being in each successive ICAS category after adjustment for CV risk factors. Conclusion: Higher glucose and HbA1c were associated with higher odds of ICAS independent of CV risk factors. The finding suggests that hyperglycemia plays a role in pathogenesis of ICAS.

P2-115: Influence of vascular risk factors on cognitive performance in community-dwelling African Americans

2008 ◽  
Vol 4 ◽  
pp. T405-T405
Author(s):  
Christine M. Khosropour ◽  
N. Maritza Dowling ◽  
Whitney Wharton ◽  
Dorothy F. Edwards ◽  
Cynthia M. Carlsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
African Americans ◽  
Cognitive Performance ◽  
Vascular Risk Factors ◽  
Community Dwelling ◽  
Vascular Risk
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