Atrial Fibrillation, Stroke, and Silent Cerebrovascular Disease: A Population-Based MRI Study

Background and Objectives:Atrial fibrillation (AF) has been associated with cognitive decline and dementia. However, the mechanisms behind these associations are not clear. Examination of cerebrovascular pathology on MRI may shed light on how AF affects the brain. This study aimed to determine whether AF is associated with a broad range of cerebrovascular diseases, beyond the well-known association with symptomatic stroke, including silent infarcts and markers of small vessel disease, e.g. cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and lacunes, in a population-based sample of 70-year-olds.Methods:Data were obtained from the Gothenburg H70 Birth Cohort Studies, where individuals are invited based on birth-date. This study has a cross-sectional design and includes individuals born 1944 who underwent structural brain MRI in 2014-17. AF diagnoses were based on self-report, EKG, and register data. Symptomatic stroke was based on self-report, proxy-interviews, and register data. Brain infarcts and CMBs were assessed by a radiologist. WMH volumes were measured on FLAIR images using the Lesion Segmentation Tool. Multivariate logistic regression was used to study the association between AF and infarcts/CMBs, and multivariate linear regression was used to study the association between AF and WMHs.Results:A total of 776 individuals were included and 65 (8.4%) had AF. AF was associated with symptomatic stroke (OR 4.5, 95% CI 2.1-9.5), and MRI findings of large infarcts (OR 5.0, 95% CI 1.5-15.9), lacunes (OR 2.7, 95% CI 1.2-5.6), and silent brain infarcts (OR 3.5; 95% CI 1.6-7.4). Among those with symptomatic stroke, individuals with AF had larger WMH volumes (0.0137 ml/total intracranial volume (TIV), 95% CI 0.0074-0.0252) compared to those without AF (0.0043 ml/TIV, 95% CI 0.0029-0.0064). There was no association between AF and WMH volumes among those without symptomatic stroke. In addition, AF was associated to CMBs in the frontal lobe.Discussion:AF was associated with broad range of cerebrovascular pathologies. Further research is needed to establish whether cerebrovascular MRI markers can be added to current treatment guidelines to further personalise anticoagulant treatment in AF patients and to further characterize the pathogenetic processes underlying the associations between AF and cerebrovascular diseases, as well as dementia.

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The Omega-3 Fatty Acid Eicosapentaenoic Acid (EPA) Correlates Inversely with Ischemic Brain Infarcts in Patients with Atrial Fibrillation

Nutrients ◽

10.3390/nu13020651 ◽

2021 ◽

Vol 13 (2) ◽

pp. 651

Author(s):

Martin F. Reiner ◽

Philipp Baumgartner ◽

Andrea Wiencierz ◽

Michael Coslovsky ◽

Nicole R. Bonetti ◽

...

Keyword(s):

Atrial Fibrillation ◽

Fatty Acid ◽

Small Vessel Disease ◽

Small Vessel ◽

Omega 3 ◽

Total N ◽

Ischemic Brain ◽

Omega 3 Fatty Acid ◽

Vessel Disease ◽

Brain Infarcts

The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs); markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29–0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49–4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.

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Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults

Neurology ◽

10.1212/wnl.0000000000012916 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012916

Author(s):

Aline Thomas ◽

Fabrice Crivello ◽

Bernard Mazoyer ◽

Stephanie Debette ◽

Christophe Tzourio ◽

...

Keyword(s):

Factor Analysis ◽

Cerebrovascular Disease ◽

Brain Mri ◽

Large Population ◽

Population Based ◽

Fish Intake ◽

Mixed Data ◽

Perivascular Spaces ◽

Intracranial Volume ◽

Cross Sectional

Background and Objective:Fish intake may prevent cerebrovascular disease (CVD), yet the mechanisms are unclear, especially regarding its impact on subclinical damage. Assuming that fish may have pleiotropic effect on cerebrovascular health, we investigated the association of fish intake with global CVD burden based on brain MRI markers.Methods:This cross-sectional analysis included participants from the Three-City Dijon population-based cohort (aged ≥65 years) without dementia, stroke, or history of hospitalized cardiovascular disease, who underwent brain MRI with automated assessment of white matter hyperintensities, visual detection of covert infarcts, and grading of dilated perivascular spaces. Fish intake was assessed through a frequency questionnaire and the primary outcome measure was defined as the first component of a factor analysis of mixed data applied to MRI markers. The association of fish intake with the CVD burden indicator was studied using linear regressions.Results:In total, 1,623 participants (mean age, 72.3 years; 63% women) were included. The first component of factor analysis (32.4% of explained variance) was associated with higher levels of all three MRI markers. Higher fish intake was associated with lower CVD burden. In a model adjusted for total intracranial volume, compared to participants consuming fish <1 per week, those consuming fish 2-3 and ≥4 times per week had a β = -0.19 (95% CI, -0.37; -0.01) and β = -0.30 (-0.57; -0.03) lower indicator of CVD burden, respectively (P trend <0.001). We found evidence of effect modification by age, so that the association of fish to CVD was stronger in younger participants (65-69 years) and not significant in participants aged ≥75 years. For comparison, in the younger age group, consuming fish 2-3 times a week was roughly equivalent (in opposite direction) to the effect of hypertension.Discussion:In this large population-based study, higher frequency of fish intake was associated with lower CVD burden, especially among participants younger than 75 years, suggesting a beneficial effect on brain vascular health before manifestation of overt brain disease.Classification of Evidence:This study provides Class II evidence that in individuals without stroke or dementia, higher fish intake is associated with lower subclinical CVD at MRI.

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Abstract 12385: Past Alcohol Consumption and Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.12385 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Shalini Dixit ◽

Alvaro Alonso ◽

Elsayed Z Soliman ◽

Lin Y Chen ◽

Gregory M Marcus

Keyword(s):

Atrial Fibrillation ◽

Alcohol Consumption ◽

Alcohol Use ◽

Population Based ◽

Self Report ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Before And After ◽

Dietary Intake Assessment ◽

Aric Study

Introduction: Although current alcohol consumption appears to be a risk factor for incident atrial fibrillation (AF), limitations related to self-reported alcohol use and confounding in observational studies limit the certainty of conclusions regarding causality. Whether cessation of alcohol consumption can protect against incident AF remains unknown. Methods: We examined all participants in the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort of 15,792 men and women aged 45-65, without prevalent AF. Past alcohol consumption was assessed via self-report during the baseline dietary intake assessment. Cases of incident AF were ascertained via study ECGs, hospital discharge ICD-9 codes, and death certificates. Results: Among 15,262 participants with complete survey data, 2,898 (19.0%) were former drinkers. During an average follow-up of 17.4 years, there were 380 cases of incident AF in former consumers. Both before and after adjustment for potential confounders, a longer duration of alcohol abstinence was associated with a lower risk of developing AF; previously consuming alcohol for a longer duration and consuming a greater quantity of alcohol were each associated with a higher risk of developing AF (Table). Conclusions: Among former drinkers, the number of years of drinking and the amount of alcohol consumed may each confer an increased risk of AF. Given that a longer duration of abstinence was associated with a decreased risk of AF, modification of alcohol use could potentially play a role in AF prevention.

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P3712The omega-3 fatty acid eicosapentaenoic acid (EPA) is inversely associated with ischemic brain infarcts in elderly patients with atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0566 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M F Reiner ◽

P Baumgartner ◽

A Wiencierz ◽

S Aeschbacher ◽

N Rodondi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Elderly Patients ◽

Eicosapentaenoic Acid ◽

Brain Mri ◽

Omega 3 ◽

Total N ◽

Stroke Incidence ◽

Ischemic Brain ◽

Brain Infarcts

Abstract Background The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation. Methods In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged ≥65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation. Results A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28–0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43–4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94–1.35), ALA (OR 0.83, 95% CI 0.23–2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92–1.16). Conclusions Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients. Acknowledgement/Funding Swiss National Science Foundation

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Volume and shape of subcortical grey matter structures related to headache: A cross-sectional population-based imaging study in the Nord-Trøndelag Health Study

Cephalalgia ◽

10.1177/0333102418780632 ◽

2018 ◽

Vol 39 (2) ◽

pp. 173-184 ◽

Cited By ~ 7

Author(s):

Andreas Kattem Husøy ◽

Carl Pintzka ◽

Live Eikenes ◽

Asta K Håberg ◽

Knut Hagen ◽

...

Keyword(s):

Brain Mri ◽

Depression Scale ◽

Imaging Study ◽

Population Based ◽

Tension Type Headache ◽

Analysis Of Covariance ◽

Health Study ◽

Intracranial Volume ◽

Cross Sectional ◽

Subcortical Nuclei

Background The relationship between subcortical nuclei and headache is unclear. Most previous studies were conducted in small clinical migraine samples. In the present population-based MRI study, we hypothesized that headache sufferers exhibit reduced volume and deformation of the nucleus accumbens compared to non-sufferers. In addition, volume and deformation of the amygdala, caudate, hippocampus, pallidum, putamen and thalamus were examined. Methods In all, 1006 participants (50–66 years) from the third Nord-Trøndelag Health Survey, were randomly selected to undergo a brain MRI at 1.5 T. Volume and shape of the subcortical nuclei from T1 weighted 3D scans were obtained in FreeSurfer and FSL. The association with questionnaire-based headache categories (migraine and tension-type headache included) was evaluated using analysis of covariance. Individuals not suffering from headache were used as controls. Age, sex, intracranial volume and Hospital Anxiety and Depression Scale were used as covariates. Results No effect of headache status on accumbens volume and shape was present. Exploratory analyses showed significant but small differences in volume of caudate and putamen and in putamen shape between those with non-migrainous headache and the controls. A post hoc analysis showed that caudate volume was strongly associated with white matter hyperintensities. Conclusion We did not confirm our hypothesis that headache sufferers have smaller volume and different shape of the accumbens compared to non-sufferers. No or only small differences in volume and shape of subcortical nuclei between headache sufferers and non-sufferers appear to exist in the general population.

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Association of Heart Rate Variability With Silent Brain Infarcts in Patients With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.684461 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peter Hämmerle ◽

Christian Eick ◽

Sven Poli ◽

Steffen Blum ◽

Vincent Schlageter ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Autonomic Dysfunction ◽

Brain Mri ◽

Low Frequency ◽

Total Power ◽

Brain Infarcts ◽

Clinical Covariates ◽

Prior Stroke ◽

Mean Heart Rate

Purpose: Silent brain infarcts (SBI) are frequently detected in patients with atrial fibrillation (AF), but it is unknown whether SBI are linked to autonomic dysfunction. We aimed to explore the association of autonomic dysfunction with SBI in AF patients.Methods: 1,358 AF patients without prior stroke or TIA underwent brain MRI and 5-min resting ECG. We divided our cohort into AF patients who presented in sinus rhythm (SR-group, n = 816) or AF (AF-group, n = 542). HRV triangular index (HRVI), standard deviation of normal-to-normal intervals, mean heart rate, root mean square root of successive differences of normal-to-normal intervals, 5-min total power and power in the low frequency, high frequency and very low frequency range were calculated. Primary outcome was presence of SBI in the SR group, defined as large non-cortical or cortical infarcts. Secondary outcomes were SBI volumes and topography.Results: Mean age was 72 ± 9 years, 27% were female. SBI were detected in 10.5% of the SR group and in 19.9% of the AF group (p < 0.001). HRVI <15 was the only HRV parameter associated with the presence of SBI after adjustment for clinical covariates in the SR group [odds ratio (OR) 1.67; 95% confidence interval (CI): 1.03–2.70; p = 0.037]. HRVI <15 was associated with larger brain infarct volumes [β (95% CI) −0.47 (−0.84; −0.09), p = 0.016] in the SR group and was more frequently observed in patients with right- than left-hemispheric SBI (p = 0.017).Conclusion: Impaired HRVI is associated with SBI in AF patients. AF patients with autonomic dysfunction might undergo systematic brain MRI screening to initiate intensified medical treatment.Clinical Trials Gov Identifier: NCT02105844.

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Abstract WP184: Differential Risk of Embolic Stroke Among Stroke Free Community Dwellers With Distinct Categories of Subcortical Infarct

Stroke ◽

10.1161/str.48.suppl_1.wp184 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jose Gutierrez ◽

Erin R Kulick ◽

Maria Santiago ◽

Tatjana Rundek ◽

Ralph Sacco ◽

...

Keyword(s):

Small Vessel Disease ◽

Brain Mri ◽

Embolic Stroke ◽

Intracranial Artery ◽

Mri Imaging ◽

Brain Infarcts ◽

Stroke Subtypes ◽

Hazard Ratios ◽

Artery Disease ◽

Predicted Risk

Introduction: Cortically-based subclinical infarcts are considered risks for embolic stroke, but few studies have stratified subcortical SBI by penetrating versus medullary artery location. We hypothesized that subclinical medullary infarcts are due to small emboli and are predictors of embolic stroke. Methods: Stroke-free participants in the Northern Manhattan Study underwent a brain MRI to assess for subclinical biomarkers of vascular disease. Subcortical brain infarcts were defined voids >3mm on axial T1 and FLAIR images, with perilesional FLAIR hyperintensities referred to as pathology-informed subclinical brain infarcts (PI-SBI). Each subcortical PI-SBI was rated as penetrating or medullary by two vascular neurologists blinded to stroke subtypes. Participants were followed prospectively for incident stroke. Two vascular neurologists ascertained ischemic stroke subtypes independent of brain MRI imaging at baseline. Embolic stroke required a cardiac source or based on a superficial location. Cox proportional risk models generated hazard ratios and 95% confidence intervals (HR, 95% CI) adjusting for age, sex, ethnicity and traditional vascular risk. Results: The sample included 1290 NOMAS participants (mean age 71±9 years, 60% women, 66% Hispanic, 75% with hypertension) who were followed on average 9±3 years. At baseline, 19% of participants had PI-SBI (11% medullary artery, 7% penetrating artery and 3% cortical). During follow up, 80 participants (6.2%) had stroke (3.6% embolic, 2.4% due to intracranial artery disease (i.e. small and large), and 0.2% other subtypes). In a fully adjusted model, medullary artery (2.04, 1.00-4.14) and not penetrating artery PI-SBI (1.64, 0.99-2.70) predicted risk of embolic stroke. Distal field PI-SBI (i.e. cortical + medullary artery) were even more robust predictors of embolic stroke (2.17, 1.11-4.25). Penetrating artery (1.98, 1.09-3.61) and not medullary artery PI-SBI (HR 1.03, 0.34-3.06) predicted risk of intracranial artery stroke. Conclusions: Subtyping PI-SBI by location and plausible mechanisms may help with risk stratification for clinical trials testing stroke prevention strategies. Our data suggest not all subcortical infarcts are due to small vessel disease.

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Abstract WP451: Cognitive Impairment in Cardiac Disease - Neuroimaging Associations

Stroke ◽

10.1161/str.48.suppl_1.wp451 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jane Cannon ◽

Mark Findlay ◽

Krishna Dani ◽

Jesse Dawson ◽

David A Dickie ◽

...

Keyword(s):

Cognitive Impairment ◽

White Matter ◽

Cardiac Disease ◽

Small Vessel Disease ◽

Brain Mri ◽

Perivascular Spaces ◽

Intracranial Volume ◽

Brain Volumes ◽

Multivariable Models ◽

Cardiac Status

Introduction: Atrial fibrillation (AF) and heart failure (HF) are associated with cognitive impairment. We used neuroimaging to describe if this association is explained by cardioembolism or other mechanisms. Methods: We included adults with HF (ejection fraction<45%) and AF but no stroke history. Healthy volunteer controls were matched, 1:2 ratio. Participants were assessed with Repeatable Battery for the Assessment of Neurospychological Status (RBANS), Hospital Anxiety and Depression Score (HADS) and 3-T brain MRI. Scans were graded for:infarct, enlarged perivascular spaces, microbleeds, global and regional (hippocampal) atrophy with consensus scoring by four raters using validated, ordinal assessment scales. Brain volumes were semi-automatically acquired using cluster analysis of T1-weighted and FLAIR voxel intensities and diffeomorphic atlas-based segmentation. CSF, hippocampal and white matter volumes were corrected for intracranial volume. We described univariable differences between groups and then created multivariable models where cardiac status was the dependent variable, RBANS and MRI data were the predictors. Results: Of 50 participants, AF-HF (n=34) had poorer RBANS (MD:16.9, SE:3.44; p<0.001). Differences were independent of education and HADS. Infarcts and ordinal markers of atrophy were significantly different between groups, SVD markers were increased in AF-HF but did not reach significance. Quantitative measures of white matter differed between groups but measures of atrophy did not.(Table) On multivariable models, no imaging feature was independently associated with cardiac status. Discussion: The association between cognitive impairment and cardiac disease may not be solely driven by occult cardioembolism; small vessel disease and other, neuroimaging independent, factors also interact. Differences between ordinal scales and quantitative scores suggest that future studies should use robust volumetric analyses.

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Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study)

BMJ Open ◽

10.1136/bmjopen-2018-021759 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021759 ◽

Cited By ~ 2

Author(s):

Naoki Saji ◽

Takashi Sakurai ◽

Kengo Ito ◽

Hidekazu Tomimoto ◽

Kazuo Kitagawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Cognitive Impairment ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Brain Mri ◽

Cerebrovascular Diseases ◽

Longitudinal Cohort Study ◽

Protective Effects ◽

Longitudinal Cohort

IntroductionNon-valvular atrial fibrillation (NVAF) is known as a robust risk factor for stroke. Recent reports have suggested a risk of dementia with NVAF, but much remains unknown regarding the relationship between this mechanism and the potential protective effects of novel anticoagulants (direct oral anticoagulants (DOACs), or non-vitamin K oral anticoagulants).Methods and analysisThis study, the strategy to obtain warfarin or DOAC’s benefit by evaluating registry, is an investigator-initiated, multicentre, prospective, observational, longitudinal cohort study comparing the effects of warfarin therapy and DOACs on cerebrovascular diseases and cognitive impairment over an estimated duration of 36 months. Once a year for 3 years, the activities of daily living and cognitive functioning of non-demented patients with NVAF will be assessed. Demographics, risk factors, laboratory investigations, lifestyle, social background and brain MRI will be assessed.Ethics and disseminationThis protocol has been approved by the ethics committee of the National Center for Geriatrics and Gerontology (No. 1017) and complies with the Declaration of Helsinki. Informed consent will be obtained before study enrolment and only coded data will be stored in a secured database. The results will be published in peer-reviewed journals and presented at scientific meetings to ensure the applicability of the findings in clinical practice.Trial registration numberUMIN000025721.

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NEUROPATHOLOGY AND GAIT SPEED DECLINE IN OLDER ADULTS: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.3377 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S927-S928

Author(s):

Kevin J Sullivan ◽

Michael Griswold ◽

Timothy Hughes ◽

Christina E Hugenschmidt ◽

Samuel Lockhart ◽

...

Keyword(s):

Older Adults ◽

Sex Education ◽

Brain Atrophy ◽

Gait Speed ◽

Small Vessel Disease ◽

Brain Mri ◽

Longitudinal Change ◽

Intracranial Volume ◽

Aric Study ◽

The Relationship

Abstract Neuropathological markers including amyloid-beta (Aβ) have been implicated in mobility decline in older adults, but no studies have examined the relationship between these markers and longitudinal change in gait speed in a racially diverse community-based sample. In the multi-site prospective ARIC study, a subsample of participants (n=1,978, mean age=76.3, 28.5% black) underwent brain MRI at Visit 5 (2011-13). Of these, 343 participants (mean age=75.9, 42.6% black) completed PET scans using the tracer florbetapir to estimate global brain Aβ. We investigated the relationship between four neuropathological markers [white matter hyperintensities (WMH; log2cm3), infarcts (present/absent), brain atrophy (log2cm3), and global Aβ (log2SUVR)] with cross-sectional usual pace gait speed (cm/s) over 4 meters, and change in gait speed through Visits 6 (2016-17) and 7 (2018-19). Linear regression models were adjusted for age, site, sex, education, BMI, intracranial volume, and all race interactions. Cross-sectionally, slower gait was associated with higher WMH volume (β=-2.16, 95%CI: -2.92, -1.39), infarcts (β=-5.81, 95%CI: -7.86, -3.76), and brain atrophy (β=-16.39, 95%CI: -21.07, -11.71). Longitudinally, only higher WMH volume was statistically associated with gait speed decline (β=-0.14, 95%CI: -0.28, -0.01). Global Aβ was not statistically associated with gait speed cross-sectionally (β=-.269, 95%CI: -8.11, 7.57) or longitudinally (β=-1.16, 95%CI: -2.94, 0.62). There were no significant interactions with race. Detrimental relations of cerebral small vessel disease to mobility and mobility decline were observed across race in this diverse sample. The magnitude of the Aβ association with gait speed decline was high, although not statistically significant in the smaller PET subsample.

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