Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment

TRACE-VCI study group, Doeschka A. Ferro, Hilde van den Brink, Lieza G. Exalto, Jooske M. F. Boomsma, Frederik Barkhof, Niels D. Prins, Wiesje M. van der Flier, Geert Jan Biessels

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome. METHODS: The TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46% female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal. RESULTS: A total of 23 ACMIs were found in 16 of the 783 patients (2.0%). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.4-18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3-9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4-12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7-13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5-144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4-6.0, p = 0.005). CONCLUSION: In patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.
Original languageEnglish
Pages (from-to)e1558-e1566
JournalNeurology
Volume92
Issue number14
DOIs
Publication statusPublished - 2019

Cite this

TRACE-VCI study group, Ferro, D. A., van den Brink, H., Exalto, L. G., Boomsma, J. M. F., Barkhof, F., ... Biessels, G. J. (2019). Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. Neurology, 92(14), e1558-e1566. https://doi.org/10.1212/WNL.0000000000007250
TRACE-VCI study group ; Ferro, Doeschka A. ; van den Brink, Hilde ; Exalto, Lieza G. ; Boomsma, Jooske M. F. ; Barkhof, Frederik ; Prins, Niels D. ; van der Flier, Wiesje M. ; Biessels, Geert Jan. / Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. In: Neurology. 2019 ; Vol. 92, No. 14. pp. e1558-e1566.
@article{4b74352effc344458acfead9a0e0ce5e,
title = "Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment",
abstract = "OBJECTIVE: To determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome. METHODS: The TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46{\%} female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal. RESULTS: A total of 23 ACMIs were found in 16 of the 783 patients (2.0{\%}). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95{\%} confidence interval [CI] 1.4-18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3-9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4-12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7-13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5-144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4-6.0, p = 0.005). CONCLUSION: In patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.",
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Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. / TRACE-VCI study group; Ferro, Doeschka A.; van den Brink, Hilde; Exalto, Lieza G.; Boomsma, Jooske M. F.; Barkhof, Frederik; Prins, Niels D.; van der Flier, Wiesje M.; Biessels, Geert Jan.

In: Neurology, Vol. 92, No. 14, 2019, p. e1558-e1566.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment

AU - TRACE-VCI study group

AU - Ferro, Doeschka A.

AU - van den Brink, Hilde

AU - Exalto, Lieza G.

AU - Boomsma, Jooske M. F.

AU - Barkhof, Frederik

AU - Prins, Niels D.

AU - van der Flier, Wiesje M.

AU - Biessels, Geert Jan

N1 - © 2019 American Academy of Neurology.

PY - 2019

Y1 - 2019

N2 - OBJECTIVE: To determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome. METHODS: The TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46% female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal. RESULTS: A total of 23 ACMIs were found in 16 of the 783 patients (2.0%). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.4-18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3-9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4-12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7-13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5-144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4-6.0, p = 0.005). CONCLUSION: In patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.

AB - OBJECTIVE: To determine the occurrence of acute cerebral microinfarcts (ACMIs) in memory clinic patients and relate their presence to vascular risk and cognitive profile, CSF and neuroimaging markers, and clinical outcome. METHODS: The TRACE-VCI study is a memory clinic cohort of patients with vascular brain injury on MRI (i.e., possible vascular cognitive impairment [VCI]). We included 783 patients (mean age 67.6 ± 8.5, 46% female) with available 3T diffusion-weighted imaging (DWI). ACMIs were defined as supratentorial DWI hyperintensities <5 mm with a corresponding hypo/isointense apparent diffusion coefficient signal and iso/hyperintense T2*-weighted signal. RESULTS: A total of 23 ACMIs were found in 16 of the 783 patients (2.0%). Patients with ACMIs did not differ in vascular risk or cognitive profile, but were more often diagnosed with vascular dementia (odds ratio [OR] 5.1; 95% confidence interval [CI] 1.4-18.9, p = 0.014). ACMI presence was associated with lower levels of β-amyloid (p < 0.004) and with vascular imaging markers (lacunar infarcts: OR 3.5, CI 1.3-9.6, p = 0.015; nonlacunar infarcts: OR 4.1, CI 1.4-12.5, p = 0.012; severe white matter hyperintensities: OR 4.8, CI 1.7-13.8, p = 0.004; microbleeds: OR 18.9, CI 2.5-144.0, p = 0.0001). After a median follow-up of 2.1 years, the risk of poor clinical outcome (composite of marked cognitive decline, major vascular event, death, and institutionalization) was increased among patients with ACMIs (hazard ratio 3.0; 1.4-6.0, p = 0.005). CONCLUSION: In patients with possible VCI, ACMI presence was associated with a high burden of cerebrovascular disease of both small and large vessel etiology and poor clinical outcome. ACMIs may thus be a novel marker of active vascular brain injury in these patients.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30850444

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DO - 10.1212/WNL.0000000000007250

M3 - Article

VL - 92

SP - e1558-e1566

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 14

ER -