Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment

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, TRACE-VCI study group

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 - 2 Apr 2019

Cite this

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 ; TRACE-VCI study group. / 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.",
author = "Ferro, {Doeschka A.} and {van den Brink}, Hilde and Exalto, {Lieza G.} and Boomsma, {Jooske M. F.} and Frederik Barkhof and Prins, {Niels D.} and {van der Flier}, {Wiesje M.} and Biessels, {Geert Jan} and {TRACE-VCI study group}",
note = "{\circledC} 2019 American Academy of Neurology.",
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Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. / 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; TRACE-VCI study group.

In: Neurology, Vol. 92, No. 14, 02.04.2019, p. e1558-e1566.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

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

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

AU - TRACE-VCI study group

N1 - © 2019 American Academy of Neurology.

PY - 2019/4/2

Y1 - 2019/4/2

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

U2 - 10.1212/WNL.0000000000007250

DO - 10.1212/WNL.0000000000007250

M3 - Article

VL - 92

SP - e1558-e1566

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 14

ER -