Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment

The framingham study

José R. Romero, Alexa Beiser, Sudha Seshadri, Emelia J. Benjamin, Joseph F. Polak, Ramachandran S. Vasan, Rhoda Au, Charles Decarli, Philip A. Wolf

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (>1 SD above age-specific mean), total brain volume, hippocampal volume, silent cerebral infarcts, and neuropsychological measures of verbal memory, executive function, and nonverbal memory measures. Results-: We observed that internal carotid artery intima-media thickness, but not common carotid artery intima-media thickness, was associated with higher prevalence of silent cerebral infarcts (OR, 1.21; 95% CI, 1.03-1.43; P<0.05), large white matter hyperintensity (OR, 1.19; 95% CI, 1.03-1.38; P<0.05), lower total brain volume (-0.05 per SD; P<0.05), and poorer performance in verbal memory (-0.06 per SD; P<0.05) and nonverbal memory measures (-0.08 per SD; P<0.01), but not with hippocampal volume. Internal carotid stenosis =25% was associated with a higher prevalence of large white matter hyperintensity (adjusted OR, 1.77; 95% CI, 1.25-2.53) and lower total brain volume (-0.11 per SD; P=0.042) but not with silent cerebral infarcts or hippocampal volume. Internal carotid stenosis =50% was associated with higher prevalence of silent cerebral infarcts (OR, 2.53; 95% CI, 1.17-5.44), large white matter hyperintensity (OR, 2.35; 95% CI, 1.08-5.13), and poorer performance on executive function (-0.39 per SD; P<0.05), but not with total brain volume or hippocampal volume. Conclusions-: Carotid atherosclerosis markers were associated with MRI indices of brain ischemia and aging and with cognitive impairment in a community-based sample of middle-aged adults. Our data suggest that internal carotid artery intima-media thickness may be a better marker for cognitive impairment than common carotid artery intima-media thickness.

Original languageEnglish (US)
Pages (from-to)1590-1596
Number of pages7
JournalStroke
Volume40
Issue number5
DOIs
StatePublished - May 1 2009
Externally publishedYes

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Carotid Intima-Media Thickness
Carotid Artery Diseases
Brain Ischemia
Carotid Arteries
Carotid Stenosis
Common Carotid Artery
Internal Carotid Artery
Brain
Executive Function
Stroke
Dementia
Ischemia
Cognitive Dysfunction
White Matter

Keywords

  • Atherosclerosis
  • Brain MRI
  • Carotid
  • Cognitive performance

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment : The framingham study. / Romero, José R.; Beiser, Alexa; Seshadri, Sudha; Benjamin, Emelia J.; Polak, Joseph F.; Vasan, Ramachandran S.; Au, Rhoda; Decarli, Charles; Wolf, Philip A.

In: Stroke, Vol. 40, No. 5, 01.05.2009, p. 1590-1596.

Research output: Contribution to journalArticle

Romero, JR, Beiser, A, Seshadri, S, Benjamin, EJ, Polak, JF, Vasan, RS, Au, R, Decarli, C & Wolf, PA 2009, 'Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment: The framingham study', Stroke, vol. 40, no. 5, pp. 1590-1596. https://doi.org/10.1161/STROKEAHA.108.535245
Romero, José R. ; Beiser, Alexa ; Seshadri, Sudha ; Benjamin, Emelia J. ; Polak, Joseph F. ; Vasan, Ramachandran S. ; Au, Rhoda ; Decarli, Charles ; Wolf, Philip A. / Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment : The framingham study. In: Stroke. 2009 ; Vol. 40, No. 5. pp. 1590-1596.
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abstract = "Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (>1 SD above age-specific mean), total brain volume, hippocampal volume, silent cerebral infarcts, and neuropsychological measures of verbal memory, executive function, and nonverbal memory measures. Results-: We observed that internal carotid artery intima-media thickness, but not common carotid artery intima-media thickness, was associated with higher prevalence of silent cerebral infarcts (OR, 1.21; 95{\%} CI, 1.03-1.43; P<0.05), large white matter hyperintensity (OR, 1.19; 95{\%} CI, 1.03-1.38; P<0.05), lower total brain volume (-0.05 per SD; P<0.05), and poorer performance in verbal memory (-0.06 per SD; P<0.05) and nonverbal memory measures (-0.08 per SD; P<0.01), but not with hippocampal volume. Internal carotid stenosis =25{\%} was associated with a higher prevalence of large white matter hyperintensity (adjusted OR, 1.77; 95{\%} CI, 1.25-2.53) and lower total brain volume (-0.11 per SD; P=0.042) but not with silent cerebral infarcts or hippocampal volume. Internal carotid stenosis =50{\%} was associated with higher prevalence of silent cerebral infarcts (OR, 2.53; 95{\%} CI, 1.17-5.44), large white matter hyperintensity (OR, 2.35; 95{\%} CI, 1.08-5.13), and poorer performance on executive function (-0.39 per SD; P<0.05), but not with total brain volume or hippocampal volume. Conclusions-: Carotid atherosclerosis markers were associated with MRI indices of brain ischemia and aging and with cognitive impairment in a community-based sample of middle-aged adults. Our data suggest that internal carotid artery intima-media thickness may be a better marker for cognitive impairment than common carotid artery intima-media thickness.",
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T1 - Carotid artery atherosclerosis, MRI indices of brain ischemia, aging, and cognitive impairment

T2 - The framingham study

AU - Romero, José R.

AU - Beiser, Alexa

AU - Seshadri, Sudha

AU - Benjamin, Emelia J.

AU - Polak, Joseph F.

AU - Vasan, Ramachandran S.

AU - Au, Rhoda

AU - Decarli, Charles

AU - Wolf, Philip A.

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N2 - Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (>1 SD above age-specific mean), total brain volume, hippocampal volume, silent cerebral infarcts, and neuropsychological measures of verbal memory, executive function, and nonverbal memory measures. Results-: We observed that internal carotid artery intima-media thickness, but not common carotid artery intima-media thickness, was associated with higher prevalence of silent cerebral infarcts (OR, 1.21; 95% CI, 1.03-1.43; P<0.05), large white matter hyperintensity (OR, 1.19; 95% CI, 1.03-1.38; P<0.05), lower total brain volume (-0.05 per SD; P<0.05), and poorer performance in verbal memory (-0.06 per SD; P<0.05) and nonverbal memory measures (-0.08 per SD; P<0.01), but not with hippocampal volume. Internal carotid stenosis =25% was associated with a higher prevalence of large white matter hyperintensity (adjusted OR, 1.77; 95% CI, 1.25-2.53) and lower total brain volume (-0.11 per SD; P=0.042) but not with silent cerebral infarcts or hippocampal volume. Internal carotid stenosis =50% was associated with higher prevalence of silent cerebral infarcts (OR, 2.53; 95% CI, 1.17-5.44), large white matter hyperintensity (OR, 2.35; 95% CI, 1.08-5.13), and poorer performance on executive function (-0.39 per SD; P<0.05), but not with total brain volume or hippocampal volume. Conclusions-: Carotid atherosclerosis markers were associated with MRI indices of brain ischemia and aging and with cognitive impairment in a community-based sample of middle-aged adults. Our data suggest that internal carotid artery intima-media thickness may be a better marker for cognitive impairment than common carotid artery intima-media thickness.

AB - Background and Purpose-: Carotid atherosclerosis has been associated with increased risk of stroke and poorer cognitive performance in older adults. The relation of carotid atherosclerosis to cognitive impairment and MRI indices of ischemia and aging in midlife is less clear. Methods-: We studied 1975 Framingham Offspring Study participants free of stroke and dementia with available carotid ultrasound, brain MRI, and neuropsychological testing. We related common and internal carotid artery intima-media thickness and internal carotid stenosis to large white matter hyperintensity (>1 SD above age-specific mean), total brain volume, hippocampal volume, silent cerebral infarcts, and neuropsychological measures of verbal memory, executive function, and nonverbal memory measures. Results-: We observed that internal carotid artery intima-media thickness, but not common carotid artery intima-media thickness, was associated with higher prevalence of silent cerebral infarcts (OR, 1.21; 95% CI, 1.03-1.43; P<0.05), large white matter hyperintensity (OR, 1.19; 95% CI, 1.03-1.38; P<0.05), lower total brain volume (-0.05 per SD; P<0.05), and poorer performance in verbal memory (-0.06 per SD; P<0.05) and nonverbal memory measures (-0.08 per SD; P<0.01), but not with hippocampal volume. Internal carotid stenosis =25% was associated with a higher prevalence of large white matter hyperintensity (adjusted OR, 1.77; 95% CI, 1.25-2.53) and lower total brain volume (-0.11 per SD; P=0.042) but not with silent cerebral infarcts or hippocampal volume. Internal carotid stenosis =50% was associated with higher prevalence of silent cerebral infarcts (OR, 2.53; 95% CI, 1.17-5.44), large white matter hyperintensity (OR, 2.35; 95% CI, 1.08-5.13), and poorer performance on executive function (-0.39 per SD; P<0.05), but not with total brain volume or hippocampal volume. Conclusions-: Carotid atherosclerosis markers were associated with MRI indices of brain ischemia and aging and with cognitive impairment in a community-based sample of middle-aged adults. Our data suggest that internal carotid artery intima-media thickness may be a better marker for cognitive impairment than common carotid artery intima-media thickness.

KW - Atherosclerosis

KW - Brain MRI

KW - Carotid

KW - Cognitive performance

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