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Stroke. 2020 Apr;51(4):1158-1165. doi: 10.1161/STROKEAHA.119.028179. Epub 2020 Mar 4.

Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging-Detected Vascular Brain Injury.

Author information

1
From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.M.S., K.T., S.Y.).
2
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.T., S.Y.).
3
Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.).
4
Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada (M.G.F.).
5
Department of Electrical and Computer Engineering, School of Biomedical Engineering, Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Canada (P.A.).
6
Research Centre, Montreal Heart Institute, Université de Montréal, Quebec, Canada (D.B., J.-C.T).
7
School of Population and Public Health, University of British Columbia, and BC Cancer Agency, Vancouver, Canada (T.J.B.D.).
8
Department of Medicine and Pediatrics, Université de Montréal, CHU Sainte Justine, Quebec, Canada (S.J.).
9
Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (A.D.).
10
Diagnostic Imaging, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario, Canada (D.K.).
11
Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario, Canada (A.K.).
12
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.).
13
Department of Radiology, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada (J.L.).
14
Department of Electrical and Computer Engineering, School of Biomedical Engineering, McMaster University, and Diagnostic Imaging, St. Joseph's Health Care, Hamilton, Ontario, Canada (M.D.N.).
15
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (L.P.).
16
Department of Medical Biophysics, and Robarts Research Institute, Western University, London, Ontario, Canada (G.P.).
17
Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Canada (P.P.).
18
Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Edmonton, Canada (P.R.).
19
Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Richmond Road Diagnostic and Treatment Centre, Calgary, Canada (J.V.).
20
Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (A.R.M.).
21
Department of Medicine (Neurology) and Hurvitz Brain Sciences Research Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.B.).
22
Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (E.E.S.).

Abstract

Background and Purpose- Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods- Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results- The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (P<0.0001), INTERHEART risk score (P<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, -1.3 to -0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, -3.2 to -0.6) per high white matter hyperintensities, 3.5 (95% CI, -6.4 to -0.7) per nonlacunar stroke, and 6.8 (95% CI, -11.5 to -2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12-17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8-30), and MRI vascular brain injury accounted for 10% (95% CI, -3 to 22) of low test scores. Conclusions- Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.

KEYWORDS:

brain; cardiovascular disease; cognition; infarction; risk factors

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