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Abstract
Objective: To determine whether microvascular damage, indicated by cerebral microbleeds (CMBs) and retinal microvascular signs, is associated with cognitive function and dementia in older persons.
Methods: This is a cross-sectional study of 3,906 participants (mean age 76 years; 58% women) in the AGES-Reykjavik Study (2002–2006). We assessed CMBs on MRI and retinal microvascular signs on digital retinal images. Composite Z scores of memory, processing speed, and executive function were derived from a battery of neurocognitive tests. Dementia and subtypes were diagnosed following international criteria. Regression models were used to relate cognitive Z scores and dementia to CMBs and retinal microvascular signs, adjusting for demographics, cardiovascular factors, and brain ischemic lesions.
Results: People with multiple (≥2) CMBs had lower Z scores on tests of processing speed (β-coefficient −0.16; 95% confidence interval −0.26 to −0.05) and executive function (−0.14; −0.24 to −0.04); results were strongest for having multiple CMBs located in the deep hemispheric or infratentorial areas. The odds ratio of vascular dementia was 2.32 (95% confidence interval 1.02 to 5.25) for multiple CMBs and 1.95 (1.04 to 3.62) for retinopathy. Having both CMBs and retinopathy, compared to having neither, was significantly associated with markedly slower processing speed (−0.25; −0.37 to −0.12), poorer executive function (−0.19; −0.31 to −0.07), and an increased odds ratio of vascular dementia (3.10; 1.11 to 8.62).
Conclusion: Having multiple CMBs or concomitant CMBs and retinopathy is associated with a profile of vascular cognitive impairment. These findings suggest that microvascular damage, as indicated by CMBs and retinopathy lesions, has functional consequences in older men and women living in the community.
Footnotes
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Study funding: The AGES-Reykjavik Study was funded by NIH contract N01-AG-12100, the Intramural Research Program of the National Institute on Aging, the National Eye Institute (ZIAEY000401), NIH, USA, and the Icelandic Heart Association and the Icelandic Parliament, Iceland.
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- AD
- Alzheimer disease
- AGES
- Age, Gene/Environment Susceptibility
- CAA
- cerebral amyloid angiopathy
- CI
- confidence interval
- CMB
- cerebral microbleed
- DSM-IV
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition
- DSST
- Digit Symbol Substitution Test
- FA
- flip angle
- FLAIR
- fluid-attenuated inversion recovery
- FOV
- field of view
- FSE
- fast spin-echo
- MR
- magnetic resonance
- OR
- odds ratio
- PD
- proton density
- TE
- echo time
- TR
- repetition time
- VaD
- vascular dementia
- VCI
- vascular cognitive impairment
- WMH
- white matter hyperintensity.
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Supplemental data at www.neurology.org
- Received May 4, 2010.
- Accepted September 2, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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