RT Journal Article
SR Electronic
T1 Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1558
OP e1566
DO 10.1212/WNL.0000000000007250
VO 92
IS 14
A1 Ferro, Doeschka A.
A1 van den Brink, Hilde
A1 Exalto, Lieza G.
A1 Boomsma, Jooske M.F.
A1 Barkhof, Frederik
A1 Prins, Niels D.
A1 van der Flier, Wiesje M.
A1 Biessels, Geert Jan
A1 on behalf of the TRACE-VCI study group
YR 2019
UL http://n.neurology.org/content/92/14/e1558.abstract
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.Aβ=β-amyloid; ACMI=acute cerebral microinfarct; AD=Alzheimer disease; ADC=apparent diffusion coefficient; CAA=cerebral amyloid angiopathy; CAT12=Computational Anatomy Toolbox; CDR=Clinical Dementia Rating; DSC=dice similarity coefficient; DWI=diffusion-weighted MRI; MMSE=Mini-Mental State Examination; MTA=medial temporal lobe atrophy; OR=odds ratio; p-tau=total tau phosphorylated at threonine 181; SVD=small vessel disease; VCI=vascular cognitive impairment; WMH=white matter hyperintensities