Saima Hilal1, Emiel Sikking1, Muhammad Amin Shaik1, Qun Lin Chan1, Susanne J van Veluw1, Henri Vrooman1, Ching-Yu Cheng1, Charumathi Sabanayagam1, Carol Y Cheung1, Tien Yin Wong1, Narayanaswamy Venketasubramanian1, Geert Jan Biessels1, Christopher Chen1, Mohammad Kamran Ikram2. 1. From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore. 2. From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore. m.ikram@erasmusmc.nl.
Abstract
OBJECTIVE: We examined the risk factors of cortical cerebral microinfarcts (CMIs) on 3T MRI and their association with cognitive impairment. METHODS: Participants (aged 60 years and older) from the multiethnic Epidemiology of Dementia In Singapore Study underwent detailed neuropsychological testing and 3T brain MRI. Cortical CMIs were graded using a previously validated protocol. Cognitive impairment was categorized into cognitive impairment, no dementia (CIND)-mild, CIND-moderate, and dementia. Cognitive function was summarized as composite and domain-specific z scores. RESULTS: Among 861 participants, 54 (6.3%) had ≥1 cortical CMI. In multivariate-adjusted models, the risk factors of cortical CMIs were increasing age, Malay ethnicity, hypertension, diabetes, history of stroke, and markers of both large (cortical infarcts and intracranial stenosis) and small (lacunar infarcts, white matter hyperintensities, cerebral microbleeds) vessel disease. Presence of cortical CMIs was associated with CIND-moderate (odds ratio: 3.12; 95% confidence interval [CI]: 1.18-8.58), dementia (odds ratio: 16.92; 95% CI: 3.37-85.05), and poorer cognitive function (mean difference in composite z score: -0.42; 95% CI: -0.62 to -0.21). Additional adjustments for vascular risk factors and other MRI markers did not alter these associations. CONCLUSIONS: Cortical CMIs are a novel MRI marker of cerebrovascular disease and are independently associated with cognitive impairment and dementia. These findings provide new insights into the burden of cerebrovascular disease in cognitive impairment. Future research is needed to establish the additional etiologic and prognostic significance of cortical CMIs.
OBJECTIVE: We examined the risk factors of cortical cerebral microinfarcts (CMIs) on 3T MRI and their association with cognitive impairment. METHODS:Participants (aged 60 years and older) from the multiethnic Epidemiology of Dementia In Singapore Study underwent detailed neuropsychological testing and 3T brain MRI. Cortical CMIs were graded using a previously validated protocol. Cognitive impairment was categorized into cognitive impairment, no dementia (CIND)-mild, CIND-moderate, and dementia. Cognitive function was summarized as composite and domain-specific z scores. RESULTS: Among 861 participants, 54 (6.3%) had ≥1 cortical CMI. In multivariate-adjusted models, the risk factors of cortical CMIs were increasing age, Malay ethnicity, hypertension, diabetes, history of stroke, and markers of both large (cortical infarcts and intracranial stenosis) and small (lacunar infarcts, white matter hyperintensities, cerebral microbleeds) vessel disease. Presence of cortical CMIs was associated with CIND-moderate (odds ratio: 3.12; 95% confidence interval [CI]: 1.18-8.58), dementia (odds ratio: 16.92; 95% CI: 3.37-85.05), and poorer cognitive function (mean difference in composite z score: -0.42; 95% CI: -0.62 to -0.21). Additional adjustments for vascular risk factors and other MRI markers did not alter these associations. CONCLUSIONS: Cortical CMIs are a novel MRI marker of cerebrovascular disease and are independently associated with cognitive impairment and dementia. These findings provide new insights into the burden of cerebrovascular disease in cognitive impairment. Future research is needed to establish the additional etiologic and prognostic significance of cortical CMIs.
Authors: Saima Hilal; Chuen Seng Tan; Hieab H H Adams; Mohamad Habes; Vincent Mok; Narayanaswamy Venketasubramanian; Edith Hofer; M Kamran Ikram; Jill Abrigo; Meike W Vernooij; Christopher Chen; Norbert Hosten; Henry Volzke; Hans J Grabe; Reinhold Schmidt; M Arfan Ikram Journal: Neurology Date: 2018-08-01 Impact factor: 9.910
Authors: Liwen Zhang; Geert Jan Biessels; Saima Hilal; Joanna Su Xian Chong; Siwei Liu; Hee Youn Shim; Xin Xu; Eddie Jun Yi Chong; Zi Xuen Wong; Yng Miin Loke; Narayanaswamy Venketasubramanian; Tan Boon Yeow; Christopher Li-Hsian Chen; Juan Helen Zhou Journal: J Cereb Blood Flow Metab Date: 2020-01-27 Impact factor: 6.200
Authors: Alifiya Kapasi; Sue E Leurgans; Bryan D James; Patricia A Boyle; Zoe Arvanitakis; Sukriti Nag; David A Bennett; Aron S Buchman; Julie A Schneider Journal: Neurobiol Aging Date: 2018-05-30 Impact factor: 4.673
Authors: Tomotaka Tanaka; Mary C Stephenson; Ying-Hwey Nai; Damian Khor; Francis N Saridin; Saima Hilal; Steven Villaraza; Bibek Gyanwali; Masafumi Ihara; Henri Vrooman; Ashley A Weekes; John J Totman; Edward G Robins; Christopher P Chen; Anthonin Reilhac Journal: Eur J Nucl Med Mol Imaging Date: 2019-12-20 Impact factor: 9.236
Authors: Emily L Johnson; Gregory L Krauss; Alexandra K Lee; Andrea L C Schneider; Anna M Kucharska-Newton; Juebin Huang; Clifford R Jack; Rebecca F Gottesman Journal: Neurology Date: 2019-01-25 Impact factor: 9.910