Mandip S Dhamoon1, Ying-Kuen Cheung2, Jose Gutierrez2, Yeseon P Moon2, Ralph L Sacco2, Mitchell S V Elkind2, Clinton B Wright2. 1. From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.). mandip.dhamoon@mssm.edu. 2. From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.).
Abstract
BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories. METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables. RESULTS: Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant. CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.
BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories. METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables. RESULTS: Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant. CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.
Authors: Chuanhui Dong; Nooshin Nabizadeh; Michelle Caunca; Ying Kuen Cheung; Tatjana Rundek; Mitchell S V Elkind; Charles DeCarli; Ralph L Sacco; Yaakov Stern; Clinton B Wright Journal: Neurology Date: 2015-07-08 Impact factor: 9.910
Authors: D Shinar; C R Gross; K S Bronstein; E E Licata-Gehr; D T Eden; A R Cabrera; I G Fishman; A A Roth; J A Barwick; S C Kunitz Journal: Arch Phys Med Rehabil Date: 1987-10 Impact factor: 3.966
Authors: Jacqueline J J Zheng; Kim Delbaere; Jacqueline C T Close; Perminder Sachdev; Wei Wen; Henry Brodaty; Stephen R Lord Journal: Gerontology Date: 2012-05-16 Impact factor: 5.140
Authors: E M Gentry; W D Kalsbeek; G C Hogelin; J T Jones; K L Gaines; M R Forman; J S Marks; F L Trowbridge Journal: Am J Prev Med Date: 1985 Nov-Dec Impact factor: 5.043
Authors: Anna Poggesi; Alida Gouw; Wiesje van der Flier; Giovanni Pracucci; Hugues Chabriat; Timo Erkinjuntti; Franz Fazekas; José M Ferro; Christian Blahak; Peter Langhorne; John O'Brien; Reinhold Schmidt; Marieke C Visser; Lars-Olof Wahlund; Gunhild Waldemar; Anders Wallin; Philip Scheltens; Domenico Inzitari; Leonardo Pantoni Journal: J Neurol Date: 2014-04-11 Impact factor: 4.849
Authors: Domenico Inzitari; Giovanni Pracucci; Anna Poggesi; Giovanna Carlucci; Frederik Barkhof; Hugues Chabriat; Timo Erkinjuntti; Franz Fazekas; José M Ferro; Michael Hennerici; Peter Langhorne; John O'Brien; Philip Scheltens; Marieke C Visser; Lars-Olof Wahlund; Gunhild Waldemar; Anders Wallin; Leonardo Pantoni Journal: BMJ Date: 2009-07-06
Authors: Mitchell S V Elkind; Robert Sciacca; Bernadette Boden-Albala; Tanja Rundek; Myunghee C Paik; Ralph L Sacco Journal: Stroke Date: 2005-11-23 Impact factor: 7.914
Authors: Astrid Suchy-Dicey; Dean Shibata; Brenna Cholerton; Lonnie Nelson; Darren Calhoun; Tauqeer Ali; Thomas J Montine; W T Longstreth; Dedra Buchwald; Steven P Verney Journal: J Int Neuropsychol Soc Date: 2019-12-03 Impact factor: 2.892