Ferro, DA; van den Brink, H; Exalto, LG; Boomsma, JMF; Barkhof, F; Prins, ND; van der Flier, WM; ... TRACE-VCI study group; + view all Ferro, DA; van den Brink, H; Exalto, LG; Boomsma, JMF; Barkhof, F; Prins, ND; van der Flier, WM; Biessels, GJ; TRACE-VCI study group; - view fewer (2019) Clinical relevance of acute cerebral microinfarcts in vascular cognitive impairment. Neurology , 92 (14) 10.1212/WNL.0000000000007250.

Text Barkhof Ferro ACMIs in TRACE-VCI R1-v3 accepted version.pdf - Accepted Version Access restricted to UCL open access staff Download (481kB)

Abstract

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.

Download activity - last month

Export as JSONCSVXML

Download activity - last 12 months

Export as XMLJSONCSV

Downloads by country - last 12 months

Export as JSONCSVXML

Archive Staff Only

View Item