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Intracranial Atherosclerotic Disease and Incident Dementia: The ARIC Study (Atherosclerosis Risk in Communities).
Zhao, Di; Guallar, Eliseo; Qiao, Ye; Knopman, David S; Palatino, Maylin; Gottesman, Rebecca F; Mosley, Thomas H; Wasserman, Bruce A.
Afiliación
  • Zhao D; Department of Epidemiology, Bloomberg School of Public Health (D.Z., E.G.), Johns Hopkins University, Baltimore, MD.
  • Guallar E; Department of Epidemiology, Bloomberg School of Public Health (D.Z., E.G.), Johns Hopkins University, Baltimore, MD.
  • Qiao Y; Department of Epidemiology, School of Global Public Health, New York University, New York (E.G.).
  • Knopman DS; Russell H. Morgan Department of Radiology and Radiological Sciences, School of Medicine (Y.Q., B.A.W.), Johns Hopkins University, Baltimore, MD.
  • Palatino M; Department of Neurology, Mayo Clinic, Rochester, MN (D.S.K.).
  • Gottesman RF; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore (M.P., B.A.W.).
  • Mosley TH; Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD (R.F.G.).
  • Wasserman BA; Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.).
Circulation ; 150(11): 838-847, 2024 Sep 10.
Article en En | MEDLINE | ID: mdl-39087353
ABSTRACT

BACKGROUND:

Studies of the neurovascular contribution to dementia have largely focused on cerebral small vessel disease (CSVD), but the role of intracranial atherosclerotic disease (ICAD) remains unknown in the general population. The objective of this study was to determine the risk of incident dementia from ICAD after adjusting for CSVD and cardiovascular risk factors in a US community-based cohort.

METHODS:

We acquired brain magnetic resonance imaging examinations from 2011 through 2013 in 1980 Black and White participants in the ARIC study (Atherosclerosis Risk in Communities), a prospective cohort conducted in 4 US communities. Magnetic resonance imaging examinations included high-resolution vessel wall magnetic resonance imaging and magnetic resonance angiography to identify ICAD. Of these participants, 1590 without dementia, without missing covariates, and with adequate magnetic resonance image quality were followed through 2019 for incident dementia. Associations between ICAD and incident dementia were assessed using Cox proportional hazard ratios adjusted for CSVD (characterized by white matter hyperintensities, lacunar infarctions, and microhemorrhages), APOE4 genotype (apolipoprotein E gene ε4), and cardiovascular risk factors.

RESULTS:

The mean age (SD) of study participants was 77.4 (5.2) years. ICAD was detected in 34.6% of participants. After a median follow-up of 5.6 years, 286 participants developed dementia. Compared with participants without ICAD, the fully adjusted hazard ratios (95% CIs) for incident dementia in participants with any ICAD, with ICAD only causing stenosis ≤50%, and with ICAD causing stenosis >50% in ≥1 vessel were 1.57 (1.17-2.11), 1.41 (1.02-1.95), and 1.94 (1.32-2.84), respectively. ICAD was associated with dementia even among participants with low white matter hyperintensities burden, a marker of CSVD.

CONCLUSIONS:

ICAD was associated with an increased risk of incident dementia, independent of CSVD, APOE4 genotype, and cardiovascular risk factors. The increased risk of dementia was evident even among participants with low CSVD burden, a group less likely to be affected by vascular dementia, and in participants with ICAD causing only low-grade stenosis. Our results suggest that ICAD may partially mediate the effect that cardiovascular risk factors have on the brain leading to dementia. Both ICAD and CSVD must be considered to understand the vascular contributions to cognitive decline.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Arteriosclerosis Intracraneal / Demencia Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Circulation Año: 2024 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Arteriosclerosis Intracraneal / Demencia Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: Circulation Año: 2024 Tipo del documento: Article