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. 2018 Nov;66(11):2144-2150.
doi: 10.1111/jgs.15557. Epub 2018 Sep 25.

Association Between Subclinical Brain Infarcts and Functional Decline Trajectories

Mandip S Dhamoon  1 , Ying-Kuen Cheung  2 , Janet T DeRosa  3 , Jose Gutierrez  3 , Yeseon P Moon  2 , Ralph L Sacco  4   5   6 , Mitchell S V Elkind  7   3 , Clinton B Wright  8
Affiliations

Association Between Subclinical Brain Infarcts and Functional Decline Trajectories

Mandip S Dhamoon et al. J Am Geriatr Soc. 2018 Nov.

Abstract

Objectives: To test associations between subclinical brain infarcts (SBIs) and functional decline independently of intervening clinical vascular events and other vascular risk factors.

Design: Longitudinal follow-up for a mean 7.3 years. Generalized estimating equation models were used to test associations between SBIs, number of perivascular spaces (PVSs), baseline Barthel Index (BI), and change in BI, adjusting for sociodemographic, vascular, and cognitive risk factors and for stroke and myocardial infarction occurring during follow-up.

Setting: Population-based prospective cohort study.

Participants: Stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (N=1,290).

Measurements: Annual functional assessments using the BI (range 0-100).

Results: Mean age was 70.6 ± 9.0, 40% of participants were male, 66% were Hispanic, 193 (16%) had SBIs, and 508 (42%) had large PVSs. SBIs were not associated with baseline BI. In a fully adjusted model, there was a change in BI of -0.85 points per year (95% confidence interval (CI)=-1.01 to -0.69); those with SBI had an additional change in BI 0f -0.88 points (95% CI=-1.43 to -0.32). There were no associations between PVS and baseline BI or change in BI.

Conclusion: In a large population-based study, we found a strong and independent association between "subclinical" markers of cerebrovascular injury and important clinical, person-centered functional trajectories. Future research could clarify the evolution of such subclinical markers over time and test strategies to prevent their progression and minimize related disability. J Am Geriatr Soc 66:2144-2150, 2018.

Keywords: disability; epidemiology; subclinical brain infarct.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1.
Figure 1.. Unadjusted and adjusted models of the association between subclinical brain infarcts and change in Barthel index
BI=Barthel index; CI=confidence interval; SBI=subclinical brain infarct; MI=myocardial infarction; RF=risk factor; QOL=quality of life; Adj=adjusted for Demographics and vascular risk factor model is adjusted for age at time of MRI, sex, race, diabetes, hypertension, coronary artery disease, hypercholesterolemia, physical activity, alcohol use, smoking, and body mass index at the time of MRI QOL and depression model is additionally adjusted for: marital status, insurance, number of friends, years lived in the community, mini-mental state score, and Spitzer quality of life index and depression Stroke and MI model is additionally adjusted for stroke and MI occurring during follow-up, as time-varying covariates
Figure 2.
Figure 2.. Unadjusted and adjusted models of the association between pathology-informed subclinical brain infarcts and change in Barthel index
BI=Barthel index; CI=confidence interval; SBI=subclinical brain infarct; MI=myocardial infarction; pSBI=pathology-informed subclinical brain infarct; RF=risk factor; QOL=quality of life; Adj=adjusted for Demographics and vascular risk factor model is adjusted for age at time of MRI, sex, race, diabetes, hypertension, coronary artery disease, hypercholesterolemia, physical activity, alcohol use, smoking, and body mass index at the time of MRI QOL and depression model is additionally adjusted for: marital status, insurance, number of friends, years lived in the community, mini-mental state score, and Spitzer quality of life index and depression Stroke and MI model is additionally adjusted for stroke and MI occurring during follow-up, as time-varying covariates
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