Metabolites and MRI-Derived Markers of AD/ADRD Risk in a Puerto Rican Cohort

Objective

Several studies have examined metabolomic profiles in relation to Alzheimer's disease and related dementia (AD/ADRD) risk; however, few studies have focused on minorities, such as Latinos, or examined Magnetic-Resonance Imaging (MRI)-based outcomes.

Methods

We used multiple linear regression, adjusted for covariates, to examine the association between metabolite concentration and MRI-derived brain age deviation. Metabolites were measured at baseline with untargeted metabolomic profiling (Metabolon, Inc). Brain age deviation (BAD) was calculated at wave 4 (~ 9 years from Boston Puerto Rican Health Study (BPRHS) baseline) as chronologic age, minus MRI-estimated brain age, representing the rate of biological brain aging relative to chronologic age. We also examined if metabolites associated with BAD were similarly associated with hippocampal volume and global cognitive function at wave 4 in the BPRHS.

Results

Several metabolites, including isobutyrylcarnitine, propionylcarnitine, phenylacetylglutamine, phenylacetylcarnitine (acetylated peptides), p-cresol-glucuronide, phenylacetylglutamate, and trimethylamine N-oxide (TMAO) were inversely associated with brain age deviation. Taurocholate sulfate, a bile salt, was marginally associated with better brain aging. Most metabolites with negative associations with brain age deviation scores also were inversely associations with hippocampal volumes and wave 4 cognitive function.

Conclusion

The metabolites identifiedin this study are generally consistent with prior literature and highlight the role of BCAA, TMAO and microbially derived metabolites in cognitive decline.

Corrigendum: APOE4 allele-specific associations between diet, multimodal biomarkers, and cognition among Puerto Rican adults in Massachusetts

[This corrects the article DOI: 10.3389/fnagi.2023.1285333.].

APOE4 allele-specific associations between diet, multimodal biomarkers, and cognition among Puerto Rican adults in Massachusetts

Background

Apolipoprotein E (APOE) is the strongest genetic risk factor for sporadic Alzheimer's Disease (AD), and the ε4 allele (APOE4) may interact with lifestyle factors that relate to brain structural changes, underlying the increased risk of AD. However, the exact role of APOE4 in mediating interactions between the peripheral circulatory system and the central nervous system, and how it may link to brain and cognitive aging requires further elucidation. In this analysis, we investigated the association between APOE4 carrier status and multimodal biomarkers (diet, blood markers, clinical diagnosis, brain structure, and cognition) in the context of gene-environment interactions.

Methods

Participants were older adults from a longitudinal observational study, the Boston Puerto Rican Health Study (BPRHS), who self-identified as of Puerto Rican descent. Demographics, APOE genotype, diet, blood, and clinical data were collected at baseline and at approximately 12th year, with the addition of multimodal brain magnetic resonance imaging (MRI) (T1-weighted and diffusion) and cognitive testing acquired at 12-year. Measures were compared between APOE4 carriers and non-carriers, and associations between multimodal variables were examined using correlation and multivariate network analyses within each group.

Results

A total of 156 BPRHS participants (mean age at imaging = 68 years, 77% female, mean follow-up 12.7 years) with complete multimodal data were included in the current analysis. APOE4 carriers (n = 43) showed reduced medial temporal lobe (MTL) white matter (WM) microstructural integrity and lower mini-mental state examination (MMSE) score than non-carriers (n = 113). This pattern was consistent with an independent sample from the Alzheimer's Disease Neuroimaging Initiative (ADNI) of n = 283 non-Hispanic White adults without dementia (mean age = 75, 40% female). Within BPRHS, carriers showed distinct connectivity patterns between multimodal biomarkers, characterized by stronger direct network connections between baseline diet/blood markers with 12-year blood/clinical measures, and between blood markers (especially lipids and cytokines) and WM. Cardiovascular burden (i.e., hypertension and diabetes status) was associated with WM integrity for both carriers and non-carriers.

Conclusion

APOE4 carrier status affects interactions between dietary factors, multimodal blood biomarkers, and MTL WM integrity across ~12 years of follow-up, which may reflect increased peripheral-central systems crosstalk following blood-brain barrier breakdown in carriers.

Abstract P211: Associations of the Mediterranean and MIND Diets With Brain Volume in the Boston Puerto Rican Health Study

Objectives: Although few studies are available, some evidence suggests that greater adherence to the MeD (Mediterranean Diet) and MIND (Mediterranean-Dietary Approaches to Reduce Hypertension Intervention for Neurocognitive Delay) dietary patterns may benefit cognitive function among Hispanic/Latino adults. Greater regional and total brain volumetric measures are associated with an increased risk of dementia, but whether the MeD and MIND dietary patterns relate to brain volume among Hispanic/Latino adults remains unclear. The objective of the current study was to quantify the associations of these dietary patterns with brain volume among Hispanic/Latino adults.

Methods: Data are from the Boston Puerto Rican Health Study, which recruited 1500 older Puerto Rican adults residing in the Boston Metro Area. Approximately 13 years from baseline, a subsample of participants (n=240) were invited to a follow-up visit where brain scans were conducted using a 3T MRI scanner. Diet was estimated using the mean intake from a validated food frequency questionnaire administered at baseline, ~2, and ~6 years. The MeD score has 6 adequacy and 3 moderation components, whereas MIND has 10 and 5 components, respectively. Component scores were summed to get a total dietary score, where a higher value indicates greater adherence to the pattern. Total scores range from 0-9 for MeD and 0-15 for MIND. Outcomes included hippocampal, amygdalar, and total gray matter volumes. The residual method was used to adjust brain volumes for differences in intracranial volume and values were z score transformed prior to analyses. Multiple linear regression models were adjusted for age, sex, total energy, the time between the baseline and 13-year visits, education, physical activity, BMI, and smoking status. After exclusions for missing data, the sample size was n=225.

Results: The mean age of the participants was 55±7 years and was primarily female [79%, (178 of 225)]. On average, the time between the baseline and MRI visits was 12.8±1.1 years. Higher MeD score was significantly associated with greater hippocampal [β (95% CI), 0.19 (0.053, 0.32), amygdalar [0.16 (0.03, 0.29)], and total grey matter volumes [0.14 (0.01, 0.26)] ( P <0.05 for all). Similarly, positive associations were observed between the MIND score and hippocampal [0.18 (0.05, 0.31), amygdalar [0.14 (0.01, 0.27)], and total grey matter volumes [0.14 (0.01, 0.27)] ( P <0.05 for all).

Conclusion: Our findings suggest that the observed beneficial associations of the MeD and MIND dietary patterns with cognitive function among Hispanic/Latino adults, may in part be through impacts on regional and total brain volume. These results provide evidence that can inform tailored dietary recommendations and interventions targeting brain health among older Puerto Rican adults.

Funding Sources: This study was supported by NIH grants R01AG055948, P50 HL105185, and P01 AG023394.

Associations of Vitamin B-6 status and Regional Brain Volumetric Measures in the Boston Puerto Rican Health Study

Objectives

We quantified the associations of circulating vitamin B-6 concentration with regional brain volumes among Puerto Rican adults. In addition, associations with plasma vitamins B-12 and folate were investigated.

Methods

Data are from the Boston Puerto Rican Health Study (n = 1499), where a subset of participants from the original cohort volunteered for T1-weighted MRI brain scans (n = 193) (78% female and aged 55 ± 7 y at baseline) approximately 13 years from the baseline visit. Circulating B-6 (pyridoxal 5′-phosphate, PLP), folate, and B-12 were measured from fasting blood samples collected at baseline and ∼2 and 5 y from baseline. Mean concentrations of these B vitamins were calculated for participants with blood samples from at least 2 of the 3 visits (baseline, 2-y, and 5-y). Whole MRI brain volumetric measures (of cortical and subcortical grey matter) were quantified using the FreeSurfer processing pipeline. Volumetric measurements included the frontal, parietal, temporal, and occipital lobes, cingulate gyrus, thalamus, caudate nucleus, putamen, hippocampus, amygdala, cerebellar white matter, and cerebellar cortex. Multivariable linear regression was used to examine associations between mean circulating B-6 and z score transformed regional brain volumes at 13-y. Secondary exposures were circulating folate and B-12 concentrations. A log transformation was applied to B vitamin concentrations. Models were adjusted for age, sex, BMI, smoking status, and intracranial volume.

Results

Mean circulating PLP, folate, and B-12 were 64.5 ± 52 nmol/L, 19.3 ± 7.1 ng/mL, and 558 ± 242 pg/mL, respectively. We observed null associations between PLP and 13-y brain volumetric measures. Conversely, greater vitamin B-12 concentration was associated with greater parietal [β = 0.49 (95% CI: 0.02, 0.96), P = 0.04], putamen [0.88 (0.221, 1.54), P = 0.009], and cerebellar white matter volumes [0.71 (0.08, 1.33), P = 0.02]. Folate was positively associated with thalamus measurements [1.06 (0.34, 1.78), P = 0.004]. Results remained similar after accounting for a history of cardiovascular disease and type 2 diabetes.

Conclusions

These results suggest that, among older Puerto Rican adults, greater vitamin B-12 and folate, but not B-6, status may be related to greater volumetric measures of select brain structures.

Funding Sources

National Institute on Aging.

Bowel Health, Brain Age, Brain Volume and Cognitive Function in the Boston Puerto Rican Health Study

Objectives

The gut-brain axis has been shown to play an important role in neurodegeneration. Bowel dysfunction, such as constipation, is a marker of gut dysbiosis, which has been associated with risk of dementia in prior studies. However, no work has been done in Puerto Ricans, who have unique dietary and lifestyle characteristics impacting both gut and brain health. We aimed to study the association between constipation and cognitive outcomes including MRI-derived brain age, brain volume and cognitive function in a cohort of Puerto Ricans.

Methods

This analysis was conducted within the Boston Puerto Rican Health Study (BPRHS), an ongoing longitudinal cohort that enrolled 1502 self-identified Puerto Rican adults residing in the Boston area, aged 45–75 y at baseline through wave-4 (mean 12.7 ± 1.2 y from baseline). Our study was comprised of 179 participants at wave-4 (12.7 y). Brain age was derived from magnetic resonance imaging (MRI) features that included cortical thickness, area, volume, cerebellar-subcortical and cortical summary, using a machine learning model. Brain age deviation score was used to represent the difference of the participants’ brain age from their biological age, with higher scores representing more advanced brain aging. Constipation was estimated from self-reported bowel health and defined as bowel frequency < 1/d. Global cognitive score (GCS) is a composite of executive function, memory and attention factors. Covariate-adjusted linear regression was used to examine the association between bowel health and brain age, brain volume and GCS at wave-4 (12.7 y).

Results

Among 179 participants with MRI, cognitive function (GCS), and bowel health measures at wave-4 (12.7 y), 45 (25.1%) self-reported constipation, defined as bowel frequency < 1/d (age 66.5 ± 7.8 y; female 75.6%). In covariate adjusted multivariable analyses, we observed that constipation was associated with higher brain age deviation (poorer brain health) (β = 0.377, P = 0.0451). We did not observe an association between constipation and brain volume (P = 0.175) or constipation and cognitive function (P = 0.573).

Conclusions

In this study of older, Boston–Area Puerto Ricans, we observed an association between constipation and brain age, but no association between constipation and brain volume or cognitive function.

Funding Sources

NIH

Association of Diabetes and Hypertension With Brain Structural Integrity and Cognition in the Boston Puerto Rican Health Study Cohort

BACKGROUND AND OBJECTIVES

The Boston Puerto Rican Health Study (BPRHS) is a longitudinal study following self-identified Puerto Rican older adults living in the Greater Boston area. Studies have shown higher prevalence of hypertension (HTN) and type 2 diabetes (T2D) within this ethnic group compared to age-matched non-Hispanic White adults. In this study, we investigated the associations of HTN and T2D comorbidity on brain structural integrity and cognitive capacity in community-dwelling Puerto Rican adults and compared these measures with older adult participants (non-Hispanic White and Hispanic) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and National Alzheimer's Coordinating Center (NACC) databases.

METHODS

BPRHS participants who underwent brain MRI and cognitive testing were divided into 4 groups based on their HTN and T2D status: HTN-/T2D-, HTN+/T2D-, HTN-/T2D+, and HTN+/T2D+. We assessed microstructural integrity of white matter (WM) pathways using diffusion MRI, brain macrostructural integrity using hippocampal volumes, and brain age using T1-weighted MRI and cognitive test scores. BPRHS results were then compared with results from non-Hispanic White and Hispanic participants from the ADNI and NACC databases.

RESULTS

The prevalence of HTN was almost 2 times (66.7% vs 38.7%) and of T2D was 5 times (31.8% vs 6.6.%) higher in BPRHS than in ADNI non-Hispanic White participants. Diffusion MRI showed clear deterioration patterns in major WM tracts in the HTN+/T2D+ group and, to a lesser extent, in the HTN+/T2D- group compared to the HTN-/T2D- group. HTN+/T2D+ participants also had the smallest hippocampal volume and larger brain aging deviations. Trends toward lower executive function and global cognitive scores were observed in HTN+/T2D+ relative to HTN-/T2D- individuals. MRI measures and the Mini-Mental State Examination (MMSE) scores from the HTN+/T2D+ BPRHS group resembled those of ADNI White participants with progressive mild cognitive impairment (MCI), while the BPRHS HTN-/T2D- participants resembled participants with stable MCI. The BPRHS was not significantly different from the ADNI + NACC Hispanic cohort on imaging or MMSE measures.

DISCUSSION

The effects of T2D and HTN comorbidity led to greater brain structural disruptions than HTN alone. The high prevalence of HTN and T2D in the Puerto Rican population may be a key factor contributing to health disparities in cognitive impairment in this group compared to non-Hispanic White adults in the same age range.

TRIAL REGISTRATION INFORMATION

ClinicalTrials.gov identifier: NCT01231958.

Endoscopic Endonasal Versus Transoral Odontoidectomy for Non-Neoplastic Craniovertebral Junction Disease: A Case Series

BACKGROUND

Odontoidectomy is a challenging yet effective operation for decompression of non-neoplastic craniovertebral junction disease. Though both the endoscopic endonasal approach (EEA) and the transoral approach (TOA) have been discussed in the literature, there remain few direct comparisons between the techniques.

OBJECTIVE

To evaluate the perioperative outcomes of EEA vs TOA odontoidectomy.

METHODS

A retrospective review of all cases undergoing odontoidectomy by either the EEA or TOA was performed. Attention was paid to the need for prolonged nutritional support, prolonged respiratory support, and hospitalization times.

RESULTS

During the study period between 2000 and 2018, 25 patients underwent odontoid process resection (18 TOA and 7 EEA). The most common indication for surgery was basilar invagination. Hospital length of stay, intensive care unit length of stay, and intubation days were all significantly shorter in the EEA group compared to the TOA group (P < .01, P = .01, P < .01, respectively). Prolonged nutritional support in the form of a gastrostomy tube was required in 5 patients and tracheostomy was required in 4 patients; all of these underwent odontoidectomy by the TOA. There was no statistical difference in neurological outcomes between the EEA and TOA groups (P = .17).

CONCLUSION

Odontoidectomy can be performed safely through both the EEA and TOA. The results of this study suggest the EEA has shorter hospitalizations and a lower probability of requiring prolonged nutritional support. These advantages are likely the results of decreased oropharyngeal mucosa disruption as compared to the TOA.

Regional Brain Volumes As Mediators of the Association Between Circulating Omega-3 Fatty Acids and Cognitive Function: The Boston Puerto Rican Health Study

Objectives

To assess the mediating role of regional brain volume in the relationship between circulating very-long-chain omega-3 fatty acids and global cognitive function.

Methods

Data are from individuals of the Boston Puerto Rican Health Study with a T1-weighted MRI brain scan available approximately 8 y from the baseline visit (n = 200, mean age at baseline = 54.7 y, 77.5% female). Red blood cell fatty acid composition was measured at baseline and very-long-chain omega-3 fatty acid was defined as the sum of EPA and DHA. A battery of 7 cognitive tests was administered at baseline and 8-y follow-up in the language of preference. Global cognitive function was the average z-score of the cognitive tests. Whole MRI brain volumetric measures (of cortical and subcortical grey matter) were quantified using the FreeSurfer processing pipeline. Structural equation modeling was conducted to examine the mediating effect of regional brain volumetric measures on the association between omega-3 fatty acid concentration and global cognitive function. Bivariate associations were assessed by age- and sex-adjusted partial Spearman's rho correlation coefficient with FDR correction.

Results

The association between baseline omega-3 fatty acid concentration and 8-y global cognitive function was mediated by several cortical regions including the left caudal middle frontal gyrus, right inferior parietal lobes, and right isthmus of cingulate gyrus. Significant mediators in the subcortex included the putamen, amygdala, left ventral dorsal tract, and right thalamus. Omega-3 fatty acid concentration was positively correlated with global cognitive function (rs = 0.17, P &lt; 0.05) and with brain regions identified as significant mediators (rs = 0.17 to 0.21, P &lt; 0.05 for all). Greater volume of the brain region mediators was associated with higher global cognitive function score (rs = 0.17 to 0.24, P &lt; 0.05 for all).

Conclusions

These results suggest that, among older Puerto Rican adults, greater circulating omega-3 fatty acids may be related to better cognitive function and that this relationship may be explained by maintenance of specific cortical and subcortical brain regions.

Funding Sources

NIA R01AG055948.

Brain Computed Tomography Angiography Maximum Intensity Projection Images for ASPECTS Derivation and Detection of Large Infarct Volumes: Preliminary Study

PURPOSE

Non-contrast CT ASPECTS (NCCT_asp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTA_asp) may be superior to NCCT_asp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPS_asp) would be superior compared to both NCCT_asp and CTA_asp in predicting FIV as measured by DWI.

MATERIALS AND METHODS

In 41 consecutive patients with MCA territory infarcts, NCCT_asp, CTA_asp and MIPS_asp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml.

RESULTS

MIPS_asp (AUC: 0.98, CI: 0.88-1.00) were statistically better than NCCT_asp (AUC: 0.87, 95% CI: 0.72-0.95; p=0.01) in predicting FIV ≥70 ml. MIPS_asp were also superior to CTA_asp (AUC: 0.9, CI: 0.79-.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPS_asp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98).

CONCLUSION

Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPS_asp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management.

Neuroimaging Markers for Studying Gulf-War Illness: Single-Subject Level Analytical Method Based on Machine Learning

Gulf War illness (GWI) refers to the multitude of chronic health symptoms, spanning from fatigue, musculoskeletal pain, and neurological complaints to respiratory, gastrointestinal, and dermatologic symptoms experienced by about 250,000 GW veterans who served in the 1991 Gulf War (GW). Longitudinal studies showed that the severity of these symptoms often remain unchanged even years after the GW, and these veterans with GWI continue to have poorer general health and increased chronic medical conditions than their non-deployed counterparts. For better management and treatment of this condition, there is an urgent need for developing objective biomarkers that can help with simple and accurate diagnosis of GWI. In this study, we applied multiple neuroimaging techniques, including T1-weighted magnetic resonance imaging (T1W-MRI), diffusion tensor imaging (DTI), and novel neurite density imaging (NDI) to perform both a group-level statistical comparison and a single-subject level machine learning (ML) analysis to identify diagnostic imaging features of GWI. Our results supported NDI as the most sensitive in defining GWI characteristics. In particular, our classifier trained with white matter NDI features achieved an accuracy of 90% and F-score of 0.941 for classifying GWI cases from controls after the cross-validation. These results are consistent with our previous study which suggests that NDI measures are sensitive to the microstructural and macrostructural changes in the brain of veterans with GWI, which can be valuable for designing better diagnosis method and treatment efficacy studies.

Chiari I malformation and pregnancy: a comprehensive review of the literature to address common questions and to guide management

BACKGROUND

The optimal management of Chiari I malformation during pregnancy remains uncertain. Labor contractions, which increase intracranial pressure, and neuraxial anesthesia both carry the theoretical risk of brainstem herniation given the altered CSF dynamics inherent to the condition. Mode of delivery and planned anesthesia, therefore, require forethought to avoid potentially life-threatening complications. Since the assumed potential risks are significant, we seek to systematically review published literature regarding Chiari I malformation in pregnancy and, therefore, to establish a best practice recommendation based on available evidence.

METHODS

The English-language literature was systematically reviewed from 1991 to 2018 according to PRISMA guidelines to assess all pregnancies reported in patients with Chiari I malformation. After analysis, a total of 34 patients and 35 deliveries were included in this investigation. Additionally, a single case from our institutional experience is presented for illustrative purposes but not included in the statistical analysis.

RESULTS

No instances of brain herniation during pregnancy in patients with Chiari I malformation were reported. Cesarean deliveries (51%) and vaginal deliveries (49%) under neuraxial blockade and general anesthesia were both reported as safe and suitable modes of delivery. Across all publications, only one patient experienced a worsening of neurologic symptoms, which was only later discovered to be the result of a previously undiagnosed Chiari I malformation. Several patients underwent decompressive suboccipital craniectomy to treat the Chiari I malformation during the preconception period (31%), during pregnancy (3%), and after birth (6%). Specific data regarding maternal management were not reported for a large number (21) of these patients (60%). Aside from one abortion in our own institutional experience, there was no report of any therapeutic abortion or of adverse fetal outcome.

CONCLUSIONS

Although devastating maternal complications are frequently feared, very few adverse outcomes have ever been reported in pregnant patients with a Chiari I malformation. The available evidence is, however, rather limited. Based on our survey of available data, we recommend vaginal delivery under neuraxial blockade for truly asymptomatic patients. Furthermore, based on our own experience and physiological conceptual considerations, we recommend limiting maternal Valsalva efforts either via Cesarean delivery under regional or general anesthesia or by choosing assisted vaginal delivery under neuraxial blockade. There is no compelling reason to offer suboccipital decompression for Chiari I malformation during pregnancy. For patients with significant neurologic symptoms prior to conception, decompression prior to pregnancy should be considered.

Radiologic characteristics of ependymomas: a case-based approach

The purpose of this paper was to introduce and review the characteristic imaging features of ependymal neoplasms through a comprehensive case-based approach. Illustrated cases highlight both common and uncommon manifestations of central nervous system-ependymomas. The combination of imaging features, location of the tumor, and patient's demographics often allow the suggestion of ependymoma as a lead entity in the differential diagnosis. However, significant overlap exists between the radiologic characteristics of ependymomas and those of other tumors commonly encountered in the same locations, which can pose a challenge for a definitive diagnosis based on imaging alone.

White matter damage in maintenance hemodialysis patients: a diffusion tensor imaging study

Background

Patients treated with dialysis have high rates of brain infarcts, brain atrophy, and white matter disease. There are limited data regarding the presence of more subtle damage to brain white matter.

Methods

In the Cognition and Dialysis Study, we compared brain structure using diffusion tensor imaging in hemodialysis (HD) patients to individuals without known kidney disease, using tract based spatial statistics (TBSS) to compare Fractional Anisotropy (FA) and Mean Diffusivity (MD). Statistical comparison of each overlaid voxel was age controlled using a permutation based corrected p value of <0.05.

Results

Thirty-four HD patients and twenty six controls (52 vs 51 years for HD vs control) had adequate magnetic resonance imaging for analysis. The HD group had fewer women (38% vs 23%) and a higher prevalence of diabetes (29% vs 8%), heart failure (29% vs 0%) and clinical stroke (15% vs 0%). Hemodialysis patients had significantly lower FA across multiple white matter fiber tracts, with fronto-temporal connections, the genu of the corpus callosum and the fornix more significantly affected than posterior regions of the brain. Similarly, HD patients had significantly higher mean diffusivity in multiple anterior brain regions. Results remained similar when those with a prior history of stroke were excluded.

Conclusions

In HD patients, there is more white matter disease in the anterior than posterior parts of the brain compared to controls without kidney disease. This pattern of injury is most similar to that seen in aging, suggesting that developing chronic kidney disease and ultimately kidney failure may result in a phenotype consistent with accelerated aging.

Quantitative microstructural deficits in chronic phase of stroke with small volume infarcts: A diffusion tensor 3-D tractographic analysis

BACKGROUND

Non-infarct zone white matter wallerian degeneration is well-documented in large volume territorial infarctions. However to what extent these abnormalities exist in small volume infarction is not known, particularly since routine T2/FLAIR MR images show minimal changes in such cases. We therefore utilized DTI based quantitative 3D tractography for quantitative assessment of white matter integrity in chronic phase of small volume anterior circulation infarcts.

METHODS

Eleven chronic stroke subjects with small anterior circulation large vessel infarcts (≤10cm(3) volume of primary infarct) were compared with 8 age matched controls. These infarcts had negligible to mild gliosis and encephalomalacia in the primary infarct territory without obvious wallerian degeneration on conventional MRI. Quantitative Diffusion Tensor 3-D tractography was performed for CST, genu and splenium of corpus callosum. Tract based Trace and fractional anisotropy (FA) were compared with age matched controls.

RESULTS

On univariate analysis, Chronic stroke subjects had significant elevation in Trace measurement in genu of corpus callosum (GCC), ipsilesional and contralesional CST, (p<0.05), compared to controls. After adjusting for smoking, hypertension (HTN) and non-specific white matter hyperintensities, (WMHs), there was significant elevation in trace within the ipsilesional CST (p=0.05). Contralesional CST FA correlated significantly with walking speed, r=0.67, p=0.03.

CONCLUSIONS

Stroke subjects with small volume infarcts demonstrate significant quantitative microstructural white matter abnormalities in chronic phase, which are otherwise subthreshold for detection on routine imaging. Ability to quantify these changes provides an important marker for assessing non-infarct zone neuroaxonal integrity in the chronic phase even in the setting of small infarction.

Added value of integrated circuit detector in head CT: objective and subjective image quality in comparison to conventional detector design

RATIONALE AND OBJECTIVES

A new computed tomography (CT) detector with integrated electric components and shorter conducting pathways has recently been introduced to decrease system inherent electronic noise. The purpose of this study was to assess the potential benefit of such integrated circuit detector (ICD) in head CT by comparing objective and subjective image quality in low-dose examinations with a conventional detector design.

MATERIALS AND METHODS

Using a conventional detector, reduced-dose noncontrast head CT (255 mAs; effective dose, 1.7 mSv) was performed in 25 consecutive patients. Following transition to ICD, 25 consecutive patients were scanned using identical imaging parameters. Images in both groups were reconstructed with iterative reconstruction (IR) and filtered back projection (FBP) and assessed in terms of quantitative and qualitative image quality.

RESULTS

Acquisition of head CT using ICD increased signal-to-noise ratio of gray and white matter by 14% (10.0 ± 1.6 vs. 11.4 ± 2.5; P = .02) and 17% (8.2 ± 0.8 vs. 9.6 ± 1.5; P = .000). The associated improvement in contrast-to-noise ratio was 12% (2.0 ± 0.5 vs. 2.2 ± 0.6; P = .121). In addition, there was a 51% increase in objective image sharpness (582 ± 85 vs. 884.5 ± 191; change in HU/Pixel; P < .000). Compared to standard acquisitions, subjective grading of noise and overall image quality scores were significantly improved with ICD (2.1 ± 0.3 vs. 1.6 ± 0.3; P < .000; 2.0 ± 0.5 vs. 1.6 ± 0.3; P = .001). Moreover, streak artifacts in the posterior fossa were substantially reduced (2.3 ± 0.7 vs. 1.7 ± 0.5; P = .004).

CONCLUSIONS

At the same radiation level, acquisition of head CT with ICD achieves superior objective and subjective image quality and provides potential for significant dose reduction.

Anatomic brain disease in hemodialysis patients: a cross-sectional study

BACKGROUND

Although dialysis patients are at high risk of stroke and have a high burden of cognitive impairment, there are few reports of anatomic brain findings in the hemodialysis population. Using magnetic resonance imaging of the brain, we compared the prevalence of brain abnormalities in hemodialysis patients with that in a control population without known kidney disease.

STUDY DESIGN

Cross-sectional cohort.

SETTING & PARTICIPANTS

45 maintenance hemodialysis patients and 67 controls without reported kidney disease, both without history of known stroke.

PREDICTOR

The primary predictor was dialysis status. Covariates included demographics (age, race, and sex), vascular risk factors (diabetes and hypertension), and cardiovascular disease (coronary artery disease and congestive heart failure).

OUTCOMES

Magnetic resonance imaging of the brain features, including severity of white matter disease and cerebral atrophy (sulcal prominence and ventricular atrophy), hippocampal size, and small-/large-vessel infarcts.

MEASUREMENTS

Semiquantitative scale (0-9 for white matter disease and cerebral atrophy, 0-3 for hippocampal size) and infarct prevalence.

RESULTS

Mean ages of hemodialysis patients and controls were 55 ± 17 (SD) and 53 ± 13 years, respectively. In comparison to controls, hemodialysis patients had more severe white matter disease (1.6 vs 0.7) and cerebral atrophy (sulcal prominence, 2.3 vs 0.6; ventricular enlargement, 2.3 vs 0.9; hippocampal size, 1.3 vs 1.0), with all P < 0.001. In multivariable analyses, hemodialysis status was associated independently with worse white matter disease and atrophy grades. Hemodialysis patients also had a higher prevalence of small- (17.8%) and large- (7.8%) vessel infarcts than controls (combined, 22% vs 0%; P < 0.001).

LIMITATIONS

The dialysis cohort likely is healthier than the overall US hemodialysis population, partly limiting generalizability.

CONCLUSIONS

Hemodialysis patients have more white matter disease and cerebral atrophy compared with controls without known kidney disease. Hemodialysis patients also have a high prevalence of unrecognized infarcts.

The relationship between plasma amyloid-β peptides and the medial temporal lobe in the homebound elderly

BACKGROUND

The ratio of high amyloid-β peptide40 (Aβ40) and low Aβ42 in plasma predicts the risk of Alzheimer's disease (AD) and is associated with episodic recall in depression. We thus examined the relationship between plasma Aβ levels and brain volumes.

METHODS

Homebound elders (N = 352) who had undergone brain MRI were used. Plasma Aβ1-40 and Aβ1-42 were measured by ELISA. Volumes of medial temporal regions, including the amygdala and hippocampus, were manually measured.

RESULTS

Amygdala volume was associated with log(10) of plasma Aβ1-42 (β = +0.19, SE = 0.07, p = 0.005) after adjusting for AD, infarcts, white matter hyperintensities and demographics. In the absence of dementia, decreasing quartiles of plasma Aβ1-42 (Mean + SD ml: Q4 = 4.1 ± 0.8; Q3 = 3.9 ± 0.7; Q2 = 3.6 ± 0.8 and Q1 = 3.7 ± 0.8, p = 0.01) and increasing quartiles of plasma Aβ1-40/1-42 ratio were associated with smaller amygdala volume. Those depressed subjects with a high plasma Aβ1-40/1-42 ratio had smaller amygdala (Mean + SD ml: 3.3 ± 0.8 vs. 3.6 ± 0.8, p = 0.04) and total brain volume (Mean + SD liter: 0.95 ± 0.07 vs. 1.04 ± 0.12, p = 0.005), and had a higher rate of MCI (67 vs. 36%, p = 0.02) than those with a low plasma Aβ1-40/1-42 ratio.

CONCLUSIONS

The combination of low plasma Aβ1-42 concentration and atrophy of the medial temporal lobe structures, which regulates mood and cognition, may represent a biomarker for a prodromal stage of AD.

Prefrontal regional correlates of self-control in male psychiatric patients: Impulsivity facets and aggression

Investigating the organization of trait aggression and impulsivity in the prefrontal cortex (PFC) advances our understanding of the neuropsychobiology of self-control. While the orbital aspect of the PFC (OFC) has received attention, there is reason to believe the lateral aspect is also relevant. In the current study using magnetic resonance imaging, gray matter volumes in lateral PFC (LPFC) were derived in a heterogeneous male psychiatric sample (N=36) in which OFC volumes had previously been reported. In an analysis using self-report measures of trait impulsivity and aggression, the left LPFC accounted for significant variance in attentional aspects of impulsivity (13%) and aggression (10%) but not motor aspects of impulsivity, as hypothesized. The OFC was associated with motor impulsivity (left-20%; right-14%) and was also more robustly associated with aggression (left-36%; right-16%). A social/emotional information processing model was explored, based upon whether the LPFC or the OFC depended upon one another for their association to trait aggression and impulsivity. It was demonstrated that association of the LPFC to both aggression and attentional impulsivity depended upon the OFC, while the converse was not supported. The LPFC appears relevant to the higher-order aspects of a cortical self-control network, and that relevance is dependent upon the robust contribution of the OFC.

Reversible uncal herniation in a neonate with a large MCA infarct

Uncal herniation due to a large cerebral infarct is well-described in adults, with high rates of morbidity and mortality. This phenomenon, however, has not been previously reported in neonates. We present a newborn male delivered via cesarean section with difficult extraction who presented with frequent seizures. He was found to have an acute left MCA territory infarct secondary to an M1 occlusion detected on MRI/MRA. He became lethargic and developed a left uncal herniation on CT at 72h of life. He was treated medically with osmolar agents and hemodynamic support, and had resolution of the herniation on CT at 120h of life. At 19 months he had residual moderate right hemiparesis with only mild gait disturbance and mild speech delay. As seen in this case, uncal herniation, though rare, may occur in neonates. Also, the outcome for this neonate was much better than for typical adults with a similar disease course.

A multivariate approach to aggression and the orbital frontal cortex in psychiatric patients

The association between orbital frontal cortex (OFC) volume and aggression was investigated in an at-risk psychiatric population. Forty-one psychiatric patients were referred for magnetic resonance imaging and a standardized psychometric assessment of aggression (Lifetime History of Aggression-Revised). Nineteen matched controls had lower levels of aggression and greater OFC volume, establishing the appropriateness of the psychiatric group for studying aggression pathophysiology. Consistent with study hypotheses, left OFC gray matter volume predicted 34% of the variance in self-reported aggression ratings. When impulsivity was not controlled for, left OFC gray matter only accounted for 26% of aggression variance, suggesting a complex relationship between impulsivity and OFC-aggression pathophysiology. Contrary to study hypotheses, right OFC gray matter volume did not predict degree of aggressive behavior. Current models do not account for lateralization, yet this may be quite important. Greater consideration should be given to laterality in OFC regulation of social/emotional behavior. Regulatory focus theory, positing two motivational systems, promotion and prevention, lateralized to the left and right hemispheres, respectively, may provide an explanatory framework for these results. Dysregulation of the left hemisphere 'promotion' motivational system may help to explain the aggressive behavior present in psychiatric populations.

Midtrimester heterotopic abdominal pregnancy diagnosed and managed with imaging guidance: a case report

BACKGROUND

An abdominal pregnancy coexisting with an intrauterine pregnancy is a rare variant of heterotopic pregnancy.

CASE

An abdominal heterotopic pregnancy was diagnosed at 22 weeks' gestation. Magnetic resonance imaging, magnetic resonance angiography and sonography were performed to elucidate the anatomy. A multidisciplinary conference was held and management options were discussed. The patient elected to terminate the abdominal fetus. Selective embolization of the abdominal fetus was attempted but was unsuccessful. Intracardiac injection of potassium chloride was performed without incident. The intrauterine fetus was delivered at 36 weeks without complications.

CONCLUSION

Abdominal heterotopic pregnancies pose unique management challenges, and close cooperation between obstetricians and radiologists is essential.

Progressive cognitive impairment after stroke

OBJECTIVE

We examined the putative relationship between stroke and cognitive function in the population-based prospective cohort of the Cardiovascular Health Study (CHS).

METHODS

Of the 5888 participants of the CHS aged 65 years or older, there were 5364 with more than one modified mini-mental (3MS) examination between 1992 and 1998. To determine the effect of baseline stroke before first and subsequent (stroke between two consecutive examinations) 3MS examination on cognitive function, linear regression models were computed with potential confounders entered as additional independent variables. Stroke was divided into right and left hemispheres or posterior circulation on the basis of the clinical and/or imaging information by the hospital that treated the event and subsequent adjudication by CHS committee.

RESULTS

Participants with baseline stroke had an average 3MS decline of 1.2 (95% confidence interval [CI]: -0.7 - -1.7) points per year more than those without one. Those with a history of subsequent stroke had an average first year 3MS decline of 6.2 (CI -8.7 - -3.7) for left hemisphere, 3.5 (CI -5.3 - -1.8) for right hemisphere, and 1.1 (CI -3.9 - 1.6) for posterior circulation more than those without stroke. The effect of stroke on the rate of cognitive decline appeared to ameliorate after the first year (test for linear trend among those with stroke, P = .003).

CONCLUSION

Results from this prospective population-based data study show that stroke in the left hemisphere results in a more pronounced decline in cognition than that in the right hemisphere and that cognitive loss because of stroke appears to attenuate over time, perhaps as a result of relearning.

Intracranial carotid artery calcification on head CT and its association with ischemic changes on brain MRI in patients presenting with stroke-like symptoms: retrospective analysis

INTRODUCTION

Our purpose was to study the association between the intracranial arterial calcifications observed on head CT and brain infarcts demonstrated by MRI in patients presenting with acute stroke symptoms.

METHODS

Institutional review board approval was obtained for this retrospective study which included 65 consecutive patients presenting acutely who had both head CT and MRI. Arterial calcifications of the vertebrobasilar system and the intracranial cavernous carotid arteries (intracranial carotid artery calcification, ICAC) were assigned a number (1 to 4) in the bone window images from CT scans. These four groups were then combined into high calcium (grades 3 and 4) and low calcium (grades 1 and 2) subgroups. Brain MRI was independently evaluated to identify acute and chronic large-vessel infarcts (LVI) and small-vessel infarcts (SVI). The relationship between ICAC and infarcts was evaluated before and after adjusting for demographics and cardiovascular risk factors.

RESULTS

Statistical analysis could not be performed for the vertebrobasilar system due to an insufficient number of patients in the high calcium group. Of the 65 patients, 46 (71%) had a high ICAC grade on head CT. They were older and had a higher prevalence of cardiovascular risk factors. Acute SVI (P = 0.006), chronic SVI (P = 0.006) and acute LVI (P = 0.04) were associated with a high ICAC grade. After adjustment for age and other risk factors, only acute SVI was associated with a high ICAC grade (P = 0.002).

CONCLUSION

Although age emerged as the most important determinant of ischemic cerebral changes, there were rather complex interactions among multiple risk factors with different infarct types. A high ICAC grade demonstrated a correlation with acute SVI in our patients independent of these risk factors.

Orbitofrontal correlates of aggression and impulsivity in psychiatric patients

The association between orbital frontal cortex (OFC) volume and aggression and impulsivity was investigated among a heterogeneous group of non-psychotic psychiatric clients. Fifteen non-psychotic subjects from two different psychiatric clinics (New England Medical Center and Lemuel Shattuck Hospital) with a variety of diagnoses were sequentially referred for magnetic resonance imaging (MRI) for clinical purposes. This convenience sample, clinically stable at the time of evaluation, received a standardized psychiatric diagnostic interview, aggression and impulsivity psychometrics (Barratt Impulsivity, Lifetime History of Aggression, and Buss-Perry Aggression scales), and an MRI protocol with image analysis. OFC gray matter volume, total as well as left and right, was significantly and positively associated with motor impulsivity. OFC asymmetry was associated with aggression, though total, left, and right OFC volume measurements were not. For subjects without affective disorder, there was a strong and positive association of the OFC to motor and no-planning subscales of the Barratt Impulsivity Scale. For subjects with affective disorder, there was a strong association of OFC asymmetry to both of the aggression psychometrics. Consistent with expectation, results are suggestive of OFC involvement in the neural circuitry of impulsivity and aggression. The findings suggest a dissociation of the role of the OFC in relation to aggression and impulsivity, such that the OFC may play a part in the regulation of aggressive behavior and a generative role in impulsive behavior.

The Nutrition, Aging, and Memory in Elders (NAME) study: design and methods for a study of micronutrients and cognitive function in a homebound elderly population

BACKGROUND

Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home.

OBJECTIVES

The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly. NAME targets homebound elders because they are understudied and particularly at risk for poor nutritional status.

METHODS

Subjects are community-based elders aged 60 and older, recruited through area Aging Services Access Points. The NAME core data include demographics; neuropsychological testing and activities of daily living measures; food frequency, health and behavioral questionnaires; anthropometrics; gene status; plasma micronutrients, homocysteine, and other blood determinants. A neurological examination, psychiatric examination, and brain MRI and volumetric measurements are obtained from a sub-sample.

RESULTS

Preliminary data from first 300 subjects are reported. These data show that the NAME protocol is feasible and that the enrolled subjects are racially diverse, at-risk, and had similar basic demographics to the population from which they were drawn.

CONCLUSION

The goal of the NAME study is to evaluate novel relationships between nutritional factors and cognitive impairment. These data may provide important information on potential new therapeutic strategies and supplementation standards for the elderly to maintain cognitive function and potentially reduce the public health costs of dementia.

Statins and cognitive function in the elderly

OBJECTIVE

To examine the association of statin drug use on cognitive and MRI change in older adults.

METHODS

Participants in the Cardiovascular Health Study, a longitudinal study of people age 65 or older, were classified into three groups determined by whether they were taking statin drugs on a continuous basis, intermittently, or not at all. The untreated group was further divided into categories based on National Cholesterol Education Program recommendations for lipid-lowering treatment. Participants with prevalent or incident clinical TIA or stroke or with baseline Modified Mini-Mental State Examination (3MS) scores at or below 80 were excluded. Outcomes examined included rate of change on the 3MS over an average observational period of 7 years, along with changes in MRI white matter grade and measures of atrophy.

RESULTS

Three thousand three hundred thirty-four participants had adequate data for analysis. At baseline, the untreated group in which lipid-lowering drug treatment was recommended were slightly older, less likely to be on estrogen replacement, and had higher serum cholesterol and lower 3MS scores than the statin-treated group. The rate of decline on the 3MS was 0.48 point/year less in those taking statins compared with the untreated group for which treatment was recommended (p = 0.069) and 0.49 point/year less in statin users compared with the group in which lipid-lowering treatment was not recommended (p = 0.009). This effect remained after controlling for serum cholesterol levels. One thousand seven hundred thirty participants with baseline 3MS scores of > 80 underwent cranial MRI scans on two occasions separated by 5 years. There was no significant difference in white matter grade change or atrophy measures between groups.

CONCLUSION

Statin drug use was associated with a slight reduction in cognitive decline in an elderly population. This relationship could not be completely explained by the effect of statins on lowering of serum cholesterol.

Rhabdomyoma of the Head and Neck Demonstrated by Prenatal Magnetic Resonance Imaging

A case of fetal rhabdomyoma (myxoid type) of the head and neck demonstrated on prenatal magnetic resonance imaging (MRI) is presented. This benign tumor of skeletal muscle is uncommon and should not be confused with its malignant counterpart-rhabdomyosarcoma. With the increasing use of ultrafast MRI, the radiologist is more likely to encounter head and neck masses in the fetus.

Homocysteine and B vitamins relate to brain volume and white-matter changes in geriatric patients with psychiatric disorders

OBJECTIVE

There is a growing literature on the relationship between low serum B-vitamins, elevated homocysteine, and cognitive impairment; however, few studies have examined radiological markers of associated neuropathology in geropsychiatry inpatients. The authors examined the relationship of homocysteine, folate, and vitamin B12 with magnetic resonance imaging (MRI) markers of neuropathology.

METHODS

In this archival study, authors reviewed the MRIs and medical records of 34 inpatients in a geriatric psychiatry unit. Patients were selected if folate, B12, and/or homocysteine levels had been assessed and if the appropriate clinical MRIs were performed (19 men; mean age, 75 years). Patients with schizophrenia or current substance dependence were excluded. The relationships between MRI volume measures, white-matter hyperintensity (WMH) grade, and serum concentrations of folate, B12, and homocysteine were analyzed, using age-adjusted Pearson correlations.

RESULTS

Homocysteine was related to WMH grade, but not brain-volume measures. Folate was associated with hippocampus and amygdala, and negatively associated with WMH. B12 level was not statistically associated with any brain measure.

CONCLUSIONS

Elevated homocysteine and low folate were associated with radiological markers of neuropathology. Since no patient had clinically deficient folate, it may be important to rethink what defines functionally significant micronutrient deficiency and explore what this means in different age- and health-status groups. Larger samples will be needed to assess interactions between homocysteine, micronutrients, and other neuropathology risk factors.

Rapid development of optic glioma in a patient with hybrid phakomatosis: neurofibromatosis type 1 and tuberous sclerosis

Increased propensity for tumor formation in neurofibromatosis and tuberous sclerosis exists because of defective tumor-suppressor genes. Although different tumor-suppressor genes may be involved in neurofibromatosis and tuberous sclerosis, at the cellular level these genes share rather common enzymatic pathways. We believe these genetic malfunctions have resulted in a cumulative or additive effect for rapid growth of optic glioma in the following unusual case that has hybrid phakomatosis.

Case report: hypoglycemia and diffusion-weighted imaging

The effect of severe hypoglycemia on the brain is well known, ranging from alterations of mental status to profound coma and death. We describe a case of global diffusion abnormalities eventually resulting in death. This otherwise healthy patient presented with seizures and a serum glucose level less than 20 mg/dL. Testing suggested that the hypoglycemia was likely caused by exogenous insulin or perhaps insulin receptor antibodies. Magnetic resonance imaging on the day after admission showed regions of restricted diffusion in the temporal and occipital lobes as well as in the basal ganglia. Despite the large body of literature concerning the pathophysiology of hypoglycemia and its clinical implications, little is known regarding its radiologic correlations.

Estrogen replacement therapy and MRI-demonstrated cerebral infarcts, white matter changes, and brain atrophy in older women: the Cardiovascular Health Study

OBJECTIVE

We studied the relationship between the use of estrogen replacement therapy (ERT) and cerebral magnetic resonance imaging (MRI) abnormalities among older women.

DESIGN

A population-based prospective study (Cardiovascular Health Study).

SETTING

Four regions in the United States.

PARTICIPANTS

A total of 2133 (62.9% of the eligible) women aged 65 to 95 years (mean age 74.8), on whom MRI was performed in 1992-1994.

MEASUREMENTS

Presence of global brain atrophy, white matter changes, small infarct-like lesion (ILL) (<3 mm), MRI infarcts (> or =3 mm, mostly small and asymptomatic), and cognitive function as measured by Mini-Mental State Exam (MMSE), and by ERT use (current/past/never), adjusted for a number of socioeconomic, lifestyle, and reproductive covariates.

RESULTS

Current use of ERT was reported by 15% and past use by another 23% of participants; 35% of all women had MRI infarcts. The prevalence of MRI infarcts did not differ in current or past users from those who had never used ERT (nonusers). Bifrontal distance, the largest distance between frontal horns, and the size of ventricles were larger among current ERT users compared to past users or nonusers (P (trend) = .01), adjusted for all other covariates, but no dose-response relationship to current or past ERT use was found. Duration of estrogen use was not associated with any atrophy measure. Cortical atrophy measure, sulcal widening, or white matter disease did not differ significantly by ERT use or duration of use. Central measures of atrophy, bifrontal distance, and ventricular size were significantly associated with cognition as measured by MMSE.

CONCLUSIONS

Current ERT users had much more clinically significant central atrophy than nonusers, but the implications remained unclear.

Relationship between ApoE, MRI findings, and cognitive function in the Cardiovascular Health Study

BACKGROUND AND PURPOSE

We determined the relationship between apolipoprotein (Apo)E, MRI, and low cognitive scores.

METHODS

The relationship between age, education, ApoE genotype, MRI examination of the brain, subclinical and clinical cardiovascular disease, and low (<80) score on the Modified Mini-Mental State Examination (3MSE, as modified by Teng and Chui) was evaluated for 3469 black and white participants in the Cardiovascular Health Study (CHS) in years 5 and 6 of the study. The participants were followed for up to 3 years.

RESULTS

The prevalence of scores <80 in years 5 and 6 of the CHS was 8.2% for participants without and 20.4% for those with prior history of stroke. Age, race, and education were important determinants of low 3MSE scores. The prevalence of ApoE-4 (odds ratio [OR], 1.6 [1.1 to 2.1]) was directly related to scores <80, as was high ventricular volume (OR, 1.6 [1.2 to 2.3]), high white matter grade (OR, 1.4 [1.1 to 1.9]), and infarctlike lesions (OR, 1.6 [1.2 to 2.1]) on the MRI in the multivariate analysis. A five-point or greater decline in scores over up to 3 years was more often observed for participants with low 3MSE scores at year 5, at older ages, with lower education, and experiencing incident stroke (OR, 3.6 [1.2 to 10.6]), ApoE-4 genotype (OR, 1.8 [1.4 to 2.3]), and with MRI findings of high ventricular volume (OR, 2.0 [1.5 to 2.7]), and infarctlike lesions (OR, 1.2 [0.9 to 1.5]).

CONCLUSIONS

These results demonstrate that vascular changes on MRI, measures of brain atrophy, ApoE-4, and age, education, and race are associated with low cognitive scores among older individuals. The MRI of the brain provides valuable information related to cognitive tests and decline over time. The potential exists for using MRI measurements to identify high-risk individuals for dementia and to test potential interventions to reduce the risk of dementia.