Association Between Subclinical Brain Infarcts and Functional Decline Trajectories

Mandip S. Dhamoon, Ying Kuen Cheung, Janet T. DeRosa, Jose Gutierrez, Yeseon P. Moon, Ralph L Sacco, Mitchell S.V. Elkind, Clinton B Wright

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - Jan 1 2018

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Brain
Blood Vessels
Stroke
Confidence Intervals
Hispanic Americans
Population
Cohort Studies
Myocardial Infarction
Prospective Studies
Wounds and Injuries
vascular factor

Keywords

  • disability
  • epidemiology
  • subclinical brain infarct

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Dhamoon, M. S., Cheung, Y. K., DeRosa, J. T., Gutierrez, J., Moon, Y. P., Sacco, R. L., ... Wright, C. B. (Accepted/In press). Association Between Subclinical Brain Infarcts and Functional Decline Trajectories. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15557

Association Between Subclinical Brain Infarcts and Functional Decline Trajectories. / Dhamoon, Mandip S.; Cheung, Ying Kuen; DeRosa, Janet T.; Gutierrez, Jose; Moon, Yeseon P.; Sacco, Ralph L; Elkind, Mitchell S.V.; Wright, Clinton B.

In: Journal of the American Geriatrics Society, 01.01.2018.

Research output: Contribution to journalArticle

Dhamoon, Mandip S. ; Cheung, Ying Kuen ; DeRosa, Janet T. ; Gutierrez, Jose ; Moon, Yeseon P. ; Sacco, Ralph L ; Elkind, Mitchell S.V. ; Wright, Clinton B. / Association Between Subclinical Brain Infarcts and Functional Decline Trajectories. In: Journal of the American Geriatrics Society. 2018.
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AB - 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.

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