Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories.

METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables.

RESULTS: Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant.

CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.

Original languageEnglish (US)
Pages (from-to)549-555
Number of pages7
JournalStroke
Volume49
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Cerebrovascular Disorders
Cognition
Pathology
Magnetic Resonance Imaging
Education
Brain
Stroke
Blood Vessels
White Matter
Myocardial Infarction
Demography

Keywords

  • brain
  • epidemiology
  • magnetic resonance imaging
  • stroke
  • white matter

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Dhamoon, M. S., Cheung, Y. K., Gutierrez, J., Moon, Y. P., Sacco, R. L., Elkind, M. S. V., & Wright, C. B. (2018). Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. Stroke, 49(3), 549-555. https://doi.org/10.1161/STROKEAHA.117.019595

Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. / Dhamoon, Mandip S.; Cheung, Ying Kuen; Gutierrez, Jose; Moon, Yeseon P.; Sacco, Ralph L; Elkind, Mitchell S.V.; Wright, Clinton B.

In: Stroke, Vol. 49, No. 3, 01.03.2018, p. 549-555.

Research output: Contribution to journalArticle

Dhamoon, MS, Cheung, YK, Gutierrez, J, Moon, YP, Sacco, RL, Elkind, MSV & Wright, CB 2018, 'Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease', Stroke, vol. 49, no. 3, pp. 549-555. https://doi.org/10.1161/STROKEAHA.117.019595
Dhamoon MS, Cheung YK, Gutierrez J, Moon YP, Sacco RL, Elkind MSV et al. Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. Stroke. 2018 Mar 1;49(3):549-555. https://doi.org/10.1161/STROKEAHA.117.019595
Dhamoon, Mandip S. ; Cheung, Ying Kuen ; Gutierrez, Jose ; Moon, Yeseon P. ; Sacco, Ralph L ; Elkind, Mitchell S.V. ; Wright, Clinton B. / Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. In: Stroke. 2018 ; Vol. 49, No. 3. pp. 549-555.
@article{26f6ab5e350f4b5f95532cf2008b3fcd,
title = "Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease",
abstract = "BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories.METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV ({\%} total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables.RESULTS: Mean age was 70.6 (SD, 9.0) years; 19{\%} had PI-SBI, and mean WMHV was 0.68{\%}. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant.CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.",
keywords = "brain, epidemiology, magnetic resonance imaging, stroke, white matter",
author = "Dhamoon, {Mandip S.} and Cheung, {Ying Kuen} and Jose Gutierrez and Moon, {Yeseon P.} and Sacco, {Ralph L} and Elkind, {Mitchell S.V.} and Wright, {Clinton B}",
year = "2018",
month = "3",
day = "1",
doi = "10.1161/STROKEAHA.117.019595",
language = "English (US)",
volume = "49",
pages = "549--555",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease

AU - Dhamoon, Mandip S.

AU - Cheung, Ying Kuen

AU - Gutierrez, Jose

AU - Moon, Yeseon P.

AU - Sacco, Ralph L

AU - Elkind, Mitchell S.V.

AU - Wright, Clinton B

PY - 2018/3/1

Y1 - 2018/3/1

N2 - BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories.METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables.RESULTS: Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant.CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.

AB - BACKGROUND AND PURPOSE: Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories.METHODS: A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables.RESULTS: Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant.CONCLUSIONS: PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.

KW - brain

KW - epidemiology

KW - magnetic resonance imaging

KW - stroke

KW - white matter

UR - http://www.scopus.com/inward/record.url?scp=85043702386&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043702386&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.019595

DO - 10.1161/STROKEAHA.117.019595

M3 - Article

VL - 49

SP - 549

EP - 555

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 3

ER -