Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study

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• 作者：Megumi Tsubota-Utsugi ; MPH ; PhD^* ; ^{mutsugky@iwate-med.ac.jp} ; Michihiro Satoh ; PhD^&dagger ; ; Naoki Tomita ; MD ; MPH ; PhD^&Dagger ; ; Azusa Hara ; PhD^§ ; ; Takeo Kondo ; PhD^‖ ; Miki Hosaka ; PhD^¶ ; ; Sho Saito ; PhD^# ; Kei Asayama ; MD ; PhD^** ; Ryusuke Inoue ; MD ; PhD^&dagger ; &dagger ; ; Mikio Hirano ; PhD^&Dagger ; &Dagger ; ; Aya Hosokawa ; PhD^§ ; § ; ; Keiko Murakami ; MPH ; DMsc^** ; Takahisa Murakami ; DDS ; PhD^&dagger ; ; Hirohito Metoki ; MD ; PhD^&dagger ; ; Masahiro Kikuya ; MD ; PhD^‖‖ ; Shin-Ichi Izumi ; MD ; PhD^‖ ; Yutaka Imai ; MD ; PhD^¶ ; ; Takayoshi Ohkubo ; MD ; PhD^**
• 关键词：Functional capacity in early stage ; elderly ; Japanese ; silent cerebrovascular lesions ; lacunar infarcts ; white matter hyperintensity
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：26
• 期：2
• 页码：376-384
• 全文大小：209 K
• 卷排序：26

文摘

We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults.Materials and MethodsFor this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors.ResultsDuring the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]).ConclusionSilent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.