You'll need to have your competent? doctor analyze this and tell you what needs to be done to prevent another stroke and dementia. You do expect your doctor to know about this before you bring it up? Don't you? Or are you giving them another pass like the non-knowledge they imparted about your stroke recovery?
Brain Imaging and Cognitive Predictors of Stroke and Alzheimer Disease in the Framingham Heart Study
- Galit Weinstein, PhD,
- Alexa S. Beiser, PhD,
- Charles DeCarli, MD,
- Rhoda Au, PhD,
- Philip A. Wolf, MD and
- Sudha Seshadri, MD, DM
+ Author Affiliations
- Correspondence to Sudha Seshadri, MD, DM, Department of Neurology, Boston University School of Medicine, B602, 72 East Concord St, Boston, MA 02118. E-mail suseshad@bu.edu
Abstract
Background and Purpose—Exposure to vascular risk factors has a gradual deleterious effect on brain MRI and cognitive measures. We explored whether
a pattern of these measures exists that predicts stroke and Alzheimer disease (AD) risk.
Methods—A cognitive
battery was administered to 1679 dementia and stroke-free Framingham
offspring (age, >55 years; mean, 65.7±7.0)
between 1999 and 2004; participants were also
free of other neurological conditions that could affect cognition and
>90% also
had brain MRI examination. We related
cognitive and MRI measures to risks of incident stroke and AD ≤10 years
of follow-up.
As a secondary analysis, we explored these
associations in The Framingham Heart Study original cohort (mean age,
67.5±7.3
and 84.8±3.3 years at the cognitive
assessment and MRI examination, respectively).
Results—A total of
55 Offspring participants sustained strokes and 31 developed AD.
Offspring who scored <1.5 SD below predicted mean
scores, for age and education, on an
executive function test, had a higher risk of future stroke (hazard
ratio [HR], 2.27;
95% confidence interval [CI], 1.06–4.85) and
AD (HR, 3.60; 95% CI, 1.52–8.52); additional cognitive tests also
predicted AD.
Participants with low (<20 percentile)
total brain volume and high (>20 percentile) white matter
hyperintensity volume had
a higher risk of stroke (HR, 1.97; 95% CI,
1.03–3.77 and HR, 2.74; 95% CI, 1.51–5.00, respectively) but not AD.
Hippocampal
volume at the bottom quintile predicted AD in
the offspring and original cohorts (HR, 4.41; 95% CI, 2.00–9.72 and HR,
2.37;
95% CI, 1.12–5.00, respectively). A stepwise
increase in stroke risk was apparent with increasing numbers of these
cognitive
and imaging markers.
Conclusions—Specific patterns of cognitive and brain structural measures observed even in early aging predict stroke risk and may serve
as biomarkers for risk prediction.
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