The association between frailty and MRI features of cerebral small vessel disease

Ilse M J Kant ,T D Witkamp ,Arjen J C Slooter ,Jeroen Hendrikse ,Claudia Spies ,Georg Winterer ,Henk‐Jan Mutsaerts ,Simone J.t Van Montfort ,Myriam G Jaarsma-Coes ,Jeroen De Bresser

doi:10.1038/s41598-019-47731-2

Abstract

Frailty is a common syndrome in older individuals that is associated with poor cognitive outcome. The underlying brain correlates of frailty are unclear. The aim of this study was to investigate the association between frailty and MRI features of cerebral small vessel disease in a group of non-demented older individuals. We included 170 participants who were classified as frail (n = 30), pre-frail (n = 85) or non-frail (n = 55). The association of frailty and white matter hyperintensity volume and shape features, lacunar infarcts and cerebral perfusion was investigated by regression analyses adjusted for age and sex. Frail and pre-frail participants were older, more often female and showed higher white matter hyperintensity volume (0.69 [95%-CI 0.08 to 1.31], p = 0.03 respectively 0.43 [95%-CI: 0.04 to 0.82], p = 0.03) compared to non-frail participants. Frail participants showed a non-significant trend, and pre-frail participants showed a more complex shape of white matter hyperintensities (concavity index: 0.04 [95%-CI: 0.03 to 0.08], p = 0.03; fractal dimensions: 0.07 [95%-CI: 0.00 to 0.15], p = 0.05) compared to non-frail participants. No between group differences were found in gray matter perfusion or in the presence of lacunar infarcts. In conclusion, increased white matter hyperintensity volume and a more complex white matter hyperintensity shape may be structural brain correlates of the frailty phenotype.

Highlights

Frailty is a chronic condition of increased vulnerability to physiological stressors that is common in older individuals and is most often described using the physical frailty phenotype[1,2,3]
Of the 178 participants that completed the MRI scanning protocol, a total of 8 participants had to be excluded from all analyses, due to extremely large ventricles that hindered accurate segmentation (n = 1), an incomplete fluid-attenuated inversion recovery (FLAIR) and arterial spin labeling (ASL) sequence (n = 1), or major MRI artifacts, leaving 170 participants for the current study
A total of 13 participants had to be excluded from the WMH feature analyses due to major segmentation errors (n = 6), FLAIR artifacts or no availability of a FLAIR sequence (n = 2)

Summary

Introduction

Frailty is a chronic condition of increased vulnerability to physiological stressors that is common in older individuals and is most often described using the physical frailty phenotype[1,2,3]. Frail older individuals have a higher risk of falling, postoperative complications, dependency and cognitive decline, compared to non-frail counterparts[1,4,5]. The impact of these consequences of frailty on a societal and economic level in an aging population stresses the importance of investigating the pathways leading to a frail condition. The most commonly used MRI features of SVD are white matter hyperintensity of presumed vascular origin (WMH) volume and the presence of lacunar infarcts[6,9]. Frailty may be associated with both structural brain changes of SVD as well as quantitative hemodynamic changes

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