Severity Of Periventricular Hyperintensities Research Articles

Impact of periventricular hyperintensities and cystatin C on different cognitive domains in the population of non-demented elderly Chinese

ObjectivesTo investigate the impact of periventricular hyperintensities and serum cystatin C on mild cognitive impairment to provide a basis for the investigation of the pathogenesis. Method286 patients enrolled the study and underwent an examination in Shanghai Fifth People’s Hospital from June 2017 to June 2018. The participants’ cognitive function was evaluated by different cognitive domains using of mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), auditory verbal learning test, Huashan version (AVLT-H), digit span test (DST), symbol digit modalities test (SDMT), trail making test (TMT) and verbal fluency test (VFT). We measured the levels of serum cystatin C at the department of clinical laboratory in Shanghai Fifth People’s Hospital and each subject took an MRI examination in the Department of Radiology of Shanghai Fifth People’s Hospital. Multivariate linear regression analyses were used to assess the relationship of cognitive score and the level of cystatin C and periventricular hyperintensities severity. All statistical analyses were performed using the SPSS system. ResultsAmong 286 eligible participants, 203 (71.0%) were enrolled to further analysis, including 69 male and 134 female (Mean age 67.93 ± 6.19 years). Significant predictors of severe periventricular hyperintensities (PVH) were older age and hypertension. Significant predictors of severe deep white matter hyperintensities (DWMH) were older age only. PVH severity was independently associated with mild cognitive impairment and that the primary impairment was executive function and processing speed. DWMH had no significant effect on cognitive function. Cystatin C only affected the overall cognitive level, and the relationship with WMH severity was not significant. ConclusionsWe demonstrated that in the chinese non-demented elderly, the severity of PVH was independent and significant associated with mild cognitive impairment and that the primary impairment was executive capacity and processing speed, while cystatin C may be an independent risk factor for overall cognitive impairment.

Endothelial Function, Adipokine Serum Levels, and White Matter Hyperintesities in Subjects With Diabetic Foot Syndrome.

No study has analyzed the prevalence of white matter hyperintensities (WMHs) in subjects with diabetic foot syndrome (DFS) and their relationship to adipokine serum levels and indexes of endothelial and cognitive performance. To evaluate omentin and vaspin serum levels and the prevalence of WMHs in subjects with DFS and to analyze their relationship with other endothelial, arterial stiffness, and cognitive functions. Case-control study enrolling 40 subjects with DFS, 40 diabetic subjects without foot complications, 40 controls with foot lesions without diabetes, and 40 patients without diabetes mellitus. Pulse wave velocity (PWV), augmentation index, reactive hyperemia index (RHI), serum vaspin and omentin levels, Fazekas score, and Mini-Mental State Examination (MMSE). Subjects with DFS showed higher mean PWV values when compared with diabetic controls and lower RHI values when compared with controls. They also showed a lower mean MMSE score, significantly lower omentin serum levels, and a higher prevalence of grade 2 severity of periventricular hyperintensities (PVHs). We observed a significant positive correlation between PWV and PVH and between Fazekas score and PWV among diabetic subjects, whereas among subjects with diabetic foot we observed a significant negative correlation between PVH and RHI. Diabetes seems to be more associated with endothelial function disturbance in comparison with patients with diabetic foot that exhibit a more strict association with microvascular brain damage as indicated by our significant finding of an association with PVHs.

Hypertriglyceridemia Is Associated with Reduced Leukoaraiosis Severity in Patients with a Small Vessel Stroke.

Intracranial hemorrhage or microbleeds and leukoaraiosis have an overlap in biology. Hyperlipidemia may reduce the risk of ICH or cerebral microbleeds; studies focusing on the relationship between different lipid profiles and severity of periventricular hyperintensities (PVH) and subcortical white matter lesions (SWMLs) in the cerebral small vessel disease are limited. Methods. Patients with recent first lacunar infarct were recruited. PVH and SWMLs were accessed on MRI with the Fazekas scale, and lipid levels were measured. Univariate and multivariable regression analyses were used to assess the relation between different lipid profiles and severity of PVH and SWMLs. Results. In univariate analyses, advancing age was correlated with increasing severity of leukoaraiosis (P < 0.001). There was an inverse relationship between hypertriglyceridemia (hyper-TG) (≥1.7 mmol/l) and severity of leukoaraiosis (P < 0.05). In the multivariable analysis, after controlling for age, sex, and significant risk factors in the univariate and age-adjusted analyses, hyper-TG demonstrated a protective effect on the severity of PVH and SWMLs (P < 0.05). Higher total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were not associated with leukoaraiosis. Conclusions. Hyper-TG is associated with the severity of leukoaraiosis independent of other risk factors, and it might be a protective role in cerebral small vessel disease.

Abstract TP202: Increased Pulse Pressure is Related to Higher Burden of Microvascular Brain Damage in Ischemic Stroke Patients

Introduction: pulse pressure (PP), a marker of arterial stiffness, is a useful tool for measuring vascular aging. White matter hyperintensities (WMH), deep and periventricular, are the expression of subclinical ischemic brain damage. Hypotesis: our objective was to evaluate the relationship between pre-stroke blood pressure and the burden of WMH. Method: acute ischemic stroke patients, excluding TIA, were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic medical records and the presence of WMH was evaluated on admission MRI. Periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) were classified according to Fazekas scale (0-3). A correlation analysis between different components of blood pressure and WMH was performed. Results: 808 patients (59% females, mean age 77±11 years) were included between January 2009 and December 2014. Main vascular risk factors were: hypertension (83%), dyslipemia (64%), obesity (52%), smoking (37%), metabolic syndrome (37%), diabetes (14%), AF (19%), CKD (45%), CHD (14%), stroke (10%), peripheral artery disease (12%). There was a positive correlation between PP values and the severity of PVH (R 0.93) and DWMH (R 0.95), but not with SBP (R 0.48 and R 0.50) and DBP (R 0.52 and 0.47). (figure) Conclusion: different blood pressure components may have different deleterious effects on large and small vessels. Pulse pressure, a pulsatile component mainly reflecting large artery stiffness and wave reflections, was the only component of blood pressure with a positive correlation with the burden of WMH in our cohort. As the world is aging, is mandatory to identify predictors of subclinical brain damage, which is related to increased risk of dementia, depression, stroke and gait disorders.

Association of cerebral white matter lesions with cognitive function and mood in Japanese elderly people: a population-based study.

BackgroundTo determine the relationships between regional white matter lesions (WMLs), lifestyle factors, and cognitive, motor function and mood.MethodsA comprehensive evaluation, including brain MRI, blood tests, the Unified Parkinson's Disease Rating Scale, the Mini Mental State Examination, and the Geriatric Depression Scale, was performed for people aged 65 years or older living in Ama-cho on October 1, 2009. Participants were classified by severity of periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) using the Fazekas score.ResultsOf 900 eligible participants, 688 (76.4%) were enrolled, including 303 men. Significant predictors of severe PVH were older age, lower low-density lipoprotein cholesterol (LDL-C) levels, elevated blood pressure (BP), cerebral infarction, and no current alcohol use. Significant predictors of severe DWMH were older age, lower 1,5-anhydroglucitol (1,5-AG) levels, elevated BP, cerebral infarction, and no current alcohol use. Higher cognitive function was associated with younger age, female sex, mild DWMH, more years of education, and higher high-density lipoprotein cholesterol levels. Depressive symptoms were associated with lower 1,5-AG levels, lower LDL-C levels, moderate to severe PVH, and no current alcohol use.ConclusionsWhite matter lesions in elderly people were related to hypertension and impaired glucose tolerance. The severity of WMLs was associated with cognitive function and mood.

Abstract W P364: Relationships Between Endothelial Function, Biological Markers and Cerebral Small Vessel Diseasein Patients with Chronic Cerebrovascular Disease and Comorbidity

Background and Purpose: Pathogenesis of white matter lesions is thought to be associated with endothelial dysfunction and inflammation. Ultrasound assessment of brachial artery flow mediated dilation (FMD) as a noninvasive and useful method has been recently used as an index of endothelium-dependent vasodilation. The aim of this study was to investigate the associations between endothelial function which was evaluated by FMD and the severity of white matter lesions in patients with chronic cerebrovascular disease and comorbidity. Additionally, we evaluated association between FMD and the number of circulating progenitor cells. Methods: Patients with cerebrovascular diseases history and other untypical neurological problems were enrolled in this study (n=63; 39 male, 69.8±10.0 years). Patients were classified according to periventricular hyperintensities (PVH) and deep white matter hyperintensities (DWMH) scores by fluid-attenuate inversion recovery image of magnetic resonance images (Fazekas gradings). Endothelial dysfunction was defined as a FMD≤4.5%. The numbers of CD34+/CD133+ cells defined as circulating progenitor cells were evaluated by flow cytometry. Results: The patients with endothelial dysfunction (n=39, 61.9%) were older (72.4±7.6 vs. 65.5±11.8, P=0.007), more frequently male (74.4% vs. 41.7%, P=0.016) and more frequently had hypertension (89.7% vs. 37.5%, P&lt;0.001) than the patients without. FMD was negatively correlated with age, the severity of PVH and the severity of DWMH (R 2 =0.120, p=0.006, R 2 =0.280, p&lt;0.001 and R 2 =0.234, p&lt;0.001, respectively). In addition, FMD was positively correlated with the number of circulating progenitor cell (R 2 =0.078, p=0.034). After multivariate analysis with age, sex, presence of stroke and comorbidities, endothelial dysfunction was independently associated with the severity of PVH (standardized partial regression coefficient [β] 0.703, p=0.002), as well as DWMH (β 0.589, p=0.042). Conclusion: Endothelial dysfunction which was evaluated by FMD might be predictive for the grade of cerebral small vessel disease.

Abstract T P145: Physiological Parameters and Radiological Findings of Cerebral Small Vessel Disease

Background and Purpose: Lacunar infarction and intracerebral hemorrhage (ICH) are closely related. Although they are classified as different stroke subtypes, both are associated with cerebral small-vessel disease (CSVD). Previous studies showed a positive correlation of CSVD with physiological parameters such as pulse wave velocity (PWV) or with radiographical findings such as cerebral microbleeds (CMB); however, the role of these parameters remains controversial. Therefore, we assessed whether there is a relationship between stroke subtypes and these potential CSVD-related parameters. Methods: In a multicenter, prospective study from 8 hospitals, we enrolled 342 patients with a history of cerebral infarction or ICH who underwent both carotid ultrasound and MRI examination between February 2011 and December 2012. Ischemic stroke subtypes were determined based on the Trial of Org 10172 in Acute Stroke Treatment criteria, and patients with small vessel occlusion (SVO) or large artery atherosclerosis (LAA) were included in this study. We evaluated the PWV, ultrasonographic parameters [max-IMT, plaque score, pulsatility index (PI), and the diameter of common carotid artery (CCA)], and MRI findings [periventricular hyperintensity (PVH) and CMB]. The severity of PVH was determined according to the Fazekas classification. Results: Of 342 patients, 130 (38%) were classified into the LAA group, 64 (19%) into the ICH group, and 148 (43%) into the SVO group. There were no significant differences in the parameters between the SVO and ICH groups; however, the parameters of the SVO or ICH groups were different from those of the LAA group. After adjustment for vascular risk factors, the following parameters in both SVO and ICH groups were significantly different from those in the LAA group: lower plaque score, higher PI of the internal carotid artery (ICA), higher PVH grade, and greater CMB frequency. Conclusion: The SVO and ICH groups showed alterations in imaging parameters reflecting the underlying pathophysiology of CSVD, including lower plaque score, higher PI of ICA, greater CMB frequency, and higher PVH grade, compared with those of the LAA group.

Abstract TP186: Associations Of Durations Of Antiplatelet Use And Vascular Risk Factors With The Presence Of Cerebral Microbleeds

The association of the presence of cerebral microbleeds with antiplatelet use remains controversial. Long durations of antiplatelet use and vascular risk factors may have a greater effect on the development of microbleeds than short durations. Our aim in the present study was to determine whether the durations of antiplatelet use and vascular risk factors are associated with cerebral microbleeds. Two hundred twenty outpatients with cerebrovascular disease detected by MRI were examined. Cerebral microbleeds were observed in 71 (32.3%) patients, and deep or infratentorial microbleeds and strictly lobar microbleeds in 53 (24.1%) patients and 18 (8.2%) patients, respectively. To determine the association the between durations of vascular risk factors and antiplatelet use, radiological findings regarding the presence and location of cerebral microbleeds were assessed by multivariate logistic regression analysis adjusted for age, sex, and relevant confounders. The duration of hypertension, the presence of lacunar infarcts and the severity of periventricular hyperintensity were associated with microbleeds in a deep or infratentorial region. Antiplatelet use and its duration of were not associated with the presence or location of microbleeds. Our results suggest that deep or infratentorial microbleeds reflect the severity of hypertensive vasculopathy. Thus, antiplatelet use may not be associated with the presence of cerebral microbleeds.

Severe underweight and cerebral microbleeds

Severely low and/or high body mass index (BMI) has been associated with intracerebral hemorrhage (ICH) risk in several large cohorts. The aim of this study is to assess the relationship between BMI and the presence of cerebral microbleeds. The presence and number of microbleeds were assessed on three-dimensional T2-weighted gradient-recalled-echo sequence on magnetic resonance imaging (MRI). The inclusion criteria were participants aged >40 years old without aneurysmal subarachnoid hemorrhage and any type of cerebral vascular malformations. BMI was categorized into severe underweight (<17.0 kg/m(2)), mild underweight (17.0-18.4 kg/m(2)), normal range (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (≥ 30.0 kg/m(2)). Multivariate analyses were adjusted for age, sex, hypertension, smoking, alcohol, stroke subtype, severity of periventricular hyperintensities and deep white matter hyperintensities, and dementia. Additionally, we conducted stratification analyses by age, ICH, smoking habit, or history of any kind of cancer, respectively. A total of 384 participants (232 males, 152 females; mean age 67.5 years) met our inclusion criteria. Overall mean BMI was 22.8 ± 3.6 kg/m(2). On multivariate analyses, severe underweight carried a significantly higher risk for cerebral microbleeds (3.48, 1.06-11.4) compared with normal range BMI, even after stratification in the subgroup aged ≥ 60 years (7.23, 1.57-33.2), nonsmokers (4.75, 1.10-20.5), noncancer subgroup (5.66, 1.31-24.5), and non-ICH subgroup (3.81, 1.14-12.7). We found that severe underweight was an independent significant risk factor for presence of cerebral microbleeds, even after effect of aging, smoking, or preexisting illness was eliminated.

Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age

Taking an advantage of the high sensitivity of 3D T2*-weighted gradient-recalled-echo (GRE) imaging to cerebral microbleeds, we investigated the relationship between cerebral microbleeds and leukoaraiosis. Participants aged 40 years or more have been evaluated for the presence of cerebral microbleeds using 3D T2*-GRE sequence since 2006. The severity of periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on fluid attenuated inversion recovery images was assessed using Fazekas rating scales. Multivariate logistic regression analyses were conducted after adjustment for stroke subtype, age, PVH, DWMH, hypertension, dementia, and use of platelet aggregation inhibitors. Additionally, we examined the association between cerebral microbleeds and other covariates using a Pearson's correlation analysis. Amongst 389 patients, 67 patients had a single microbleed and 93 had multiple microbleeds. The prevalence of microbleeds was 83% amongst 53 patients with intracerebral hemorrhage (ICH), 49% amongst 173 with infarction, and 20% amongst 163 without any type of stroke. In the multivariate analyses, the odds ratio (95% CIs) of microbleed detection was 10.1, (4.12-24.8) for ICH, 2.33 (1.12-4.85) for atherosclerotic infarction, 1.66 (1.10-2.48) for PVH, and 1.49 (1.02-2.19) for DWMH. In the Pearson's correlation analysis, cerebral microbleeds were closely related to PVH (Pearson's correlation coefficient; 0.48) and DWMH (0.37), compared with age (0.16). High-grade PVH, high-grade DWMH, ICH, and atherosclerotic infarction were significantly independent predictors for cerebral microbleeds. In addition, we found that the grades of PVH and DWMH have a closer association with the number of cerebral microbleeds than age.

Silent Cerebral Infarcts and Cerebral White Matter Lesions in Patients with Nonvalvular Atrial Fibrillation

Nonvalvular atrial fibrillation (NVAF) is a well-known strong risk factor for stroke, although few studies have examined silent cerebral ischemic lesions in patients with NVAF. We investigated silent cerebral infarcts (SCIs) and cerebral white matter lesions and risk factors for stroke in NVAF patients. Subjects included 71 consecutive patients with NVAF and 71 sex-and age-matched controls with sinus rhythm who had undergone MRI. Number, size, and localization of SCIs and severity of periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH) on magnetic resonance imaging were analyzed. The risk factors and CHADS2 score for stroke were also investigated. The number of SCIs was significantly larger and the rates of SCIs in the cortex/subcortex and deep white matter were higher in the NVAF group than in the control group. The DSWMH grade was also significantly higher in the NVAF group. NVAF was an independent risk factor for SCIs and DSWMH. The number of cortical and subcortical SCIs was significantly correlated with CHADS2 score. Cortical/subcortical and deep white matter SCIs were more frequent and DSWMH grades were higher in NVAF patients compared with control subjects. CHADS2 score was an effective scheme not only in stroke risk but also in risk of SCI.

Effect of the Ca Antagonist Nilvadipine on Stroke Occurrence or Recurrence and Extension of Asymptomatic Cerebral Infarction in Hypertensive Patients with or without History of Stroke (PICA Study)

Background: We examined the effect of a Ca antagonist (nilvadipine) on the occurrence or recurrence of symptomatic stroke in hypertensive patients with MRI-defined asymptomatic cerebral infarction (ACI), periventricular hyperintensity (PVH), and deep and subcortical white matter hyperintensity (DSWMH), with or without a history of stroke, and evaluated the effect of long-term treatment on the lesions. Methods: Patients with hypertension and incidental ACI were divided into those with (group B, 235 patients) or without (group A, 181 patients) a history of symptomatic stroke, and were given nilvadipine 4–8 mg/day for 3 years. Primary evaluation points were occurrence of symptomatic ischemic stroke and development or extension of asymptomatic ischemic lesions. Results: Male sex, hyperuricemia, diabetes, maximum diameter of infarction and PVH severity were stronger risk factors for group B. Numbers of cerebral infarctions were 31 ± 28 (group A) and 42 ± 32 (group B) at enrollment (p < 0.001). Infarctions were larger and located more frequently on the internal capsule, putamen, thalamus and brainstem in group B. The severity of PVH and DSWMH paralleled the number of cerebral infarctions in both groups. Conclusion: The study design and status of asymptomatic ischemic brain lesions in hypertensive subjects at enrollment are presented.

Correlation of NO metabolites and 8-iso-prostaglandin F2a with periventricular hyperintensity severity.

Oxidative stress and NO are thought to play important roles in arteriosclerosis pathogenesis, a major cause of white matter lesions in the brain. Therefore, we examined whether NO metabolites (NOx) and 8-iso-prostaglandin F(2alpha) (IsoP) levels in vivo correlated with the severity of periventricular hyperintensity (PVH) to evaluate potential roles of oxidative stress and NO in white matter lesions. Participants (687 males and 528 females) of a health-screening examination were recruited into the study. The plasma NOx and urinary IsoP levels were measured using the Griess method and ELISA, respectively. PVH was diagnosed on the basis of MRIs. In nonparametric univariate trend analyses, plasma NOx as well as aging, presence of hypertension and of lacunes, mean blood pressure, and high-density lipoprotein cholesterol showed highly significant monotone correlation with PVH severity (P</=0.01). By the multivariate ordinal regression analysis, the plasma NOx (P=0.002) and urinary IsoP (P=0.01) levels were found to be independent factors influencing the severity of PVH together with aging (P<0.001), presence of hypertension (P<0.001) and lacunes (P<0.001), and mean blood pressure (P=0.001). Oxidative stress and NO have a close correlation with PVH severity. Oxidative stress and NO levels were evaluated in a general population with or without mild periventricular hyperintensity under a cross-sectional study design. Serum NOx (NO metabolites) and urinary 8-iso-PG F2alpha (a marker for oxidative stress) correlated with the severity of periventricular hyperintensity in a multivariate analysis.

Reduced cerebral glucose metabolism in subjects with incidental hyperintensities on magnetic resonance imaging

Objective: To clarify the significance of incidental and asymptomatic hyperintensities on T 2-weighted magnetic resonance images (MRI) in adults, we examined the relationship between a variety of these lesions and cerebral metabolism evaluated by positron emission tomography (PET) with 18F-labeled fluorodeoxyglucose ([ 18F]FDG). Subjects and methods: Two hundred and thirty-one persons with hyperintensities on T 2-weighted MRI but without overt neurological disease (mean age 60±9 years) were studied. MR hyperintensities were classified into deep and/or subcortical white matter hyperintensities (DSWMHs), periventricular hyperintensities (PVHs) and hyperintensities in the basal ganglia and/or thalamus (HBGTs). The relationship between these lesions and cerebral metabolic rate of glucose (CMRgl) measured by [ 18F]FDG-PET was investigated. Results: The CMRgl values in white matter and cerebral cortex in the group with severe PVHs were lower than those in the group with mild PVHs ( P<0.0001 and P<0.005). Although the severity of PVHs was associated with the numbers of DSWMHs and HBGTs, the results of multivariate analysis showed a significant relationship of PVHs to glucose metabolism in cerebral cortex and white matter. Conclusions: We conclude that increasing severity of MRI hyperintensities in adults is associated with a deterioration of cerebral metabolism. In particular, involvement of PVHs may be a marker of widespread deterioration of cortical metabolism.

Effect of extracranial carotid artery stenosis and other risk factors for stroke on periventricular hyperintensity.

The pathogenesis of periventricular hyperintensity (PVH) is still uncertain. We investigated the relationship between PVH and risk factors for cerebrovascular diseases, especially extracranial carotid artery stenosis (ECAS). We studied PVH and ECAS in 323 subjects between 1991 and 1994. Using 1.5-T MRI scan images, we measured PVH quantitatively at eight points and evaluated cerebral infarction. Duplex carotid sonography was performed on the carotid arteries bilaterally and used to divide the severity of ECAS into five grades. Risk factors for cerebrovascular diseases and atherosclerotic complications were assessed from the clinical history. Age was significantly correlated with the size of frontal and whole PVH (P < .01). Frontal PVH was significantly more severe in subjects with hypertension (P < .05). Frontal, occipital, and whole PVH were significantly more severe in subjects with a history of cerebrovascular accident (P < .01). Other risk factors and atherosclerotic complications were not correlated with PVH. There were no significant differences in the severity of PVH among the five groups of ECAS. The severity of PVH in each region was not related to ECAS. There was no significant difference in the age of patients in relation to the five grades of ECAS. However, PVH was significantly more severe in subjects with lacunar infarction or infarction of the deep border zone (P < .05). There was no relationship between PVH and cortical infarction or infarction of the cortical border zone. PVH correlated with age, hypertension, and past history of cerebrovascular disease but not with ECAS. PVH was significantly more severe in lacunar infarction and infarction of the deep border zone. These results suggest that small-vessel disease may underlie the pathogenesis and development of PVH.

Decreased cerebrovascular dilatory capacity in subjects with asymptomatic periventricular hyperintensities.

The clinical significance of the periventricular hyperintensity incidentally found on magnetic resonance images of the brain is questionable. We evaluated resting cerebral blood flow and cerebrovascular dilatory capacity of subjects with asymptomatic periventricular hyperintensities to study their cerebral hemodynamics. Magnetic resonance imaging of the brain was performed in 28 asymptomatic subjects with cerebrovascular risk factors to determine the severity of periventricular hyperintensity. Mean gray matter flow was computed by a 133Xe-clearance technique in subjects at rest and after the administration of 1 g acetazolamide. Flow values were correlated with the scores for periventricular hyperintensity. Resting gray matter flow was not significantly correlated with the severity of periventricular hyperintensity for the whole brain (rs = -.364), whereas flow after acetazolamide loading (rs = -.783, P < .001) and the absolute value of increased flow (rs = -.567, P < .01) were significantly and negatively correlated with the severity of periventricular hyperintensity. A decrease in vasodilatory capacity and compensatory vasodilation occur in the cerebral cortex of subjects with asymptomatic periventricular lesions and maintain cerebral blood flow.

Leuko-araiosis and event-related potentials (P300) in normal aged subjects.

To investigate the relationship between cerebral leuko-araiosis and cognitive function in normal aged subjects, 48 neurologically normal aged volunteers (24 males, 24 females, 64-85 years old, mean age 75.2 years) with no silent lacunar lesions on their MRI images were examined. The severity of periventricular hyperintensity was estimated quantitatively based on the T1 values on MRI. Cognitive function was evaluated on the basis of P300 event-related potentials employing an auditory oddball paradigm. The severity of frontal lobe leuko-araiosis significantly increased with advancing age (p < 0.05), however, P300 latency was not correlated with age. There was no significant correlation between the severity of leuko-araiosis and P300 latency. The severity of leuko-araiosis was correlated with mean arterial blood pressure (p < 0.05). These results suggest that the severity of leuko-araiosis may be unrelated to cognitive function in normal aged subjects and that arterial blood pressure may contribute to the progression of leuko-araiosis.

Magnetic resonance imaging of periventricular hyperintensity in a Veterans Administration hospital population.

Using a beta-permanent magnet (Fonar 3000), we evaluated magnetic resonance imaging of periventricular hyperintensity (PVH) patterns in 60 patients (59 white, 58 men) from the Veterans Administration Hospital, North Chicago, Ill. Eighty percent of the patients had evidence of PVH, which increased significantly in patients older than age 50 years. In addition to age, history of atherosclerotic cardiovascular disease and extracranial malignancy showed a significant association with PVH. A linear correlation was observed between the severity of PVH and an abnormal neurologic examination. In this retrospective, uncontrolled study, we concluded that PVH incidence among white men is high and increases with age or the presence of cardiovascular disease or extracranial malignancy. The degree of PVH positively correlates with abnormal neurologic evaluation and additional abnormalities seen on magnetic resonance imaging. However, the disease-related specificity is as yet undetermined.