title: Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) scans in the elderly commonly show white matter findings that may raise concerns. We sought to document incidence, manifestations, and predictors of worsening white matter grade on serial imaging.
  
  
  METHODS
  The Cardiovascular Health Study is a population-based, longitudinal study of 5888 people aged 65 years and older, of whom 1919 have had extensive initial and follow-up evaluations, including 2 MRI scans separated by 5 years. Scans were read without clinical information in standard side-by-side fashion to determine worsening white matter grade.
  
  
  RESULTS
  Worsening was evident in 538 participants (28%), mostly (85%) by 1 grade. Although similar at initial scan, participants with worsening white matter grade, compared with those without, experienced greater decline on modified Mini-Mental State examination and Digit-Symbol Substitution test (both P< or =0.001) after controlling for potential confounding factors, including occurrence of transient ischemic attack or stroke between scans. Independent predictors of worsening white matter grade included cigarette smoking before initial scan and infarct on initial scan. Otherwise, predictors differed according to white matter grade on initial scan. For low initial grade, increased age, increased diastolic blood pressure, increased high-density lipoprotein cholesterol, and decreased low-density lipoprotein cholesterol were associated with increased risk of worsening. For high initial grade, any cardiovascular disease and low ankle-arm index were associated with decreased risk of worsening, whereas use of diuretics and statins were associated with increased risk.
  
  
  CONCLUSIONS
  Worsening white matter grade on serial MRI scans in elderly is common, is associated with cognitive decline, and has complex relations with cardiovascular risk factors.
authors.affiliation: Department of Neurology, University of Washington, Seattle, Wash, USA. wl@u.washington.edu
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Alice M
authors.initials: AM
authors.lastname: Arnold
authors.forename: Norman J
authors.initials: NJ
authors.lastname: Beauchamp
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: David
authors.initials: D
authors.lastname: Lefkowitz
authors.forename: Charles
authors.initials: C
authors.lastname: Jungreis
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000150:complications; D003072:Cognition Disorders / Q000175:diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D049292:Leukoaraiosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology