Relationship between cerebral vasomotor reactivity and white matter lesions in elderly subjects without large artery occlusive disease.
OBJECTIVE
The relationships between cerebral vasomotor reactivity (CVR) and white matter lesions (WMLs) were investigated mainly in patients with carotid stenosis. We aimed to study the relationship in asymptomatic elderly subjects without large artery occlusive disease.


METHODS
A total of 33 elderly individuals (mean age was 76.2 years) who were free from neurological deficit or cognitive impairment were studied. Bilateral mean blood flow velocity was measured in the middle cerebral artery using a 2-MHz pulsed transcranial Doppler (TCD) system together with intravenous administration of acetazolamide as vasodilatory stimuli. WMLs on a fluid-attenuated inversion recovery (FLAIR) sequence of MRI were classified into two categories: subcortical deep white matter hyperintensity (SDWMH) and periventricular hyperintensity (PVH). The lesions in each category were then divided into three grades (grade 0-I, grade II, grade III) according to the Fazekas scale.


RESULTS
CVR was inversely associated with the extent of SDWMH and PVH. The differences in CVR were statistically significant among different severity of WMLs: for SDWMH (70%+/- 10% in grade 0-I, 60%+/- 10% in grade II, and 40%+/- 10% in grade III, P < .001); for PVH (80%+/- 10% in grade 0-I, 60%+/- 10% in grade II, and 40%+/- 10% in grade III, P < .001).


CONCLUSIONS
Impaired CVR is related to the extent of WMLs in asymptomatic elderly individuals without large artery stenosis. The findings in our study suggest that dysfunction of cerebral vascular autoregulation might be an important factor in the development of WMLs in the asymptomatic elderly without large artery occlusive disease.
Fu
Jian Hui
JH
Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. jianhuif@21cn.com
Lu
Chuan Zhen
CZ
Hong
Zhen
Z
Dong
Qiang
Q
Ding
Ding
D
Wong
Ka Sing
KS
D000086:Acetazolamide; D000368:Aged; D001783:Blood Flow Velocity; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D017585:Ultrasonography, Doppler, Transcranial; D014666:Vasomotor System / Q000187:drug effects / Q000503:physiopathology*
D000086:Acetazolamide