title: Carotid atherosclerosis and progression of brain atrophy: the SMART-MR study.
abstract: OBJECTIVE
  Atherosclerosis has been implicated in the development of brain atrophy. However, support for this association comes from cross-sectional studies.
  
  
  METHODS
  Within the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study, a prospective cohort study among patients with symptomatic atherosclerotic disease (mean age ± standard deviation, 58 ± 10 years; 80% men), magnetic resonance imaging of the brain was performed in 1,232 patients at baseline (2001-2005) and in 663 patients at follow-up (2006-2009). Brain segmentation was used to quantify total brain volume, cortical gray matter volume, and ventricular volume as indicators of global, cortical, and subcortical atrophy. At baseline, measurements of carotid intima-media thickness (CIMT) and carotid stenosis were performed. Carotid stenosis was classified into groups 0 of 50%, 50 of 70% (moderate), and >70% (severe) and into unilateral or bilateral stenosis.
  
  
  RESULTS
  Cross-sectional regression analyses showed that both increased CIMT and carotid stenosis were associated with decreased relative total brain and cortical gray matter volume. Our prospective findings showed that after a mean follow-up of 3.9 years (range, 3.0-5.8 years), CIMT and moderate stenosis were not related to progression of brain atrophy. Only severe or bilateral carotid stenosis was related to progression of global atrophy (β [95% confidence interval (CI)], -0.52% [-0.84 to -0.20%], -0.94% [-1.45 to -0.43%]), cortical atrophy (β [95% CI], -0.75% [-1.37 to -0.13%], -1.34% [-2.32 to -0.35%]), and subcortical atrophy (β [95% CI], 0.06% [-0.02 to 0.16%], 0.13% [0.01 to 0.28%]).
  
  
  CONCLUSIONS
  In a study of patients with atherosclerotic disease with 4 years of follow-up, only severe or bilateral carotid stenosis, and not moderate carotid stenosis and increased CIMT, were associated with progression of brain atrophy.
authors.affiliation: Department of Internal Medicine, VU University Medical Center, Amsterdam.
authors.forename: Majon
authors.initials: M
authors.lastname: Muller
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hendrikse
authors.forename: Willem P
authors.initials: WP
authors.lastname: Mali
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000209:etiology / Q000473:pathology*; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000473:pathology; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D011446:Prospective Studies; D012039:Regional Blood Flow; D012307:Risk Factors