title: Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden.
abstract: OBJECTIVE
  In this cross-sectional study, we tested the construct validity of a "total SVD score," which combines individual MRI features of small-vessel disease (SVD) in one measure, by testing associations with vascular risk factors and stroke subtype.
  
  
  METHODS
  We analyzed data from patients with lacunar or nondisabling cortical stroke from 2 prospective stroke studies. Brain MRI was rated for the presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces independently. The presence of each SVD feature was summed in an ordinal "SVD score" (range 0-4). We tested associations with vascular risk factors, stroke subtype, and cerebral atrophy using ordinal regression analysis.
  
  
  RESULTS
  In 461 patients, multivariable analysis found that age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08-1.12), male sex (OR 1.58, 95% CI 1.10-2.29), hypertension (OR 1.50, 95% CI 1.02-2.20), smoking (OR 2.81, 95% CI 1.59-3.63), and lacunar stroke subtype (OR 2.45, 95% CI 1.70-3.54) were significantly and independently associated with the total SVD score. The score was not associated with cerebral atrophy.
  
  
  CONCLUSIONS
  The total SVD score may provide a more complete estimate of the full impact of SVD on the brain, in a simple and pragmatic way. It could have potential for patient or risk stratification or early efficacy assessment in clinical trials of interventions to prevent SVD progression and may (after further testing) have a useful role in clinical practice.
authors.affiliation: From the Centre for Clinical Brain Sciences (S.D.J.M., F.N.D., M.S.D., J.M.W.), University of Edinburgh, UK; and Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands.
authors.forename: Julie
authors.initials: J
authors.lastname: Staals
authors.affiliation: From the Centre for Clinical Brain Sciences (S.D.J.M., F.N.D., M.S.D., J.M.W.), University of Edinburgh, UK; and Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands.
authors.forename: Stephen D J
authors.initials: SD
authors.lastname: Makin
authors.affiliation: From the Centre for Clinical Brain Sciences (S.D.J.M., F.N.D., M.S.D., J.M.W.), University of Edinburgh, UK; and Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands.
authors.forename: Fergus N
authors.initials: FN
authors.lastname: Doubal
authors.affiliation: From the Centre for Clinical Brain Sciences (S.D.J.M., F.N.D., M.S.D., J.M.W.), University of Edinburgh, UK; and Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands.
authors.forename: Martin S
authors.initials: MS
authors.lastname: Dennis
authors.affiliation: From the Centre for Clinical Brain Sciences (S.D.J.M., F.N.D., M.S.D., J.M.W.), University of Edinburgh, UK; and Department of Neurology and Cardiovascular Research Institute Maastricht (J.S.), Maastricht University Medical Centre, the Netherlands. joanna.wardlaw@ed.ac.uk.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking; D020521:Stroke / Q000145:classification / Q000473:pathology*; D059409:Stroke, Lacunar / Q000473:pathology*