title: Accelerated development of cerebral small vessel disease in young stroke patients.
abstract: OBJECTIVE
  To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls.
  
  
  METHODS
  This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18-50 years, without a history of TIA or stroke. In addition, 90 age- and sex-matched controls were included. At follow-up, lacunes, microbleeds, and white matter hyperintensity (WMH) volume were assessed using MRI. To investigate the relation between risk factors and small vessel disease, logistic and linear regression were used.
  
  
  RESULTS
  After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age of patients was 49.8 years (SD 10.3) and 45.4% were men; for controls, mean age was 49.4 years (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least 1 lacune (24.0% vs 4.5%, p < 0.0001). In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5-3.7] vs 0.4 mL [IQR 0.0-1.0], p < 0.001). Compared with controls, patients had the same volume WMHs on average 10-20 years earlier. In the patient group, age at stroke (β = 0.03, 95% confidence interval [CI] 0.02-0.04) hypertension (β = 0.22, 95% CI 0.04-0.39), and smoking (β = 0.18, 95% CI 0.01-0.34) at baseline were associated with WMH volume.
  
  
  CONCLUSIONS
  Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10-20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Renate M
authors: RM
authors: Arntz
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Steffen M A
authors: SM
authors: van den Broek
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Inge W M
authors: IW
authors: van Uden
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Mohsen
authors: M
authors: Ghafoorian
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Bram
authors: B
authors: Platel
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Loes C A
authors: LC
authors: Rutten-Jacobs
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Noortje A M
authors: NA
authors: Maaijwee
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Pauline
authors: P
authors: Schaapsmeerders
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Hennie C
authors: HC
authors: Schoonderwaldt
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
authors: Ewoud J
authors: EJ
authors: van Dijk
authors: From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK. FrankErik.deLeeuw@radboudumc.nl.
authors: Frank-Erik
authors: FE
authors: de Leeuw
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D066127:White Matter / Q000000981:diagnostic imaging; D055815:Young Adult