title: Cortical cerebral microinfarcts on 3T MRI: A novel marker of cerebrovascular disease.
abstract: OBJECTIVE
  We examined the risk factors of cortical cerebral microinfarcts (CMIs) on 3T MRI and their association with cognitive impairment.
  
  
  METHODS
  Participants (aged 60 years and older) from the multiethnic Epidemiology of Dementia In Singapore Study underwent detailed neuropsychological testing and 3T brain MRI. Cortical CMIs were graded using a previously validated protocol. Cognitive impairment was categorized into cognitive impairment, no dementia (CIND)-mild, CIND-moderate, and dementia. Cognitive function was summarized as composite and domain-specific z scores.
  
  
  RESULTS
  Among 861 participants, 54 (6.3%) had ≥1 cortical CMI. In multivariate-adjusted models, the risk factors of cortical CMIs were increasing age, Malay ethnicity, hypertension, diabetes, history of stroke, and markers of both large (cortical infarcts and intracranial stenosis) and small (lacunar infarcts, white matter hyperintensities, cerebral microbleeds) vessel disease. Presence of cortical CMIs was associated with CIND-moderate (odds ratio: 3.12; 95% confidence interval [CI]: 1.18-8.58), dementia (odds ratio: 16.92; 95% CI: 3.37-85.05), and poorer cognitive function (mean difference in composite z score: -0.42; 95% CI: -0.62 to -0.21). Additional adjustments for vascular risk factors and other MRI markers did not alter these associations.
  
  
  CONCLUSIONS
  Cortical CMIs are a novel MRI marker of cerebrovascular disease and are independently associated with cognitive impairment and dementia. These findings provide new insights into the burden of cerebrovascular disease in cognitive impairment. Future research is needed to establish the additional etiologic and prognostic significance of cortical CMIs.
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Saima
authors: S
authors: Hilal
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Emiel
authors: E
authors: Sikking
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Muhammad Amin
authors: MA
authors: Shaik
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Qun Lin
authors: QL
authors: Chan
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Susanne J
authors: SJ
authors: van Veluw
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Henri
authors: H
authors: Vrooman
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Ching-Yu
authors: CY
authors: Cheng
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Charumathi
authors: C
authors: Sabanayagam
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Carol Y
authors: CY
authors: Cheung
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Tien Yin
authors: TY
authors: Wong
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Narayanaswamy
authors: N
authors: Venketasubramanian
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Geert Jan
authors: GJ
authors: Biessels
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore.
authors: Christopher
authors: C
authors: Chen
authors: From the Memory Ageing and Cognition Centre (S.H., M.A.S., Q.L.C., C.C., M.K.I.), National University Health System, Singapore; Department of Pharmacology (S.H., M.A.S., Q.L.C., C.C.), National University of Singapore; Department of Neurology (E.S., S.J.v.V., G.J.B., M.K.I.), Brain Center Rudolf Magnus, University Medical Center Utrecht; Departments of Radiology and Medical Informatics (H.V.) and Neurology and Epidemiology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands; Singapore Eye Research Institute (C.-Y. Cheng, C.S., C.Y. Cheung, T.Y.W.), Singapore National Eye Center; Academic Medicine Research Institute (T.Y.W., M.K.I.), Duke-NUS Graduate Medical School; and Raffles Neuroscience Centre (N.V.), Raffles Hospital, Singapore. m.ikram@erasmusmc.nl.
authors: Mohammad Kamran
authors: MK
authors: Ikram
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000208:ethnology / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology