title: Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study.
abstract: OBJECTIVE
  We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults.
  
  
  METHODS
  For this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors.
  
  
  RESULTS
  During the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]).
  
  
  CONCLUSIONS
  Silent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan. Electronic address: mutsugky@iwate-med.ac.jp.
authors.forename: Megumi
authors.initials: M
authors.lastname: Tsubota-Utsugi
authors.affiliation: Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.affiliation: Institute of Development, Aging and Cancer, Department of Geriatrics and Gerontology, Tohoku University, Sendai, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Tomita
authors.affiliation: Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Hara
authors.affiliation: Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Hosaka
authors.affiliation: Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.affiliation: Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.affiliation: Department of Community Medical Support, Tohoku University, Sendai, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Hirano
authors.affiliation: Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Hosokawa
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Murakami
authors.affiliation: Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.affiliation: Tohoku Medical Megabank organization, Tohoku University, Sendai, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.affiliation: Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan.
authors.forename: Shin-Ichi
authors.initials: SI
authors.lastname: Izumi
authors.affiliation: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
mesh_terms: D000359:Aftercare; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012044:Regression Analysis; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000000981:diagnostic imaging* / Q000453:epidemiology; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Functional capacity in early stage; Japanese; elderly; lacunar infarcts; silent cerebrovascular lesions; white matter hyperintensity