Intracranial atherosclerosis and dementia: The Atherosclerosis Risk in Communities (ARIC) Study.
OBJECTIVE
To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia.


METHODS
From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression.


RESULTS
A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4).


CONCLUSIONS
This study demonstrates associations between ICAD and clinical MCI and dementia.
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Jennifer L
JL
Dearborn
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Yiyi
Y
Zhang
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Ye
Y
Qiao
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Muhammad Fareed K
MFK
Suri
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Li
L
Liu
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Rebecca F
RF
Gottesman
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Andreea M
AM
Rawlings
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Thomas H
TH
Mosley
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Alvaro
A
Alonso
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
David S
DS
Knopman
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN.
Eliseo
E
Guallar
From the Department of Neurology (J.L.D.), Yale University School of Medicine, New Haven, CT; Welch Center for Prevention, Epidemiology, and Clinical Research (Y.Z., R.F.G., A.M.R., E.G.), Johns Hopkins Bloomberg School of Public Health; The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., L.L., B.A.W.) and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (M.F.K.S.), University of Minnesota School of Medicine, Minneapolis; Department of Medicine, Division of Geriatrics (T.H.M.), The University of Mississippi School of Medicine, Jackson; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; and Department of Neurology (D.S.K.), The Mayo Clinic, Rochester, MN. bwasser@jhmi.edu.
Bruce A
BA
Wasserman
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States