28 Aug Small and Large Brain Infarctions Associated with Cognitive Decline

MedicalResearch.com Interview with:

Dr. Windham

Gwen Windham, MD MHS
Professor of Medicine
Memory Impairment & Neurodegenerative Dementia (MIND) Center
University of Mississippi Medical Center

MedicalResearch.com: What is the background for this study?

Response: Silent infarctions are a primary cause of strokes in the brain, but they are also common in people without a history of a stroke. Infarctions are generally only reported if they are larger (at least 3mm) and are ignored clinically if they are smaller (less than 3mm).

We examined 20 years of cognitive decline among stroke free, middle-aged people with and without smaller, and larger infarctions. The comparison groups included participants as follows: those with

(1) no infarctions, the reference group;
(2) only smaller infarctions;
(3) only larger infarctions
4) both smaller and larger infarctions

 MedicalResearch.com: What are the main findings?

Response: We found that people who had a combination of smaller infarctions (<3mm and typically ignored) and larger infarctions had the steepest decline in cognitive function over a 20-year period from middle-age. At the end of the 20-year follow-up, those with both smaller and larger infarctions had cognitive scores that were akin to having aged 50 years, instead of just 20.

MedicalResearch.com: What should readers take away from your report?

Response: We believe our data suggest that people who have both smaller and larger infarctions may have more pervasive cerebrovascular disease processes. This is clinically meaningful because ignoring the smaller infarctions, particularly when they occur along with larger infarctions, may lead to underestimating dementia risk. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Future research is needed to better understand vascular pathology including early changes in the vascular system that may contribute to pathological changes in brain structure, function and cognitive decline. 

No disclosures relevant to this study (grant funding as printed in article). 

 Citation:

Midlife Smaller and Larger Infarctions, White Matter Hyperintensities, and 20-Year Cognitive Decline
A Cohort Study
B. Gwen Windham, MD, MHS; Michael E. Griswold, PhD; Steven R. Wilkening, MD, MS; Dan Su, MS; Jonathan Tingle, BS; Laura H. Coker, PhD; David Knopman, MD; Rebecca F. Gottesman, MD, PhD; Dean Shibata, MD; Thomas H. Mosley, PhD
Ann Intern Med. 2019.
DOI: 10.7326/M18-0295 ©
2019 American College of Physicians

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Last Updated on August 28, 2019 by Marie Benz MD FAAD