02759nas a2200313 4500008004100000022001400041245011600055210006900171260001300240300001200253490000700265520187400272653000902146653002402155653001102179653001102190653002502201653003102226653000902257653002602266653001702292100002002309700001502329700001702344700001302361700001902374700001602393856003602409 1998 eng d a0003-994200aLacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study.0 aLacunar infarcts defined by magnetic resonance imaging of 3660 e c1998 Sep a1217-250 v553 a

OBJECTIVE: To identify risk factors for and functional consequences of lacunar infarct in elderly people.

METHODS: The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years or older, in which 3660 participants underwent cranial magnetic resonance imaging (MRI). Neuroradiologists read scans in a standard fashion without any clinical information. Lacunes were defined as subcortical areas consistent with infarcts measuring 3 to 20 mm. In cross-sectional analyses, clinical correlates were contrasted among groups defined by MRI findings.

RESULTS: Of the 3660 subjects who underwent MRI, 2529 (69%) were free of infarcts of any kind and 841 (23%) had 1 or more lacunes without other types present, totaling 1270 lacunes. For most of these 841 subjects, their lacunes were single (66%) and silent (89%), namely without a history of transient ischemic attack or stroke. In multivariate analyses, factors independently associated with lacunes were increased age, diastolic blood pressure, creatinine, and pack-years of smoking (listed in descending order of strength of association; for all, P < .005), as well as maximum internal carotid artery stenosis of more than 50% (odds ratio [OR], 1.81; P < .005), male sex (OR, 0.74; P < .005), and history of diabetes at entrance into the study (OR, 1.33; P < .05). Models for subgroups of single, multiple, silent, and symptomatic lacunes differed only minimally. Those with silent lacunes had more cognitive, upper extremity, and lower extremity dysfunction not recognized as stroke than those whose MRIs were free of infarcts.

CONCLUSIONS: In this group of older adults, lacunes defined by MRI are common and associated with factors that likely promote or reflect small-vessel disease. Silent lacunes are also associated with neurologic dysfunction.

10aAged10aCerebral Infarction10aFemale10aHumans10aLongitudinal Studies10aMagnetic Resonance Imaging10aMale10aMultivariate Analysis10aRisk Factors1 aLongstreth, W T1 aBernick, C1 aManolio, T A1 aBryan, N1 aJungreis, C, A1 aPrice, T, R uhttps://chs-nhlbi.org/node/151402782nas a2200289 4500008004100000022001400041245011100055210006900166260000900235300001100244490000700255520193000262100001902192700002202211700001702233700001902250700001902269700002202288700002002310700002102330700002402351700001802375700002202393700002002415700002102435856003602456 2016 eng d a1875-890800aLongitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study.0 aLongitudinal Relationships between Caloric Expenditure and Gray  c2016 a719-290 v523 a

BACKGROUND: Physical activity (PA) can be neuroprotective and reduce the risk for Alzheimer's disease (AD). In assessing physical activity, caloric expenditure is a proxy marker reflecting the sum total of multiple physical activity types conducted by an individual.

OBJECTIVE: To assess caloric expenditure, as a proxy marker of PA, as a predictive measure of gray matter (GM) volumes in the normal and cognitively impaired elderly persons.

METHODS: All subjects in this study were recruited from the Institutional Review Board approved Cardiovascular Health Study (CHS), a multisite population-based longitudinal study in persons aged 65 and older. We analyzed a sub-sample of CHS participants 876 subjects (mean age 78.3, 57.5% F, 42.5% M) who had i) energy output assessed as kilocalories (kcal) per week using the standardized Minnesota Leisure-Time Activities questionnaire, ii) cognitive assessments for clinical classification of normal cognition, mild cognitive impairment (MCI), and AD, and iii) volumetric MR imaging of the brain. Voxel-based morphometry modeled the relationship between kcal/week and GM volumes while accounting for standard covariates including head size, age, sex, white matter hyperintensity lesions, MCI or AD status, and site. Multiple comparisons were controlled using a False Discovery Rate of 5 percent.

RESULTS: Higher energy output, from a variety of physical activity types, was associated with larger GM volumes in frontal, temporal, and parietal lobes, as well as hippocampus, thalamus, and basal ganglia. High levels of caloric expenditure moderated neurodegeneration-associated volume loss in the precuneus, posterior cingulate, and cerebellar vermis.

CONCLUSION: Increasing energy output from a variety of physical activities is related to larger gray matter volumes in the elderly, regardless of cognitive status.

1 aRaji, Cyrus, A1 aMerrill, David, A1 aEyre, Harris1 aMallam, Sravya1 aTorosyan, Nare1 aErickson, Kirk, I1 aLopez, Oscar, L1 aBecker, James, T1 aCarmichael, Owen, T1 aGach, Michael1 aThompson, Paul, M1 aLongstreth, W T1 aKuller, Lewis, H uhttps://chs-nhlbi.org/node/700002427nas a2200193 4500008004100000022001400041245009200055210006900147260001600216520182200232100001702054700002002071700002102091700001802112700002102130700002002151700002602171856003602197 2018 eng d a1526-632X00aLeft atrial diameter and vascular brain injury on MRI: The Cardiovascular Health Study.0 aLeft atrial diameter and vascular brain injury on MRI The Cardio c2018 Aug 293 a

OBJECTIVE: To determine the association left atrial diameter (LAD) and vascular brain injury on brain MRI.

METHODS: We analyzed data from the Cardiovascular Health Study (CHS), a prospective cohort of community-dwelling adults ≥65 years old. LAD was measured from 2-dimensional transthoracic echocardiograms. Among CHS participants who underwent brain MRI, we examined associations of LAD with brain infarcts and leukoaraiosis. Primary outcomes (number for analysis) were prevalent infarcts (2,327) and degree of leukoaraiosis on initial MRI (2,315). Secondary outcomes were prevalent nonlacunar infarcts (2,327), incident infarcts (939), incident nonlacunar infarcts (1,185), and degree of leukoaraiosis on follow-up MRI adjusted for initial MRI (1,158). Relative risk (RR) and linear regression models were adjusted for demographics, vascular risk factors, and potential confounders.

RESULTS: Mean age of the 2,335 participants with initial brain MRI was 72.0 ± 4.8 years; 38.7% were men; and 29.0% participants had prevalent infarcts. In multivariable, fully adjusted models, LAD was associated with prevalent infarcts (RR 1.20, 95% confidence interval [CI] 1.08-1.34) and prevalent nonlacunar infarcts (RR 1.28, 95% CI 1.06-1.54) but not with leukoaraiosis (-0.08, 95% CI -0.17 to 0.07), incident infarcts (RR 1.00, 95% CI 0.78-1.29), nonlacunar infarcts (RR 0.98, 95% CI 0.67-1.42), or worsening leukoaraiosis (-0.04, 95% CI -0.10 to 0.02).

CONCLUSION: LAD is independently associated with prevalent brain infarcts, particularly nonlacunar infarcts, but not leukoaraiosis. Larger studies are needed to determine associations with incident infarct risk and whether this risk in patients with left atrial enlargement can be reduced with anticoagulant agents.

1 aYaghi, Shadi1 aBartz, Traci, M1 aKronmal, Richard1 aKamel, Hooman1 aGottdiener, John1 aLongstreth, W T1 aElkind, Mitchell, S V uhttps://chs-nhlbi.org/node/782002788nas a2200325 4500008004100000022001400041245013300055210006900188260001300257300001200270490000700282520178400289100002402073700002302097700002402120700002002144700002002164700002302184700002002207700002102227700001902248700002402267700002202291700002402313700002202337700002602359700002002385700002102405856003602426 2018 eng d a1941-329700aLong-Term Cognitive Decline After Newly Diagnosed Heart Failure: Longitudinal Analysis in the CHS (Cardiovascular Health Study).0 aLongTerm Cognitive Decline After Newly Diagnosed Heart Failure L c2018 Mar ae0044760 v113 a

BACKGROUND: Heart failure (HF) is associated with cognitive impairment. However, we know little about the time course of cognitive change after HF diagnosis, the importance of comorbid atrial fibrillation, or the role of ejection fraction. We sought to determine the associations of incident HF with rates of cognitive decline and whether these differed by atrial fibrillation status or reduced versus preserved ejection fraction.

METHODS AND RESULTS: Participants were 4864 men and women aged ≥65 years without a history of HF and free of clinical stroke in the CHS (Cardiovascular Health Study)-a community-based prospective cohort study in the United States, with cognition assessed annually from 1989/1990 through 1998/1999. We identified 496 participants with incident HF by review of hospital discharge summaries and Medicare claims data, with adjudication according to standard criteria. Global cognitive ability was measured by the Modified Mini-Mental State Examination. In adjusted models, 5-year decline in model-predicted mean Modified Mini-Mental State Examination score was 10.2 points (95% confidence interval, 8.6-11.8) after incident HF diagnosed at 80 years of age, compared with a mean 5-year decline of 5.8 points (95% confidence interval, 5.3-6.2) from 80 to 85 years of age without HF. The association was stronger at older ages than at younger ages, did not vary significantly in the presence versus absence of atrial fibrillation (=0.084), and did not vary significantly by reduced versus preserved ejection fraction (=0.734).

CONCLUSIONS: Decline in global cognitive ability tends to be faster after HF diagnosis than without HF. Clinical and public health implications of this finding warrant further attention.

1 aHammond, Christa, A1 aBlades, Natalie, J1 aChaudhry, Sarwat, I1 aDodson, John, A1 aLongstreth, W T1 aHeckbert, Susan, R1 aPsaty, Bruce, M1 aArnold, Alice, M1 aDublin, Sascha1 aSitlani, Colleen, M1 aGardin, Julius, M1 aThielke, Stephen, M1 aNanna, Michael, G1 aGottesman, Rebecca, F1 aNewman, Anne, B1 aThacker, Evan, L uhttps://chs-nhlbi.org/node/768003468nas a2200361 4500008004100000022001400041245011800055210006900173260001500242300001300257490000600270520245000276653000902726653002202735653001902757653001102776653001202787653001702799653001102816653000902827653001302836653002402849653001802873653002102891100002202912700002002934700002402954700002502978700001803003700002103021700002803042856003603070 2022 eng d a2574-380500aLongitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States.0 aLongitudinal Changes in Hearing and Visual Impairments and Risk  c2022 05 02 ae22107340 v53 a

Importance: Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known.

Objective: To evaluate whether DSI is associated with incident dementia in older adults.

Design, Setting, and Participants: This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020.

Exposures: Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits.

Main Outcomes and Measures: All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria.

Results: A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05).

Conclusions and Relevance: In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.

10aAged10aAlzheimer Disease10aCohort Studies10aFemale10aHearing10aHearing Loss10aHumans10aMale10aMedicare10aProspective Studies10aUnited States10aVision Disorders1 aHwang, Phillip, H1 aLongstreth, W T1 aThielke, Stephen, M1 aFrancis, Courtney, E1 aCarone, Marco1 aKuller, Lewis, H1 aFitzpatrick, Annette, L uhttps://chs-nhlbi.org/node/909502514nas a2200169 4500008004100000022001400041245010800055210006900163260001600232520196400248100002002212700002002232700002002252700001702272700001902289856003602308 2023 eng d a1875-890800aLongitudinal Patterns of Brain Changes in a Community Sample in Relation to Aging and Cognitive Status.0 aLongitudinal Patterns of Brain Changes in a Community Sample in  c2023 Jun 203 a

BACKGROUND: Aging and Alzheimer's disease (AD) are characterized by widespread cortical and subcortical atrophy. Though atrophy patterns between aging and AD overlap considerably, regional differences between these two conditions may exist. Few studies, however, have investigated these patterns in large community samples.

OBJECTIVE: Elaborate longitudinal changes in brain morphometry in relation to aging and cognitive status in a well-characterized community cohort.

METHODS: Clinical and neuroimaging data were compiled from 72 participants from the Cardiovascular Health Study-Cognition Study, a community cohort of healthy aging and probable AD participants. Two time points were identified for each participant with a mean follow-up time of 5.36 years. MRI post-processing, morphometric measurements, and statistical analyses were performed using FreeSurfer, Version 7.1.1.

RESULTS: Cortical volume was significantly decreased in the bilateral superior frontal, bilateral inferior parietal, and left superior parietal regions, among others. Cortical thickness was significantly reduced in the bilateral superior frontal and left inferior parietal regions, among others. Overall gray and white matter volumes and hippocampal subfields also demonstrated significant reductions. Cortical volume atrophy trajectories between cognitively stable and cognitively declined participants were significantly different in the right postcentral region.

CONCLUSION: Observed volume reductions were consistent with previous studies investigating morphometric brain changes. Patterns of brain atrophy between AD and aging may be different in magnitude but exhibit widespread spatial overlap. These findings help characterize patterns of brain atrophy that may reflect the general population. Larger studies may more definitively establish population norms of aging and AD-related neuroimaging changes.

1 aChwa, Won, Jong1 aLopez, Oscar, L1 aLongstreth, W T1 aDai, Weiying1 aRaji, Cyrus, A uhttps://chs-nhlbi.org/node/9413