Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People

TLDR

White matter abnormalities on cranial MRI are frequently observed in older adults and may indicate underlying cerebrovascular disease. This study sought to determine the risk factors and clinical correlates of such white matter findings in a large cohort of community‑dwelling seniors. Researchers sampled 5,888 Medicare‑eligible adults aged 65 or older, selected 3,301 participants who underwent MRI without prior stroke or TIA, and collected comprehensive baseline and follow‑up data—including questionnaires, physical exams, laboratory tests, ECG, pulmonary function, carotid sonography, echocardiography—and had neuroradiologists grade white matter lesions from 0 to 9 blind to clinical information. Multivariate analysis revealed that older age, silent stroke, higher systolic blood pressure, lower FEV1, and income below $50,000 were independently associated with higher white matter grade, and these findings were also linked to impaired cognition and lower‑extremity function, underscoring that white matter lesions are not benign.

Abstract

Background and Purpose Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people. Methods Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. Correlates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologists graded white matter findings from 0 (none) to 9 (maximal) without clinical information. Results Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P <.01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV 1 ), and income less than $50 000 per year. If excluded, FEV 1 was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade, especially those indicating impaired cognitive and lower extremity function. Conclusions White matter findings were significantly associated with age, silent stroke, hypertension, FEV 1 , and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.