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From the Departments of Neurology, School of Medicine (Drs. Seshadri, Wolf, Kase, and Au), Biostatistics, School of Public Health (Dr. Beiser), and Mathematics and Statistics (Drs. Elias and D’Agostino), Boston University, MA; and the National Heart, Lung and Blood Institute’s Framingham Heart Study and the Department of Neurology and Center for Neuroscience (Dr. DeCarli), University of California–Davis, Sacramento, CA.
Address correspondence and reprint requests to Dr. Philip A. Wolf, Department of Neurology (Neurologic Epidemiology and Genetics Division), Boston University School of Medicine, 715 Albany Street, B-608, Boston, MA 02118-2526; e-mail: pawolf{at}bu.edu
Background: Mid-life stroke risk factors have been related to late-life cognitive impairment. This association may result not only from clinical strokes but also from subclinical brain injury, such as a global atrophy demonstrable on quantitative brain MRI.
Methods: The authors evaluated the community-based cohort of Framingham Offspring Study participants. A total of 1,841 subjects (mean age, 62 years; 857 men, 984 women) who underwent quantitative MRI and cognitive testing between 1999 and 2001 and were free of clinical stroke and dementia constituted our study sample. The authors used age- and sex-adjusted linear regression models to relate previous (1991 to 1995) and recent (1998 to 2001) Framingham Stroke Risk Profile (FSRP) scores to the total cerebral brain volume ratio (TCBVr) on follow-up MRI, and further to relate the TCBVr with education-adjusted scores on neuropsychological tests administered at the time of imaging.
Results: There was an inverse association between FSRP scores and TCBVr. The TCBVr also showed a significant positive association with performance on tests of attention (Trails A), executive function (Trails B), and visuospatial function (visual reproduction, Hooper visual organization), but not with performance on tests of verbal memory or naming.
Conclusions: The Framingham Stroke Risk Profile may identify subjects with smaller brains and poorer cognitive function among stroke- and dementia-free subjects, reinforcing the importance of managing stroke risk factors.
Received October 23, 2003. Accepted in final form June 23, 2004.
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D. A. Drachman Do we have brain to spare? Neurology, June 28, 2005; 64(12): 2004 - 2005. [Full Text] [PDF]
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