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December 13, 2010

Cerebral microbleeds, retinopathy, and dementia
The AGES-Reykjavik Study

C. Qiu, PhD, M.F. Cotch, PhD, S. Sigurdsson, MSc, P.V. Jonsson, MD, M.K. Jonsdottir, PhD, S. Sveinbjrnsdottir, MD, G. Eiriksdottir, MSc, R. Klein, MD, T.B. Harris, MD, M.A. van Buchem, MD, V. Gudnason, MD, and L.J. Launer, PhDAuthors Info & Affiliations
December 14, 2010 issue
75 (24) 2221-2228
https://doi.org/10.1212/WNL.0b013e3182020349
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Abstract

Objective:

To determine whether microvascular damage, indicated by cerebral microbleeds (CMBs) and retinal microvascular signs, is associated with cognitive function and dementia in older persons.

Methods:

This is a cross-sectional study of 3,906 participants (mean age 76 years; 58% women) in the AGES-Reykjavik Study (2002–2006). We assessed CMBs on MRI and retinal microvascular signs on digital retinal images. Composite Z scores of memory, processing speed, and executive function were derived from a battery of neurocognitive tests. Dementia and subtypes were diagnosed following international criteria. Regression models were used to relate cognitive Z scores and dementia to CMBs and retinal microvascular signs, adjusting for demographics, cardiovascular factors, and brain ischemic lesions.

Results:

People with multiple (≥2) CMBs had lower Z scores on tests of processing speed (β-coefficient −0.16; 95% confidence interval −0.26 to −0.05) and executive function (−0.14; −0.24 to −0.04); results were strongest for having multiple CMBs located in the deep hemispheric or infratentorial areas. The odds ratio of vascular dementia was 2.32 (95% confidence interval 1.02 to 5.25) for multiple CMBs and 1.95 (1.04 to 3.62) for retinopathy. Having both CMBs and retinopathy, compared to having neither, was significantly associated with markedly slower processing speed (−0.25; −0.37 to −0.12), poorer executive function (−0.19; −0.31 to −0.07), and an increased odds ratio of vascular dementia (3.10; 1.11 to 8.62).

Conclusion:

Having multiple CMBs or concomitant CMBs and retinopathy is associated with a profile of vascular cognitive impairment. These findings suggest that microvascular damage, as indicated by CMBs and retinopathy lesions, has functional consequences in older men and women living in the community.

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Information & Authors

Information

Published In

Neurology®
Volume 75 • Number 24 • December 14, 2010
Pages: 2221-2228
PubMed: 21172845

Copyright

Copyright © 2010 by AAN Enterprises, Inc.

Publication History

Received: May 4, 2010
Accepted: September 2, 2010
Published online: December 13, 2010
Published in print: December 14, 2010

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Disclosure

Dr. Qiu serves as an Associate Editor for the Journal of Alzheimer's Disease and receives research support from the Swedish Council for Working Life and Social Research for the Future Leaders on Ageing Research in Europe (FLARE) Program (2007-1728 and 2009-1934) and the Swedish Research Council (K2008-69X-20821-01-3 [PI]). Dr. Cotch receives research support from the Intramural Research Program of the NIH (ZIAEY000401). S. Sigurdsson, Dr. Jonsson, Dr. Jonsdottir, Dr. Sveinbjörnsdottir, and G. Eiriksdottir report no disclosures. Dr. Klein serves on a scientific advisory board for AstraZeneca; serves on the editorial board of Ophthalmology; has served/serves as a consultant for Pfizer Inc., Eli Lilly and Company, Novartis, Genentech Inc., CoMentis, Inc., Allergan, Inc., and Merck Serono; and has received/receives research support from the NIH (NEI 2 U10 EY006594-21A1 [PI], NEI 1 R01 HL6997 [PI], NEI 1 R01 EY016379 [PI], 1 R01 DK073217-01 [PI], and N01-AG-12100 [PI]). Dr. Harris serves on the editorial boards of the Journal of Gerontology: Medical Sciences, Age and Nutrition, and Ageing: Clinical and Geriatric Science. Dr. van Buchem reports no disclosures. Dr. Gudnason receives research support from the NIH (N01-AG-12100 [PI]) and the Icelandic Heart Association. Dr. Launer reports no disclosures.

Authors

Affiliations & Disclosures

C. Qiu, PhD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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M.F. Cotch, PhD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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S. Sigurdsson, MSc
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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P.V. Jonsson, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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M.K. Jonsdottir, PhD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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S. Sveinbjrnsdottir, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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G. Eiriksdottir, MSc
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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R. Klein, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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T.B. Harris, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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M.A. van Buchem, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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V. Gudnason, MD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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L.J. Launer, PhD
From the Laboratory of Epidemiology, Demography and Biometry (C.Q., T.B.H., L.J.L.), National Institute on Aging, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Clinical Applications (M.F.C.), National Eye Institute, Bethesda, MD; Icelandic Heart Association (S.S., P.V.J., M.K.J., G.E., V.G.), Kopavogur; Landspitali University Hospital (P.V.J., M.K.J., S.S.), Reykjavik; Faculty of Medicine (P.V.J., V.G.) and Faculty of Psychology (M.K.J.), University of Iceland, Reykjavik, Iceland; Department of Ophthalmology (R.K.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Radiology (M.A.v.B.), Leiden University Medical Center, Leiden, the Netherlands.
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Notes

Address correspondence and reprint requests to Dr. Chengxuan Qiu, Aging Research Center, Karolinska Institutet, Gävlegatan 16, S-113 30 Stockholm, Sweden [email protected]; or Dr. Lenore J. Launer, LEDB, National Institute on Aging, NIH, Gateway Building, Suite 3C-309, 7201 Wisconsin Avenue, Bethesda, MD 20892 [email protected]
Study funding: The AGES-Reykjavik Study was funded by NIH contract N01-AG-12100, the Intramural Research Program of the National Institute on Aging, the National Eye Institute (ZIAEY000401), NIH, USA, and the Icelandic Heart Association and the Icelandic Parliament, Iceland.

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