To Investigate When and What to Do for Deep Subcortical White Matter Hyperintensity (DSWMH) in a Large Cohort Study
Yoshinori Nishimoto1, Kyoko Hiyoshi-Arai2, Sadanori Higashino3, Hidetaka Takeda4, Takahiro Amano4
1Department of Neurology, Keio University School of Medicine, 2Graduate School of Nursing, University of Shizuoka, 3Graduate School of Management and Information of Innovation, University of Shizuoka, 4Sanno Medical Center
Objective:
To investigate important risk factors for DSWMH by logistic regression analysis in a large long-term cohort study
Background:
DSWMH is one of the important findings for gait disturbance and vascular cognitive impairment. Risk factors for DSWMH have been reported as, for example, hypertension, glucose metabolism, lipid metabolism, renal dysfunction, hyperuricemia, alcohol consumption, smoking, and age. However, the strength of each risk factor is still unknown. It is also unknown which affects the onset and/or the progression of DSWMH. In Japan, brain MRI is widely performed as a part of health examination even in asymptomatic subjects. Here we identified risk factors for DSWMH based on the changes in the images of asymptomatic subjects, and discussed about the appropriate age for initiating care before the onset of DSWMH and the means of intervention.
Design/Methods:
DSWMH grade was measured in 1,954 subjects without brain disease under constant brain MRI imaging conditions (Philips Ingenia 3.0T, slice section parallel to OM line, 6 mm thick). The mean observation period between the first and second imaging was 4.47 years (0.53-9.48 years duration). Binomial logistic regression analysis, as used in the Framingham study, was performed.
Results:
Factors associated with DSWMH "appearance" at the first visit included gender, hypertension, systolic blood pressure, dyslipidemia, abnormal glucose metabolism, and eGFR. Among these factors, hypertension and age were the only two factors that contributed to "progression" of DSWMH grade. DSWMH started appearing by the age of 39.
Conclusions:
Only hypertension and age were associated with the "progression" of DSWMH. Controlling the blood pressure is required to prevent the progression of DSWMH.