Brain abnormalities in the elderly: frequency and predictors in the United States (the Cardiovascular Health Study)

Summary

Purpose: Characterize brain abnormalities in elderly people using cranial magnetic resonance imaging (MRI).

Methods: Comprehensive lists of people 65 years and older living in the United States of America were used to obtain a representative sample of 5,888 community-dwelling participants who underwent extensive standardized evaluations. A subset of 3,660 underwent MRI. Without clinical information, neuroradiologists evaluated each scan.

Results: Enlarged ventricles and sulci and prominent white matter changes were relatively common, even in a subset of the healthiest participants. Infarcts 3 mm or greater were present in 31% of all participants and 28% of those without a history of stroke. Most infarcts were clinically silent, small, and in the basal ganglia. Among those without a history of stroke, white matter changes were common but mostly of a mild degree. These changes were independently related to greater age, silent stroke, higher systolic blood pressure, lower forced expiratory volume in one second and income less than $ 50,000 per year. Changes were also associated with dysfunction, especially of cognition and the lower extremities.

Conclusion: MRI abnormalities are common in elderly people. Cautious interpretation is appropriate because participants are healthier than the general population and the study’s design is cross-sectional.