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NEUROLOGY 1994;44:1246
© 1994 American Academy of Neurology

Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study

The Rotterdam Study M.M.B. Breteler, MD, PhD, J. C. van Swieten, MD, PhD, M. L. Bots, MD, PhD, D. E. Grobbee, MD, PhD, J. J. Claus, MD, PhD, J. H.W. van den Hout, MD, F. van Harskamp, MD, H. L.J. Tanghe, MD, P. T.V.M. de Jong, MD, PhD, FCOpth, J. van Gijn, MD, FRCPE and A. Hofman, MD, PhD

Department of Epidemiology and Biostatistics (Drs. Breteler, Bots, Grobbee, Claus, and Hofman), Erasmus University Medical School, Rotterdam; the University Department of Neurology (Drs. van Swieten and van Gijn), University of Utrecht, Utrecht; the University Department of Neurology (Drs. Claus and van Harskamp), Erasmus University, Rotterdam; the University Department of Radiology (Dr. van den Hout), University of Utrecht, Utrecht; and the University Departments of Radiology (Dr. Tanghe) and Ophthalmology (Dr. de Jong), Erasmus University, Rotterdam, The Netherlands.

Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic factors, and cognitive function in an age- and gender-stratified random sample from the general population that consisted of 111 subjects 65 to 84 years of age. Overall, 27% of subjects had white matter lesions. The prevalence and severity of lesions increased with age. A history of stroke or myocardial infarction, factor VIIc activity, and fibrinogen level were each significantly and independently associated with the presence of white matter lesions. Significant relations with blood pressure level, hypertension, and plasma cholesterol were present only for subjects aged 65 to 74 years. White matter lesions tended to be associated with lower scores on tests of cognitive function and were significantly associated with subjective mental decline. This study suggests that classic cardiovascular risk factors, as well as thrombogenic factors, are associated with white matter lesions in subjects over 65 years of age in the general population, and that these lesions may be related to cognitive function.

Address correspondence and reprint requests to Dr. M.M.B. Breteler, Department of Epidemiology and Biostatistics, Erasmus University Medical School, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.

Supported in part by the NESTOR program for geriatric research (Ministry of Health and Ministry of Education), the Netherlands Heart Foundation, the Netherlands Organisation for Scientific Research (NWO), and the Municipality of Rotterdam.

Received March 3, 1993. Accepted in final form January 25, 1994.




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 Mayo Clin Proc.Home page
D. S. Knopman, B. F. Boeve, and R. C. Petersen
Essentials of the Proper Diagnoses of Mild Cognitive Impairment, Dementia, and Major Subtypes of Dementia
Mayo Clin. Proc., October 1, 2003; 78(10): 1290 - 1308.
[Abstract] [PDF]

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 Eur Heart J SupplHome page
A. Coca
Cerebral involvement in hypertensive cardiovascular disease
Eur. Heart J. Suppl., August 1, 2003; 5(suppl_F): F19 - F25.
[Abstract] [PDF]

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D. Inzitari
Leukoaraiosis: An Independent Risk Factor for Stroke?
Stroke, August 1, 2003; 34(8): 2067 - 2071.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
J. S. Pekala, A. C. Mamourian, H. A. Wishart, W. F. Hickey, and J. D. Raque
Focal Lesion in the Splenium of the Corpus Callosum on FLAIR MR Images: A Common Finding with Aging and after Brain Radiation Therapy
AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 855 - 861.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
C. Dufouil, A. Alperovitch, and C. Tzourio
Influence of education on the relationship between white matter lesions and cognition
Neurology, March 11, 2003; 60(5): 831 - 836.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
J. R. Petrella, R. E. Coleman, and P. M. Doraiswamy
Neuroimaging and Early Diagnosis of Alzheimer Disease: A Look to the Future
Radiology, February 1, 2003; 226(2): 315 - 336.
[Abstract] [Full Text] [PDF]

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J M Starr, S A Leaper, A D Murray, H A Lemmon, R T Staff, I J Deary, and L J Whalley
Brain white matter lesions detected by magnetic resosnance imaging are associated with balance and gait speed
J. Neurol. Neurosurg. Psychiatry, January 1, 2003; 74(1): 94 - 98.
[Abstract] [Full Text] [PDF]

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 DiabetesHome page
S. C. Ferguson, A. Blane, P. Perros, R. J. McCrimmon, J. J.K. Best, J. Wardlaw, I. J. Deary, and B. M. Frier
Cognitive Ability and Brain Structure in Type 1 Diabetes: Relation to Microangiopathy and Preceding Severe Hypoglycemia
Diabetes, January 1, 2003; 52(1): 149 - 156.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
L. Pantoni, M. Simoni, G. Pracucci, R. Schmidt, F. Barkhof, and D. Inzitari
Visual Rating Scales for Age-Related White Matter Changes (Leukoaraiosis): Can the Heterogeneity Be Reduced?
Stroke, December 1, 2002; 33(12): 2827 - 2833.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
D. S. Knopman, W. A. Rocca, R. H. Cha, S. D. Edland, and E. Kokmen
Incidence of Vascular Dementia in Rochester, Minn, 1985-1989
Arch Neurol, October 1, 2002; 59(10): 1605 - 1610.
[Abstract] [Full Text] [PDF]

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 Arch Gen PsychiatryHome page
A. J. Thomas, J. T. O'Brien, S. Davis, C. Ballard, R. Barber, R. N. Kalaria, and R. H. Perry
Ischemic Basis for Deep White Matter Hyperintensities in Major Depression: A Neuropathological Study
Arch Gen Psychiatry, September 1, 2002; 59(9): 785 - 792.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
C. C. Wu, D. Mungas, C. I. Petkov, J. L. Eberling, P. A. Zrelak, M. H. Buonocore, J. A. Brunberg, M. N. Haan, and W. J. Jagust
Brain structure and cognition in a community sample of elderly Latinos
Neurology, August 13, 2002; 59(3): 383 - 391.
[Abstract] [Full Text] [PDF]

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 JAMAHome page
T. Y. Wong, R. Klein, A. R. Sharrett, D. J. Couper, B. E. K. Klein, D.-P. Liao, L. D. Hubbard, T. H. Mosley, and for the ARIC Investigators
Cerebral White Matter Lesions, Retinopathy, and Incident Clinical Stroke
JAMA, July 3, 2002; 288(1): 67 - 74.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
H Koga, T Yuzuriha, H Yao, K Endo, S Hiejima, Y Takashima, F Sadanaga, T Matsumoto, A Uchino, K Ogomori, et al.
Quantitative MRI findings and cognitive impairment among community dwelling elderly subjects
J. Neurol. Neurosurg. Psychiatry, June 1, 2002; 72(6): 737 - 741.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning
Neurology, May 28, 2002; 58(10): 1525 - 1532.


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 J Neuropsychiatry Clin NeurosciHome page
G. T. Lim, M. F. Mendez, Y. L. Bronstein, L. Jouben-Steele, and H. V. Vinters
Clinicopathologic Case Report: Akinetic Mutism With Findings of White Matter Hyperintensity
J Neuropsychiatry Clin Neurosci, May 1, 2002; 14(2): 214 - 221.
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 BrainHome page
F.-E. de Leeuw, J. C. de Groot, M. Oudkerk, J. C. M. Witteman, A. Hofman, J. van Gijn, and M. M. B. Breteler
Hypertension and cerebral white matter lesions in a prospective cohort study
Brain, March 1, 2002; 125(4): 765 - 772.
[Abstract] [Full Text] [PDF]

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 Journal of Renin-Angiotensin-Aldosterone SystemHome page
O. Hanon and D. Leys
Cognitive decline and dementia in the elderly hypertensive
Journal of Renin-Angiotensin-Aldosterone System, March 1, 2002; 3(1_suppl): S32 - S38.
[PDF]

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 HypertensionHome page
C. Sierra, A. Coca, E. Gomez-Angelats, E. Poch, J. Sobrino, and A. de la Sierra
Renin-Angiotensin System Genetic Polymorphisms and Cerebral White Matter Lesions in Essential Hypertension
Hypertension, February 1, 2002; 39(2): 343 - 347.
[Abstract] [Full Text] [PDF]

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 Eur J Heart FailHome page
J. Taylor and D. J. Stott
Chronic heart failure and cognitive impairment: co-existence of conditions or true association?
Eur J Heart Fail, January 1, 2002; 4(1): 7 - 9.
[Full Text] [PDF]

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 NeurologyHome page
G. Zuccala, G. Onder, C. Pedone, L. Carosella, M. Pahor, R. Bernabei, and A. Cocchi
Hypotension and cognitive impairment: Selective association in patients with heart failure
Neurology, December 11, 2001; 57(11): 1986 - 1992.
[Abstract] [Full Text] [PDF]

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 RadiologyHome page
S. A. Leaper, A. D. Murray, H. A. Lemmon, R. T. Staff, I. J. Deary, J. R. Crawford, and L. J. Whalley
Neuropsychologic Correlates of Brain White Matter Lesions Depicted on MR Images: 1921 Aberdeen Birth Cohort
Radiology, October 1, 2001; 221(1): 51 - 55.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
M. C. Morris, P. A. Scherr, L. E. Hebert, R. J. Glynn, D. A. Bennett, and D. A. Evans
Association of Incident Alzheimer Disease and Blood Pressure Measured From 13 Years Before to 2 Years After Diagnosis in a Large Community Study
Arch Neurol, October 1, 2001; 58(10): 1640 - 1646.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
K. J. Mukamal, W. T. Longstreth Jr, M. A. Mittleman, R. M. Crum, D. S. Siscovick, and D. Bereczki
Alcohol Consumption and Subclinical Findings on Magnetic Resonance Imaging of the Brain in Older Adults: The Cardiovascular Health Study Editorial Comment: The Cardiovascular Health Study
Stroke, September 1, 2001; 32(9): 1939 - 1946.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
J.C. de Groot, F.-E. de Leeuw, M. Oudkerk, A. Hofman, J. Jolles, and M.M.B. Breteler
Cerebral white matter lesions and subjective cognitive dysfunction: The Rotterdam Scan Study
Neurology, June 12, 2001; 56(11): 1539 - 1545.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
R. P. Kivisaari, O. Salonen, A. Servo, T. Autti, J. Hernesniemi, and J. Ohman
MR Imaging After Aneurysmal Subarachnoid Hemorrhage and Surgery: A Long-term Follow-up Study
AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1143 - 1148.
[Abstract] [Full Text] [PDF]

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L. O. Wahlund, F. Barkhof, F. Fazekas, L. Bronge, M. Augustin, M. Sjogren, A. Wallin, H. Ader, D. Leys, L. Pantoni, et al.
A New Rating Scale for Age-Related White Matter Changes Applicable to MRI and CT
Stroke, June 1, 2001; 32(6): 1318 - 1322.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
C. Dufouil, A. de Kersaint-Gilly, V. Besancon, C. Levy, E. Auffray, L. Brunnereau, A. Alperovitch, and C. Tzourio
Longitudinal study of blood pressure and white matter hyperintensities: The EVA MRI Cohort
Neurology, April 10, 2001; 56(7): 921 - 926.
[Abstract] [Full Text] [PDF]

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A.-S. Rigaud and B. Forette
Hypertension in Older Adults
J Gerontol A Biol Sci Med Sci, April 1, 2001; 56(4): M217 - M225.
[Abstract] [Full Text] [PDF]

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R. H. Paul, R. A. Cohen, D. Moser, B. R. Ott, T. Zawacki, N. Gordon, S. Bell, and W. Stone
Performance on the Mattis Dementia Rating Scale in Patients with Vascular Dementia: Relationships to Neuroimaging Findings
J Geriatr Psychiatry Neurol, March 1, 2001; 14(1): 33 - 36.
[Abstract] [PDF]

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 NeurologyHome page
D. Knopman, L.L. Boland, T. Mosley, G. Howard, D. Liao, M. Szklo, P. McGovern, and A. R. Folsom
Cardiovascular risk factors and cognitive decline in middle-aged adults
Neurology, January 9, 2001; 56(1): 42 - 48.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
F-E de Leeuw, J C de Groot, E Achten, M Oudkerk, L M P Ramos, R Heijboer, A Hofman, J Jolles, J van Gijn, and M M B Breteler
Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study
J. Neurol. Neurosurg. Psychiatry, January 1, 2001; 70(1): 9 - 14.
[Abstract] [Full Text] [PDF]

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C. D. McCullagh, D. Craig, S. P. McIlroy, and A. P. Passmore
Risk factors for dementia
Adv. Psychiatr. Treat., January 1, 2001; 7(1): 24 - 31.
[Full Text]

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 Arch NeurolHome page
D. Sander, K. Winbeck, J. Klingelhofer, and B. Conrad
Extent of Cerebral White Matter Lesions Is Related to Changes of Circadian Blood Pressure Rhythmicity
Arch Neurol, September 1, 2000; 57(9): 1302 - 1307.
[Abstract] [Full Text] [PDF]