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Prevalence, incidence, and risk factors of lacunar infarcts in a community sample

From the School of Psychiatry (X.C., W.W., P.S.S.), University of New South Wales; Neuropsychiatric Institute (X.C., W.W., P.S.S.), the Prince of Wales Hospital, Sydney; and Centre for Mental Health Research (K.J.A.), Australian National University, Canberra, Australia.

Address correspondence and reprint requests to Professor Perminder Sachdev, Neuropsychiatric Institute, Euroa Centre, Prince of Wales Hospital, Barker Street, Randwick NSW 2031, Australia p.sachdev{at}unsw.edu.au

Background: Lacunar infarcts are small cavitated lesions no larger than 2 cm in diameter. Although often asymptomatic, they have been suggested as an important pathologic substrate of vascular dementia. The prevalence and risk factor profile of lacunar infarction has been variously reported, but the incidence data are scarce for large community-based data.

Methods: Participants (n = 477) were recruited randomly from the electoral roll of community residents aged 60–64 years as part of the PATH Through Life Study. Demographic information and risk factor data were collected and MRI brain scans performed in two waves, 4 years apart. The number and locations of lacunar infarcts as well as other volumetric data were assessed on T1-weighted and T2-weighted fluid-attenuated inversion recovery images.

Results: In wave 1, 37 (7.8%) participants had at least one lacunar infarct. New lacunar infarcts were detected in 6 (6/375, 1.6%) participants at wave 2. Lacunes present at wave 1 increased significantly in mean volume from 53.90 to 69.86 mm³ over 4 years. Hypertension (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.01–2.60), anterior ventricle-brain ratio (%) (OR = 1.02; CI = 1.003–1.036), and volume of white matter hyperintensities (OR = 4.9; CI = 1.53–15.80) were independently associated with the prevalence of lacunar infarction.

Conclusion: Lacunes were common incidental findings in the brains of individuals in their 60s, and their prevalence as well as size increased with age. Hypertension was the major treatable risk factor, and lacunar infarction was usually associated with severe white matter hyperintensities on T2-weighted imaging.

Abbreviations: BP = blood pressure; CI = confidence interval; FLAIR = fluid-attenuated inversion recovery; FOV = field of view; GM = gray matter; ICC = intraclass correlation; ICV = intracranial volume; MMSE = Mini-Mental State Examination; OR = odds ratio; TE = echo time; TI = inversion time; TR = repetition time; VBR = ventricle-to-brain ratio; WM = white matter; WMH = white matter hyperintensity.

Supplemental data at www.neurology.org

Supported by Project Grant ID 157125 and Program Grant 179805 from the National Health and Medical Research Council (NHMRC) of Australia.

Disclosure: The authors report no disclosures.

Received September 8, 2008. Accepted in final form March 16, 2009.