LACUNAR INFARCTS DEFINED BY MAGNETIC-RESONANCE-IMAGING OF 3660 ELDERLY PEOPLE - THE CARDIOVASCULAR HEALTH STUDY

Objective: To identify risk factors for and functional consequences of lacunar infarct in elderly people. Methods: The Cardiovascular Health Study (CHS) is a longitudinal study of people 65 years or older, in w hich 3660 participants underwent cranial magnetic resonance imaging (M RI). Neuroradiologists read scans in a standard fashion without any cl inical information. lacunes were defined as subcortical areas consiste nt with infarcts measuring 3 to 20 mm. In cross-sectional analyses, cl inical correlates were contrasted among groups defined by MRI findings . Results: Of the 3660 subjects who underwent MRI, 2529 (69%) were fre e of infarcts of any kind and 841 (23%) had 1 or more lacunes without other types present, totaling 1270 lacunes. For most of these 841 subj ects, their lacunes were single (66%) and silent (89%), namely without a history of transient ischemic attack or stroke. In multivariate ana lyses, factors independently associated with lacunes were increased ag e, diastolic blood pressure, creatinine, and pack-years of smoking (li sted in descending order of strength of association; for all, P<.005), as well as maximum internal carotid artery stenosis of more than 50% (odds ratio [OR], 1.81; P<.005), male sex (OR, 0.74; P<.005), and hist ory of diabetes at entrance into the study (OR, 1.33; P<.05). Models f or subgroups of single, multiple, silent, and symptomatic lacunes diff ered only minimally. Those with silent lacunes had more cognitive, upp er extremity, and lower extremity dysfunction not recognized as stroke than those whose MRIs were free of infarcts. Conclusions: In this gro up of older adults, lacunes defined by MRI are common and associated w ith factors that likely promote or reflect small-vessel disease. Silen t lacunes are also associated with neurologic dysfunction.