SILENT BRAIN INFARCTION ON MAGNETIC-RESONANCE-IMAGING AND NEUROLOGICAL ABNORMALITIES IN COMMUNITY-DWELLING OLDER ADULTS - THE CARDIOVASCULAR HEALTH STUDY

Background and Purpose Infarctlike lesions are frequently detected in symptomatic and asymptomatic older persons undergoing cerebral MRI, bu t their significance in older adults has not been examined. We determi ned the prevalence of MRI infarcts in a population-based sample of men and women aged greater than or equal to 65 years and related these fi ndings to demographic, cognitive, and neurological status. Methods MRI scanning was performed in 3660 Cardiovascular Health Study (CHS) part icipants after brief neurological examinations and tests of cognitive function. MRIs were read centrally for the presence of an infarct grea ter than or equal to 3 mm in diameter or smaller infarctlike lesions. Results MRI infarcts were detected in 1131 of 3647 participants with r eadable infarct information (31%) and in 961 of the subgroup of 3397 p articipants (28%) without known prior stroke (''silent'' MRI infarcts) . Smaller infarctlike lesions were found in 196 of 2516 participants w ho had no MRI infarcts greater than or equal to 3 mm. MRI infarcts wer e more common in participants who were older, had prior stroke, impair ed cognition, visual field deficits, slowed repetitive finger tapping (all P < .0001), weakness on toe and heel walking, and history of memo ry loss, coma, or migraine headaches. Multivariate analysis in those w ithout prier stroke showed strong associations of silent MRI infarcts with older age, history of migraines, lower digit symbol scores, and m ore abnormalities on neurological examination. Conclusions MRI evidenc e of brain infarction is common in older men and women without a clini cal history of stroke. Their strong associations with impaired cogniti on and neurological deficits suggest that they are neither silent nor innocuous.