RESUMO
BACKGROUND: The association between edentulism and cerebral small vessel disease is controversial. We aimed to assess this relationship in community-dwelling older adults living in rural Ecuador. METHODS: MRI was performed in 311 (81%) of 385 individuals ≥60 years enrolled in the Atahualpa Project. Participants were classified in 2 groups according to whether they have severe edentulism (<10 remaining teeth) or not. Using multivariate logistic regression and exposure effect models, we assessed whether edentulism correlated with severity of white matter hyperintensities (WMHs), after adjusting for relevant confounders. RESULTS: Mean age of participants was 70 ± 8 years (57% women). Severe edentulism was noticed in 152 (49%) individuals and moderate-to-severe WMHs in 81 (26%). In univariate analyses, moderate-to-severe WMHs were more common among edentulous individuals (OR 1.88, 95% CI 1.13-3.16, p = 0.015). Such difference became non-significant in the logistic regression model (OR 1.65, 95% CI 0.91-2.99, p = 0.098); in this model, the single relevant covariate was age. A weighted exposure effect model revealed no association of severe edentulism with moderate-to-severe WMH (average exposure effect: 0.73, 95% CI -0.01 to 0.16, p = 0.10). CONCLUSION: The relationship between edentulism and diffuse subcortical damage of vascular might be explained by the high prevalence of both variables in older adults.
Assuntos
Doenças de Pequenos Vasos Cerebrais/diagnóstico , Países em Desenvolvimento , Boca Edêntula/diagnóstico , Periodontite/diagnóstico , População Rural , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Equador , Feminino , Humanos , Leucoaraiose/diagnóstico , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estatística como AssuntoRESUMO
BACKGROUND AND PURPOSE: Prevalence of cerebral microbleeds (CMB) in white and Asian populations range from 4% to 15%. However, there is no information from indigenous Latin American people. We aimed to assess prevalence and cerebrovascular correlates of CMB in stroke-free older adults living in rural Ecuador. METHODS: Of 311 Atahualpa residents aged ≥60 years identified during a door-to-door survey, 258 (83%) underwent brain magnetic resonance imaging. Twenty-one were further excluded for a diagnosis of overt stroke. Using multivariate logistic regression models, adjusted for demographics and cardiovascular risk factors, we evaluated whether CMB were independently associated with silent strokes, white matter hyperintensities, and global cortical atrophy. RESULTS: Twenty-six (11%) of 237 participants had CMB, which were single in 54% of cases. CMB were deep in 11 patients, cortical in 9, and located both deep and cortical in 6. In univariate analyses, CMB were associated with age, systolic blood pressure, moderate-to-severe white matter hyperintensities, silent lacunar infarcts, and cortical atrophy. Mean (±SD) values for systolic blood pressure were 155±27 mm Hg in patients who had CMB versus 142±26 mm Hg in those who did not (P=0.017). In the adjusted models, moderate-to-severe white matter hyperintensities (P=0.009), silent lacunar infarcts (P=0.003), and global cortical atrophy (P=0.04) were independently associated with CMB. CONCLUSIONS: Prevalence of CMB in stroke-free older adults living in Atahualpa is comparable with those reported from other ethnic groups. There is a strong relationship between CMB and increased age, high systolic blood pressure, silent markers of cerebral small vessel disease, and cortical atrophy.
Assuntos
Hemorragia Cerebral/diagnóstico , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Vigilância da População , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Hemorragia Cerebral/etnologia , Doenças de Pequenos Vasos Cerebrais/etnologia , Equador/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Acidente Vascular Cerebral/etnologiaRESUMO
BACKGROUND: An abnormal ankle-brachial index has been associated with overt stroke and coronary heart disease, but little is known about its relationship with silent cerebral small vessel disease. AIM: To assess the value of ankle-brachial index as a predictor of silent small vessel disease in an Ecuadorian geriatric population. METHODS: Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Ankle-brachial index determinations and brain magnetic resonance imaging were performed in consented persons. Ankle-brachial index ≤0.9 and ≥1.4 were proxies of peripheral artery disease and noncompressible arteries, respectively. Using logistic regression models adjusted for age, gender, and cardiovascular health status, we evaluated the association between abnormal ankle-brachial index with silent lacunar infarcts, white matter hyperintensities, and cerebral microbleeds. RESULTS: Mean age of the 224 participants was 70 ± 8 years, 60% were women, and 80% had poor cardiovascular health status. Ankle-brachial index was ≤0.90 in 37 persons and ≥1.4 in 17. Magnetic resonance imaging showed lacunar infarcts in 27 cases, moderate-to-severe white matter hyperintensities in 47, and cerebral microbleeds in 26. Adjusted models showed association of lacunar infarcts with ankle-brachial index ≤ 0.90 (OR: 3.72, 95% CI: 1.35-10.27, P = 0.01) and with ankle-brachial index ≥ 1.4 (OR: 3·85, 95% CI: 1.06-14.03, P = 0.04). White matter hyperintensities were associated with ankle-brachial index ≤ 0.90 (P = 0.03) and ankle-brachial index ≥ 1.4 (P = 0.02) in univariate analyses. There was no association between ankle-brachial index groups and cerebral microbleeds. CONCLUSIONS: In this population-based study conducted in rural Ecuador, apparently healthy individuals aged ≥60 years with ankle-brachial index values ≤0.90 and ≥1.4 are almost four times more likely to have a silent lacunar infarct. Ankle-brachial index screening might allow recognition of asymptomatic people who need further investigation and preventive therapy.
Assuntos
Índice Tornozelo-Braço , Encéfalo/patologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Doenças de Pequenos Vasos Cerebrais/patologia , Idoso , Doenças de Pequenos Vasos Cerebrais/fisiopatologia , Equador , Feminino , Humanos , Modelos Logísticos , Imageamento por Ressonância Magnética , Masculino , População Rural , Acidente Vascular Cerebral Lacunar/patologia , Substância Branca/patologiaRESUMO
Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.
Assuntos
Ataxia/patologia , Neoplasias Encefálicas/patologia , Encéfalo/patologia , Calcinose/patologia , Cistos do Sistema Nervoso Central/patologia , Doenças de Pequenos Vasos Cerebrais/patologia , Leucoencefalopatias/patologia , Imageamento por Ressonância Magnética , Espasticidade Muscular/patologia , Neuroimagem/métodos , Doenças Retinianas/patologia , Convulsões/patologia , Adolescente , Adulto , Ataxia/diagnóstico , Neoplasias Encefálicas/diagnóstico , Calcinose/diagnóstico , Cistos do Sistema Nervoso Central/diagnóstico , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Diagnóstico Diferencial , Feminino , Cor de Cabelo , Humanos , Hipopigmentação/etiologia , Deficiência Intelectual/etiologia , Leucoencefalopatias/diagnóstico , Espasticidade Muscular/diagnóstico , Quadriplegia/etiologia , Doenças Retinianas/diagnóstico , Convulsões/diagnóstico , Doenças do Nervo Troclear/etiologiaRESUMO
La microangiopatía cerebral retiniana con calcificaciones y quistes es una enfermedad poco frecuente, caracterizada por alteraciones cerebrales, retinianas y óseas, así como por predisposición al sangrado gastrointestinal. Existen pocos reportes de casos de esta condición, especialmente en adultos, en quienes la incidencia es baja. Los hallazgos por medio de neuroimágenes son característicos, con calcificaciones bilaterales y múltiples formaciones quísticas. El propósito de este artículo fue hacer una revisión bibliográfica e ilustrar dos casos cuyo diagnóstico fue posible con la ayuda de neuroimágenes.
Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.