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The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis.

Debette, S; Markus, HS (2010) The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ, 341. ISSN 1756-1833
SGUL Authors: Markus, Hugh Stephen

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Abstract

Objectives: To review the evidence for an association of white matter hyperintensities with risk of stroke, cognitive decline, dementia, and death. Design: Systematic review and meta-analysis. Data sources: PubMed from 1966 to 23 November 2009. Study selection: Prospective longitudinal studies that used magnetic resonance imaging and assessed the impact of white matter hyperintensities on risk of incident stroke, cognitive decline, dementia, and death, and, for the meta-analysis, studies that provided risk estimates for a categorical measure of white matter hyperintensities, assessing the impact of these lesions on risk of stroke, dementia, and death. Data extraction: Population studied, duration of follow-up, method used to measure white matter hyperintensities, definition of the outcome, and measure of the association of white matter hyperintensities with the outcome. Data synthesis: 46 longitudinal studies evaluated the association of white matter hyperintensities with risk of stroke (n=12), cognitive decline (n=19), dementia (n=17), and death (n=10). 22 studies could be included in a meta-analysis (nine of stroke, nine of dementia, eight of death). White matter hyperintensities were associated with an increased risk of stroke (hazard ratio 3.3, 95% confidence interval 2.6 to 4.4), dementia (1.9, 1.3 to 2.8), and death (2.0, 1.6 to 2.7). An association of white matter hyperintensities with a faster decline in global cognitive performance, executive function, and processing speed was also suggested. Conclusion: White matter hyperintensities predict an increased risk of stroke, dementia, and death. Therefore white matter hyperintensities indicate an increased risk of cerebrovascular events when identified as part of diagnostic investigations, and support their use as an intermediate marker in a research setting. Their discovery should prompt detailed screening for risk factors of stroke and dementia.

Item Type: Article
Additional Information: © Debette et al 2010. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
Keywords: Cerebrovascular Disorders, Cognition Disorders, Dementia, Vascular, Disease Progression, Humans, Longitudinal Studies, Magnetic Resonance Angiography, Microcirculation, Prognosis, Risk Factors, Stroke, Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, MEDICINE, GENERAL & INTERNAL, MILD COGNITIVE IMPAIRMENT, SMALL-VESSEL DISEASE, CARDIOVASCULAR HEALTH COGNITION, AUSTRIAN STROKE PREVENTION, MEDIAL TEMPORAL ATROPHY, CEREBROVASCULAR-DISEASE, RISK-FACTORS, VASCULAR DEMENTIA, VOLUMETRIC MRI, BLOOD-PRESSURE, 1117 Public Health And Health Services
Journal or Publication Title: BMJ
Article Number: c3666
ISSN: 1756-1833
Language: eng
Dates:
DateEvent
May 2010Published
PubMed ID: 20660506
Web of Science ID: WOS:000280569500002
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URI: http://sgultest.da.ulcc.ac.uk/id/eprint/2068

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