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Cluster Analysis and Patterns of Findings on Cranial Magnetic Resonance Imaging of the Elderly
The Cardiovascular Health Study
W. T. Longstreth, Jr, MD, MPH;
Paula Diehr, PhD;
Teri A. Manolio, MD, MHS;
Norman J. Beauchamp, MD, MHS;
Charles A. Jungreis, MD;
David Lefkowitz, MD;
for the Cardiovascular Health Study Collaborative Research Group
Arch Neurol. 2001;58:635-640.
Objective To characterize patterns of findings on cranial magnetic resonance imaging
(MRI) of the elderly using a statistical technique called cluster analysis.
Subjects and Methods The Cardiovascular Health Study is a population-based, longitudinal
study of 5888 people 65 years and older. Of these, 3230 underwent cranial
MRI scans, which were coded for presence of infarcts and grades for white
matter, ventricles, and sulci. Cluster analysis separated participants into
5 clusters based solely on patterns of MRI findings. Participants comprising
each cluster were contrasted with respect to cardiovascular risk factors and
clinical manifestations.
Results One cluster was low on all the MRI findings (normal) and another was
high on all of them (complex infarcts). Another cluster had evidence for infarcts
alone (simple infarcts), whereas the last 2 clusters lacked infarcts, one
having enlarged ventricles and sulci (atrophy) and the other having prominent
white matter changes and enlarged ventricles (leukoaraiosis). Factors that
distinguished these clusters in a discriminant analysis were age, sex, several
measures of hypertension, internal carotid artery wall thickness, smoking,
and prevalent claudication before the MRI. The atrophy group had the highest
percentage of men and the normal group had the lowest. Cognitive and motor
performance also differed across clusters, with the atrophy cluster performing
better than may have been expected.
Conclusions These MRI patterns identified participants with different vascular disease
risk factors and clinical manifestations. Results of these exploratory analyses
warrant consideration in other populations of elderly people. Such patterns
may provide clues about the pathophysiology of structural brain changes in
the elderly.
From the Departments of Epidemiology (Dr Longstreth), Neurology (Dr
Longstreth), and Biostatistics (Dr Diehr), University of Washington, Seattle;
Division of Epidemiology and Clinical Applications, National Heart, Lung,
and Blood Institute, Bethesda, Md (Dr Manolio); Neuroradiology Division, Department
of Radiology, Johns Hopkins University School of Medicine, Baltimore, Md (Dr
Beauchamp); Neuroradiology Division, Department of Radiology and Neurological
Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa (Dr Jungreis);
and Department of Neurology, Wake Forest University, Winston-Salem, NC (Dr
Lefkowitz).
Corresponding author: W. T. Longstreth, Jr, MD, MPH, Department of
Neurology, Box 359775, Harborview Medical Center, 325 Ninth Ave, Seattle WA
98104-2499.
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