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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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