Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: The cardiovascular health study

Background and Purpose: Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people. Methods: Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. CorreLates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologist graded white matter findings from 0 (none) to 9 (maximal) without clinical information. Results: Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P<.01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV₁), and income less than $50 000 per year. If excluded, FEV₁ was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade especially those indicating impaired cognitive and lower extremity function. Conclusions: White matter findings were significantly associated with age, silent stroke, hypertension, FEV₁, and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.