News | CT Angiography (CTA) | March 15, 2016

Vascular Disease after Age 80 Associated with Greater Dementia Risk

Study using computed tomography angiography finds correlation between coronary artery calcium levels and dementia risk

coronary artery calcium, dementia risk, patients over 80, JACC

March 15, 2016 — People who reach their 80s without cardiovascular disease are more likely to suffer from the effects of dementia than a heart attack or stroke, according to a study in the Journal of the American College of Cardiology (JACC). In a small group of participants, an association was also found between zero or low levels of artery-clogging calcium deposits and a low risk of dementia and cardiovascular events, suggesting that the cardiovascular risk factors that lead to coronary heart disease could also affect the brain.

Increasingly successful heart disease prevention and treatment methods have led to longer lifespans, which in turn creates a larger population of older people at risk for dementia. In the United States, dementia mainly affects people over the age of 75.

Researchers in the study looked at individuals over age 80 to determine if coronary artery calcium levels predict risk of death and risk of dementia and coronary heart disease. Beginning in 1998, 532 participants from the Cardiovascular Health Study-Cognition Study were evaluated annually through 2013 for signs of dementia. Measurements of coronary artery calcium, which can narrow your arteries and increase your heart attack risk, were also taken.

People with coronary artery calcium levels of zero showed signs of dementia on average just over seven years from the initial measurement, versus an average of just over five years for those with coronary artery calcium scores over 400, which is the highest level.

“This paper validates the strong trend in the literature, which demonstrates an important link between cardiovascular disease and dementia,” said JACC Editor-in-Chief Valentin Fuster, M.D., Ph.D. “We are learning that the disease states are closely related.”

This study is limited because the sample size was very small, considering very few women (13 percent) and almost zero men have coronary artery calcium scores of zero in this older age group. An additional limitation is that it is an observational study, which means it is impossible to determine cause and effect.

According to researchers, these results suggest several scenarios. The first is that the prevalence of dementia in older populations will likely increase as prevention and treatment of coronary heart disease improve and increase the longevity of the general population.

“As age at first heart attack continues to rise, dementia will be an important comorbidity and will affect treatment decisions and outcomes,” said Lewis H. Kuller, M.D., Dr.P.H., lead author of the study and emeritus professor, Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health.

A second scenario is that a zero or very low coronary artery calcium score is associated with a low risk of dementia, but because of the small sample size these results need to be replicated in other studies of the elderly.

A third scenario is that cardiovascular risk factors such as high blood pressure, diabetes, smoking and not exercising that lead to the development of atherosclerosis and eventually coronary heart disease could also affect progression of brain pathology, such as the risk of dementia.

“If delay or prevention of atherosclerosis resulted in the reduction or slowing of progression of brain disease and subsequent incidence of dementia, then there is the potential for a very substantial impact on reducing the majority of dementia in very old ages,” Kuller said. “There is a need to test such hypotheses by substantially modifying risk factors, slowing the progression of atherosclerosis and determining whether such an effect will substantially reduce the incidence of dementia and specific neuropathology among older patients.”

In an accompanying editorial, Sandra E. Black, M.D., said this study highlights the importance of determining whether preventing atherosclerosis will also prevent dementia, including the most common form — Alzheimer’s disease.

“The findings of Kuller and colleagues reinforce the notion that as more individuals live to older ages, we can expect a dramatic increase in the incidence and prevalence of dementia,” Black said. “Atherosclerosis, even if clinically undeclared, will likely contribute to these cases, suggesting the importance of pharmacological and non-pharmacological management of vascular risk factors beginning in mid-life.”

For more information: www.content.onlinejacc.org

Related Content

Remote reading of imaging studies on home picture archiving and communication systems (PACS) workstations can contribute to social distancing, protect vulnerable radiologists and others in the hospital, and ensure seamless interpretation capabilities in emergency scenarios, according to an open-access article published ahead-of-print by the American Journal of Roentgenology (AJR).

Srini Tridandapani, M.D., Ph.D.

News | PACS | May 21, 2020
May 21, 2020 — 
Examples of chest CT images of COVID-19 (+) patients and visualization of features correlated to COVID-19 positivity. For each pair of images, the left image is a CT image showing the segmented lung used as input for the CNN (convolutional neural network algorithm) model trained on CT images only, and the right image shows the heatmap of pixels that the CNN model classified as having SARS-CoV-2 infection (red indicates higher probability). (a) A 51-year-old female with fever and history of exposure to SARS-

Figure 1: Examples of chest CT images of COVID-19 (+) patients and visualization of features correlated to COVID-19 positivity. For each pair of images, the left image is a CT image showing the segmented lung used as input for the CNN (convolutional neural network algorithm) model trained on CT images only, and the right image shows the heatmap of pixels that the CNN model classified as having SARS-CoV-2 infection (red indicates higher probability). (a) A 51-year-old female with fever and history of exposure to SARS-CoV-2. The CNN model identified abnormal features in the right lower lobe (white color), whereas the two radiologists labeled this CT as negative. (b) A 52-year-old female who had a history of exposure to SARS-CoV-2 and presented with fever and productive cough. Bilateral peripheral ground-glass opacities (arrows) were labeled by the radiologists, and the CNN model predicted positivity based on features in matching areas. (c) A 72-year-old female with exposure history to the animal market in Wuhan presented with fever and productive cough. The segmented CT image shows ground-glass opacity in the anterior aspect of the right lung (arrow), whereas the CNN model labeled this CT as negative. (d) A 59-year-old female with cough and exposure history. The segmented CT image shows no evidence of pneumonia, and the CNN model also labeled this CT as negative.  

News | Coronavirus (COVID-19) | May 19, 2020
May 19, 2020 — Mount Sinai researchers are the first in the country to use...
Advanced imaging data exchange is now live in Colorado due to the partnership of Health Images and the Colorado Regional Health Information Organization

Getty Images

News | Radiology Business | May 18, 2020
May 18, 2020 — 
Radiologists from Shanghai discuss modifying exam process and disinfecting exam room, while outlining personal protection measures during the coronavirus disease outbreak

(HIS = hospital information system, RIS = radiology information system) Image courtesy of American Journal of Roentgenology (AJR)

News | Coronavirus (COVID-19) | May 18, 2020
May 18, 2020 — In an open-access article published ahead-of-print
Now a research team — led by Tohoku University Professor, Wataru Yashiro — has developed a new method using intense synchrotron radiation that produces higher quality images within milliseconds.

How the bent crystal changes the direction of the X-rays. Image courtesy of Tohoku University

News | Computed Tomography (CT) | May 15, 2020
May 15, 2020 — Many will undergo a computed tomogr...
Colored areas of the brain represent regions where the loss of brain synapses in people with early-stage Alzheimer’s was greater than people with normal cognitive function.

Colored areas of the brain represent regions where the loss of brain synapses in people with early-stage Alzheimer’s was greater than people with normal cognitive function. Image courtesy of YaleNews.

News | PET Imaging | May 14, 2020
May 14, 2020 — New imaging technology allows scientists to see the widespread loss of brain synapses in early stages
Experimental Protocol and Representative MRI of Brains at Various Key Points in That Protocol.

Experimental Protocol and Representative MRI of Brains at Various Key Points in That Protocol. (A) Experimental timeline. (B) Representative T2WI (using an 11.7T MRI) of the brain of a postnatal day (PND) 11 pup, 1 day after inducing left HII and prior to hNSC transplantation. Note the beginning of an increasingly intense “water signal” (white) on the left (“HII lesion”). (C) Representative T2WI (using an 11.7T MRI) 3 days post-HII, shortly after implantation of SPIO pre-labeled hNSCs into the contralateral cerebral ventricle (“Lateral Vent”). Note the “HII lesion” on the left becoming hyperintense (white) and the black signal void of the SPIO-labeled hNSCs in the lateral ventricle (black arrow). Red arrows denote the needle track. In contrast to what occurs in the intact brain (Figure S4), in a brain subjected to left HII, the implanted SPIO-labeled hNSCs (black signal void) (black arrow) migrate from the right (“R”) to the left (“L”) hemisphere to enter the lesion. (D and E) Shown here (using a 4.7T MRI) are SPIO-labeled hNSCs (black signal void) (black arrow) at 1 month post-implantation into the contralateral ventricle (D) and, in the same representative animal, at 3 months post-implantation (E)–stably integrated and surrounding a much-reduced residual lesion, with no interval enlargement of the graft or ventricles.

News | Magnetic Resonance Imaging (MRI) | May 13, 2020
May 13, 2020 — Scientists at Sanford Burnham Prebys Medical Discov...
In today’s challenging healthcare environment, radiology departments are often faced with the difficult decision of how to safely image patients who are suspected of being positive with infectious disease. To help hospitals and institutions effectively utilize computed tomography (CT) with these conditions, Canon Medical Systems USA, Inc. introduces a deployable CT with a rapid decontamination solution.
News | Computed Tomography (CT) | May 11, 2020
May 11, 2020 — In today’s challenging healthcare environment, radiology departments are often faced with the difficul
Axial (A) and coronal (B) CT of the abdomen and pelvis with IV contrast in a 57-year-old man with a high clinical suspicion for bowel ischemia. There was generalized small bowel distension and segmental thickening (arrows), with adjacent mesenteric congestion (thin arrow in B), and a small volume of ascites (* in B). Findings are nonspecific but suggestive of early ischemia or infection.

Axial (A) and coronal (B) CT of the abdomen and pelvis with IV contrast in a 57-year-old man with a high clinical suspicion for bowel ischemia. There was generalized small bowel distension and segmental thickening (arrows), with adjacent mesenteric congestion (thin arrow in B), and a small volume of ascites (* in B). Findings are nonspecific but suggestive of early ischemia or infection. Image courtesy of RSNA

News | Coronavirus (COVID-19) | May 11, 2020
May 11, 2020 — Patients with COVID-19 can have b