for the SMART Study Group
Carotid atherosclerosis and progression of brain atrophy: The SMART-MR Study
Article first published online: 14 JUN 2011
Copyright © 2011 American Neurological Association
Annals of Neurology
Volume 70, Issue 2, pages 237–244, August 2011
How to Cite
Muller, M., van der Graaf, Y., Algra, A., Hendrikse, J., Mali, W. P. and Geerlings, M. I. (2011), Carotid atherosclerosis and progression of brain atrophy: The SMART-MR Study. Ann Neurol., 70: 237–244. doi: 10.1002/ana.22392
for the SMART Study Group
- Issue published online: 5 AUG 2011
- Article first published online: 14 JUN 2011
- Manuscript Accepted: 28 JAN 2011
- Manuscript Revised: 3 JAN 2011
- Manuscript Received: 15 SEP 2010
- Netherlands Organization for Scientific Research-Medical Sciences. Grant Number: NWO-MW904-65-095
- Netherlands Organization for Scientific Research. Grant Number: NWO: project No. 917-66-311; M.I.G.
Atherosclerosis has been implicated in the development of brain atrophy. However, support for this association comes from cross-sectional studies.
Within the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study, a prospective cohort study among patients with symptomatic atherosclerotic disease (mean age ± standard deviation, 58 ± 10 years; 80% men), magnetic resonance imaging of the brain was performed in 1,232 patients at baseline (2001–2005) and in 663 patients at follow-up (2006–2009). Brain segmentation was used to quantify total brain volume, cortical gray matter volume, and ventricular volume as indicators of global, cortical, and subcortical atrophy. At baseline, measurements of carotid intima–media thickness (CIMT) and carotid stenosis were performed. Carotid stenosis was classified into groups 0 of 50%, 50 of 70% (moderate), and >70% (severe) and into unilateral or bilateral stenosis.
Cross-sectional regression analyses showed that both increased CIMT and carotid stenosis were associated with decreased relative total brain and cortical gray matter volume. Our prospective findings showed that after a mean follow-up of 3.9 years (range, 3.0–5.8 years), CIMT and moderate stenosis were not related to progression of brain atrophy. Only severe or bilateral carotid stenosis was related to progression of global atrophy (β [95% confidence interval (CI)], −0.52% [−0.84 to −0.20%], −0.94% [−1.45 to −0.43%]), cortical atrophy (β [95% CI], −0.75% [−1.37 to −0.13%], −1.34% [−2.32 to −0.35%]), and subcortical atrophy (β [95% CI], 0.06% [−0.02 to 0.16%], 0.13% [0.01 to 0.28%]).
In a study of patients with atherosclerotic disease with 4 years of follow-up, only severe or bilateral carotid stenosis, and not moderate carotid stenosis and increased CIMT, were associated with progression of brain atrophy. Ann Neurol 2011;