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White Matter Lesions on Brain Magnetic Resonance Imaging Scan and 5-Year Cognitive Decline: The Honolulu-Asia Aging Study

Authors

  • Michiko Inaba MD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • Lon White MD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • , Christina Bell MD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • , Randi Chen MS,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • Helen Petrovitch MD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • ,,, Lenore Launer PhD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • Robert D. Abbott PhD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • , G. Webster Ross MD,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • and ,, Kamal Masaki MD ,

    1. From the *Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Kuakini Medical Center, Honolulu, Hawaii; Pacific Health Research and Education Institute, Honolulu, Hawaii; §Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii; National Institute on Aging, Bethesda, Maryland; and #Radiation Effects Research Foundation, Hiroshima, Japan.
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  • These data were presented as abstracts at the Hawaii Chapter American College of Physicians Meeting, Honolulu, Hawaii, January 2010, and the American Geriatrics Society National Conference, Orlando, Florida, May 2010.

Address correspondence to Michiko Inaba, Department of Geriatric Medicine, The John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, 347 N. Kuakini St., HPM-9, Honolulu, HI 96817. E-mail: mckinaba@hotmail.com

Abstract

OBJECTIVES: To study white matter lesions (WMLs) and 5-year cognitive decline in elderly Japanese-American men.

DESIGN: Longitudinal cohort study.

SETTING: Population-based study in Honolulu, Hawaii.

PARTICIPANTS: Japanese-American men aged 74 to 95 from the Honolulu-Asia Aging Study (HAAS) who were free of prevalent dementia, underwent a protocol brain MRI scan at the fifth HAAS examination (1994–1996), and returned for cognitive testing 5 years later (N=267).

MEASUREMENTS: WMLs were dichotomized as present (grade 3–9, 38.2%) or absent (grade 1–2, 61.8%). Cognitive function was measured using the Cognitive Abilities Screening Instrument (CASI), and 5-year cognitive decline was defined as a drop in CASI score of 12 points or more (1 standard deviation).

RESULTS: Men with WMLs on MRI at baseline were significantly more likely to experience cognitive decline at 5 years than those without (22.4% vs 34.4%, P=.03). Using multiple logistic regression, adjusting for age, education, apolipoprotein (Apo)E4 allele, large or small infarcts on MRI, baseline CASI score, and hypertension, those with WMLs were significantly more likely to develop 5-year cognitive decline (odds ratio=2.00, 95% confidence interval=1.10–3.65, P=.02). This association was stronger in men who were cognitively intact and free of the ApoE4 genotype and clinical stroke at baseline.

CONCLUSION: Presence of WMLs on MRI was significantly associated with higher odds of 5-year cognitive decline in older Japanese-American men. Presence of WMLs may help identify people at risk for developing dementia, who may benefit from early intervention.

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