Abstract Details

Title Impact of Race, Ethnicity and White Matter Hyperintensity on Incident Mild Cognitive Impairment at One Year after Lacunar Stroke: a Secondary Analysis of the SPS-3 Trial

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-003

Objective

To determine the effect of white matter hyperintensity (WMH) and race/ethnicity on the development of mild cognitive impairment (MCI) following lacunar stroke.

Background

Prior research has shown that WMH and race/ethnicity are risk factors for the development of MCI. However, that research has not focused on lacunar stroke survivors.

Design/Methods This is a secondary analysis of the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. The primary outcome is MCI, defined as a Cognitive Abilities Screening Instrument (CASI) score < 80 at one year after stroke. We excluded patients with baseline MCI or dementia. The primary predictors are the Fazekas score, an ordinal visual scale of WMH on MRI graded as 0-1 vs 2 vs 3, and race/ethnicity. We fit regression models to MCI and adjusted for age, sex, Barthel Index, college education, employment status, diabetes, and randomization arm.

Results

We included 1,811 patients with a mean (SD) age of 61.6 (10.3) years and 65.8% male. 87 patients (4.8%) developed MCI. There were 1,130 Caucasians, 310 Hispanics, 249 African-Americans, 20 Asians, and 102 other/mixed race. Fazekas 0-1 was seen in 760, 2 in 751, and 3 in 300 patients. The rate of incident MCI increased with WMH burden (Fazekas 0-1=3.6%, 2=5.1%, 3=7.3%, p=0.032) and varied across race/ethnicity (Caucasian=2.4%, Hispanic=9.7%, African-American=6.4%, Asian=5.0%, and other/mixed=12.8%, p<0.001).

In the adjusted regression models, Fazekas score lost significance, but, compared to Caucasians, the odds ratio (95% CI, p value) for incident MCI in Hispanics was 4.1 (2.3-7.2, <0.001), in African-Americans was 4.0 (2.1-7.9, p<0.001), in Asians was 2.6 (0.3-21.2, p=0.366), and in other/mixed was 5.6 (2.7-11.6, p<0.001). The interaction term of Fazekas*race/ethnicity was not significant, suggesting the effect of race/ethnicity on incident MCI is not influenced by WMH.

Conclusions

Incident MCI is more prevalent in non-white lacunar stroke survivors compared to Caucasians. This finding is not influenced by WMH.

Authors/Disclosures
Cecilia Peterson PRESENTER	An immediate family member of Ms. Peterson has received personal compensation for serving as an employee of 100Plus.
Ka-Ho Wong (U of U Neurology Clinic)	The institution of Mr. Wong has received research support from The Sumaira Foundation . The institution of Mr. Wong has received research support from The Siegel Rare Neuroimmune Association.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has or had stock in Certus.Dr. De Havenon has or had stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.

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