Abstract Details

Title The Presence of Covert Brain Infarcts or White Matter Disease Is Associated with Increased Stroke and Dementia Risks in a Large Integrated Healthcare System

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-012

Objective To determine prognostic implications of covert brain infarcts (CBI) and white matter disease (WMD) on future stroke and dementia risks.

Background CBI and WMD are frequently detected incidentally on neuroimaging in adults without clinical stroke.

Design/Methods

We applied natural language processing (NLP) to radiology reports from head CT and brain MRI performed between 2009 and 2022 among adults aged ≥50 years in Kaiser Permanente Northern California, excluding those with prior ischemic stroke, transient ischemic attack, or dementia. NLP algorithms were trained and validated against manually reviewed reports to identify CBI and WMD with high accuracy. Multivariate Cox proportional hazards regression models estimated the association of CBI and WMD with incident stroke and dementia, ascertained from electronic health records, adjusting for vascular risk factors.

Results Among 255,112 adults (mean age 63.5 ± 10.2 years; 60% female; ethnically diverse), 73.6% underwent CT and 26.4% MRI. Median follow-up was 3.5 years. The prevalence of CBI was 2.2% and 27.6% of WMD. For stroke, CBI was associated with increased risk on both CT (HR = 1.45; 95% CI: 1.36–1.68) and MRI (HR = 2.10; 95% CI: 1.82–2.43). WMD effects on stroke varied by age: HR = 2.21 (95% CI: 2.00–2.44) for age <70, and HR = 1.85 (95% CI: 1.67–2.05) for age ≥70. For dementia, CBI was associated with higher risk (HR = 1.63; 95% CI: 1.47–1.80). WMD effects varied by age and modality: for <70 years, HR = 3.31 (95% CI: 2.82–3.89) on CT and HR = 2.50 (95% CI: 2.13–2.94) on MRI; for ≥70 years, HR was 2.06 (95% CI: 1.76-2.42) on CT and 1.56 (95% CI: 1.33-1.83) on MRI.

Conclusions The presence of CBI or WMD on neuroimaging was associated with a significant increased risk of future stroke and dementia. These findings support further research into targeted prevention strategies for patients with these incidental findings.

Authors/Disclosures
Mai N. Nguyen-Huynh, MD (The Permanente Medical Group) PRESENTER	Dr. Nguyen-Huynh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bayer. Dr. Nguyen-Huynh has received research support from The Permanente Medical Group. Dr. Nguyen-Huynh has received research support from NIH. Dr. Nguyen-Huynh has a non-compensated relationship as a Member, Board of Directors with SEQUINS that is relevant to AAN interests or activities.
Eric Puttock, PhD	Mr. Puttock has nothing to disclose.
Dan Chen, MD, PhD	Dr. Chen has received personal compensation for serving as an employee of Axsome. Dr. Chen has stock in Axsome.
Lester Y. Leung, MD (Tufts Medical Center)	Dr. Leung has received research support from NIH.
David Kent, MD	Dr. Kent has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Dubai Health. The institution of Dr. Kent has received research support from NIH. The institution of Dr. Kent has received research support from ADDF.

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