Dataset Information

Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study.

ABSTRACT:

Objectives

The objective was to develop and validate a risk model for the likelihood of extensive white matter lesions (extWML) to inform clinicians on whether to proceed with or forgo diagnostic MRI.

Design

Population-based cohort study and multivariable prediction model.

Setting

Two representative samples from France.

Participants

Persons aged 60-80 years without dementia or stroke. Derivation sample n=1714; validation sample n=789.

Primary and secondary outcome measures

Volume of extWML (log cm³) was obtained from T2-weighted images in a 1.5 T scanner. 20 candidate risk factors for extWML were evaluated with the C-statistic. Secondary outcomes in validation included incident stroke over 12 years follow-up.

Results

The multivariable prediction model included six clinical risk factors (C-statistic=0.61). A cut-off of 7 points on the multivariable prediction model yielded the optimum balance in sensitivity 63.7% and specificity 54.0% and the negative predictive value was high (81.8%), but the positive predictive value was low (31.5%). In further validation, incident stroke risk was associated with continuous scores on the multivariable prediction model (HR 1.02; 95% CI 1.01 to 1.04, P=0.02) and dichotomised scores from the multivariable prediction model (HR 1.28; 95% CI 1.02 to 1.60, P=0.03).

Conclusions

A simple clinical risk equation for WML constituted by six variables can inform decisions whether to proceed with or forgo brain MRI. The high-negative predictive value demonstrates potential to reduce unnecessary MRI in the population aged 60-80 years.

SUBMITTER: Tully PJ

PROVIDER: S-EPMC5778304 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study.

Tully Phillip J PJ Qchiqach Sarah S Pereira Edwige E Debette Stephanie S Mazoyer Bernard B Tzourio Christophe C

BMJ open 20171229 12

<h4>Objectives</h4>The objective was to develop and validate a risk model for the likelihood of extensive white matter lesions (extWML) to inform clinicians on whether to proceed with or forgo diagnostic MRI.<h4>Design</h4>Population-based cohort study and multivariable prediction model.<h4>Setting</h4>Two representative samples from France.<h4>Participants</h4>Persons aged 60-80 years without dementia or stroke. Derivation sample n=1714; validation sample n=789.<h4>Primary and secondary outcome ...[more]

PMID: 29289936

Similar Datasets

Project description:ObjectivesStudies of longitudinally extensive spinal cord lesions (LESCLs) in neuromyelitis optica (NMO) have focused on gray matter, where the relevant antigen, aquaporin-4 (AQP4), is abundant. Because spinal white matter pathology in NMO is not well characterized, we aimed to clarify spinal white matter pathology of LESCLs in NMO.MethodsWe analyzed 50 spinal cord lesions from eleven autopsied NMO/NMO spectrum disorder (NMOSD) cases. We also evaluated LESCLs with three or fewer spinal cord attacks by 3-tesla MRI in 15 AQP4 antibody-positive NMO/NMOSD patients and in 15 AQP4 antibody-negative multiple sclerosis (MS) patients.ResultsPathological analysis revealed seven cases of AQP4 loss and four predominantly demyelinating cases. Forty-four lesions from AQP4 loss cases involved significantly more frequently posterior columns (PC) and lateral columns (LC) than anterior columns (AC) (59.1%, 63.6%, and 34.1%, respectively). The posterior horn (PH), central portion (CP), and anterior horn (AH) were similarly affected (38.6%, 36.4% and 31.8%, respectively). Isolated perivascular inflammatory lesions with selective loss of astrocyte endfoot proteins, AQP4 and connexin 43, were present only in white matter and were more frequent in PC and LC than in AC (22.7%, 29.5% and 2.3%, Pcorr = 0.020, and Pcorr = 0.004, respectively). MRI indicated LESCLs more frequently affected PC and LC than AC in anti-AQP4 antibody-seropositive NMO/NMOSD (86.7%, 60.0% and 20.0%, Pcorr = 0.005, and Pcorr = 0.043, respectively) and AQP4 antibody-seronegative MS patients (86.7%, 73.3% and 33.3%, Pcorr = 0.063, and Pcorr = 0.043, respectively). PH, CP and AH were involved in 93.3%, 86.7% and 73.3% of seropositive patients, respectively, and in 53.3%, 60.0% and 40.0% of seronegative patients, respectively.ConclusionsNMO frequently and extensively affects spinal white matter in addition to central gray matter, especially in PC and LC, where isolated perivascular lesions with astrocyte endfoot protein loss may emerge. Spinal white matter involvement may also appear in early NMO, similar to cerebral white matter lesions.

Project description:BackgroundThis study aimed to investigate whether white matter lesions (WML), β-amyloid-, and tau pathologies are independently associated with mobility, dual tasking, and dynamic balance performance in older nondemented individuals.MethodsWe included 299 older people (mean, SD, age: 71.8, 5.6 years) from the Swedish BioFINDER study, whereof 175 were cognitively unimpaired and 124 had mild cognitive impairment (MCI). In multivariable regression analyses, dependent variables included mobility (Timed Up & Go [TUG]), dual tasking (TUG with a simultaneous subtraction task, that is, TUG-Cog, as well as dual task cost), and balance (Figure-of-eight). The analyses were controlled for age, sex, education, diagnosis (ie, MCI), and comorbidity (stroke, diabetes, and ischemic heart disease). Independent variables included WML volume, and measures of β-amyloid (abnormal cerebrospinal fluid [CSF] Aβ42/40 ratio) and tau pathology (CSF phosphorylated tau [p-tau]).ResultsMultivariable regression analyses showed that an increased WML volume was independently associated with decreased mobility, that is, TUG (standardized β = 0.247; p < .001). Tau pathology was independently associated with dual tasking both when using the raw data of TUG-Cog (β = 0.224; p = .003) and the dual-task cost (β= -0.246; p = .001). Amyloid pathology was associated with decreased balance, that is, Figure-of-eight (β = 0.172; p = .028). The independent effects of WML and tau pathology were mainly observed in those with MCI, which was not the case for the effects of amyloid pathology on balance.ConclusionsCommon brain pathologies have different effects where WML are independently associated with mobility, tau pathology has the strongest effect on dual tasking, and amyloid pathology seems to be independently associated with balance. Although these novel findings need to be confirmed in longitudinal studies, they suggest that different brain pathologies have different effects on mobility, balance, and dual-tasking in older nondemented individuals.

Dataset Information

Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Development and validation of a priori risk model for extensive white matter lesions in people age 65 years or older: the Dijon MRI study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets