What are the differences between younger and older patients with symptomatic small vessel disease?

• Published in: Clinical neurology and neurosurgery Vol. 113; no. 9; pp. 762 - 767
• Main Authors: Pavlović, Aleksandra M, Pekmezović, Tatjana, Zidverc-Trajković, Jasna, Jovanović, Zagorka, Mijajlovic, Milija, Pavlović, Dragan, Tomić, Gordana, Šternić, Nadežda
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01-11-2011; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Aging - pathology; Biological and medical sciences; Brain; Brain - pathology; Cardiac arrhythmia; Cardiovascular disease; Cerebral Small Vessel Diseases - complications; Cerebral Small Vessel Diseases - diagnosis; Cerebral Small Vessel Diseases - pathology; Cerebral small-vessel disease; Cognition; Cognition - physiology; Cognition Disorders - etiology; Cognition Disorders - pathology; Cognitive ability; Confidence intervals; Coronary vessels; Cross-Sectional Studies; Dementia, Vascular - diagnosis; Dementia, Vascular - psychology; Family medical history; Female; Glucose; Hospitals; Humans; Hypertension; Image Interpretation, Computer-Assisted; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - pathology; Ischemic stroke; Logistic Models; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurologic Examination; Neurology; Neuropsychological Tests; Neurosurgery; Older people; Risk Factors; Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular dementia; Vascular Diseases - physiopathology; White matter lesions; Young adults; White matter lesions; Cerebral small-vessel disease; Young adults; Vascular dementia; Cognition; Ischemic stroke; Risk factors; Human; Cerebral infarction; Stroke; Nervous system diseases; Cardiovascular disease; White matter; Cerebral disorder; Encephalon; Vascular disease; Surgery; Central nervous system disease; Young adult; Risk factor; Brain ischemia; Degenerative disease; Cerebrovascular disease
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2011.08.011

Abstract Objective Although typically linked to aging, small vessel disease (SVD) is also observed in younger adult patients, with common vascular risk factors (RF). We aimed to investigate features of SVD occurrence at an early adult age. Patients and methods Vascular RF, functional and cognitive status and severity of lesions on MRI expressed as total score on Age-Related White Matter Changes (ARWMC) scale were analyzed in 200 consecutive patients with cerebral SVD admitted to a tertiary neurological hospital. Variables were compared between younger (35–55 years) and older (>56 years) patients. Results In this study, 63 (31.5%) of patients were 55 years or younger. Both age groups had comparable RF profiles, but smoking emerged as an independent predictor for SVD at a younger age (OR 2.9; 95% CI 1.5–5.5; p = 0.002). Younger patients had better functional (OR 1.8; 95% CI 1.3–2.5; p = 0.0001) and cognitive ( χ2 13.94; p = 0.0009) status compared to older patients. However, two thirds of younger patients had some degree of cognitive deficit. Total score on ARWMC scale was lower in younger patients (mean 12.3 in younger versus 15.2 in older, OR 1.11; 95% CI 1.0–1.18; p = 0.001). There was a strong correlation in both groups between functional score, cognitive status and ARWMC score ( p < 0.0001). Conclusion In our dataset, younger patients with SVD shared common vascular RF with older patients. In the group aged ≤55, better functional and cognitive status and less severe MRI changes were noted. However, a substantial number of younger SVD patients presenting with TIA or ischemic stroke had various deficits.