In a study involving 477 community-dwelling adults in 60s, 10% of the people developed lacunar infarcts. The Australian prospective research showed that high systolic blood pressure in these kind of patients appears to be the most significant treatable risk factor.
This research is part of the PATH Through Life Study, and it has three cohorts aged 20-24, 40-44 and 60-64 who are being followed up every 4 years for 20 years, to essentially look at ‘normal’ aging from 20-80 years, told Dr. Perminder S. Sachdev, from the Prince of Wales Hospital in Sydney. This work relates to the 60+ cohort.
The study involved paticipants with mean age 63 years, out of which 53% were men who underwent MRI. Lacunar infarcts, which are small cavitated lesions with diameters ranging from 3 to 20 mm, were detected in 7.8% of subjects. They were identified in 7.2% of those with no previous history of stroke diagnosis and 20% of those who had stroke.
Independent correlates for lacunae were hypertension (OR = 1.6, p = 0.045) and white matter hyperintensities (OR 4.9, p = 0.008). MRIs repeated 4 years later showed new lacunar infarct in 1.6%.
The mean volume of lacunar infarcts increased from 54 mm during the first wave of MRIs, to 70 mm at the second wave. Although this was only demonstrated in a limited number of subjects, the research team suggests, it may indicate a progressive process of atrophy in surrounding tissue of the lesion.
The authored explained that if the rate of lacunar infarcts in subjects younger than 60 is similar to their observations in the current sample, 0.6% per year, the upper limit of age at onset would be around 40.
We were not really surprised by this finding, Dr. Sachdev said. There is a lot of small vessel disease in the brain as we age, and it has perhaps been under-appreciated.
He also reported that their study emphasizes on the importance of controlling for risk factors such as hypertension, diabetes, high homocysteine, smoking, cholesterol, obesity and inactivity.
In an aging society, prevention of cognitive deficits later in life is a major public health issue we must focus on this as a society, and interventions targeting young people may reduce the burden in the future.