Distribution of cerebral age-related white matter changes in relation to risk factors in stroke patients

Introduction: The distribution of cerebral age-related white matter changes (ARWMC) may be indicative of the underlying etiology and could suggest optimal interventions. We aimed to determine if left ventricular hypertrophy (LVH), a marker of uncontrolled hypertension, along with additional risk factors are associated with the distribution of cerebral ARWMC. Methods: We analyzed data of 172 patients from a hospital stroke registry who had acute stroke and brain MRI. We classified lesion location as superficial (frontal, parieto-occipital, or temporal) or deep (basal nuclei) using the ARWMC scale. We defined a superficial ARWMC index as the superficial minus the deep score. We excluded infratentorial lesions and patients with bilateral strokes. Regression analysis analyzed LVH and other relevant clinical factors for independent association with the superficial ARWMC index. Results: The superficial ARWMC scores ranged from 0 to 6, the deep scores from 0 to 3, and the superficial ARWMC index from −2 to 6. We categorized the superficial ARWMC index as −2 to 1 (n = 65), 2 (n = 50), and 3 – 6 (n = 57). In bivariate analysis, ARWMC distribution was significantly associated with older age, lower household income (HI), and lower serum triglyceride (TG) levels. In multiple logistic regression analysis, higher superficial ARWMC index was significantly associated with lower HI (OR 10.72, 95 % CI 2.30–49.85), lower serum low density cholesterol (LDL) (OR 0.86, 95 % CI 0.75–0.98, per 10 mg/dL), and lower serum TG levels (OR 0.91, 95 % CI 0.85–0.99, per 10 mg/dL). The area under the curve in receiver operating characteristic analysis (95 % CI) for HI was 0.63 (0.49–0.76), LDL level 0.64 (0.51–0.77), and TG level 0.77 (0.65–0.88). Conclusion: In this study, LVH was not associated with the distribution of cerebral ARWMC. Using an alternate classification of ARWMC distribution and analyzing additional risk factors in larger studies may yield further discoveries.