Sex differences in cerebrovascular pathologies on FLAIR in cognitively unimpaired elderly. (6th February 2018)

• Record Type: Journal Article
• Authors: Fatemi, Farzan; Kantarci, Kejal; Graff-Radford, Jonathan; Preboske, Gregory M.; Weigand, Stephen D.; Przybelski, Scott A.; Knopman, David S.; Machulda, Mary M.; Roberts, Rosebud O.; Mielke, Michelle M.; Petersen, Ronald C.; Jack, Clifford R.; Vemuri, Prashanthi
• Is Part Of: Neurology. Volume 90:Number 6(2018)
• Publication Date: 2018-02-06
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000004913
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To examine sex differences in cerebrovascular pathologies (CVPs) as seen on fluid-attenuated inversion recovery (FLAIR) MRI and in cardiovascular and metabolic risk factors in a population-based cognitively unimpaired cohort and to examine whether sex is independently associated with FLAIR findings after accounting for differences in important midlife risk factors. Methods: We identified 1, 301 cognitively normal participants (663 men and 638 women) enrolled in the Mayo Clinic Study of Aging (age ≥70 years) who had FLAIR MRI and ascertained total burden of white matter (WM) hyperintensities (WMH), subcortical infarctions, and cortical infarctions. We compared CVPs and midlife and late-life vascular risk factors between men and women. We fit regression models with each CVP as an outcome, treating age, sex, and midlife risk factors as predictors. Results: Women had significantly greater WMH volume relative to their WM volume compared to men (2.8% vs 2.4% of WM, p < 0.001), while men had a greater frequency of cortical infarctions compared to women (9% vs 4%, p < 0.001). Subcortical infarctions were equally common in men and women (20%). In regression modeling after adjustment for WM volume, the mean WMH volume difference between men and women was of the same magnitude as a 7-year difference in age. In contrast, men had 2.2-greater relative odds of having a cortical infarction compared to women. These sex differences persisted even after adjustment for midlife vascular risk factors. Conclusions: There were important sex differences in CVP findings on FLAIR in cognitively unimpaired elderly. Understanding these sex differences could aid in the development of sex-specific preventive strategies.