Psychosocial Health and the Association Between Cerebral Small Vessel Disease Markers With Dementia: The ARIC Study

Surabhee Eswaran, Tulane University, New Orleans, LA (S.E.).
David S. Knopman, Department of Neurology, Mayo Clinic, Rochester, MN (D.S.K.).
Silvia Koton, Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Israel (S.K.).
Anna M. Kucharska-Newton, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill (A.M.K.-N., A.C.L.).
Albert C. Liu, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill (A.M.K.-N., A.C.L.).
Chelsea Liu, Department of Epidemiology, George Washington University-Milken Institute School of Public Health, DC (C.L.).
Pamela L. Lutsey, Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (P.L.L.).
Thomas H. Mosley, Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., K.J.S.).
Priya Palta, Department of Neurology, University of North Carolina at Chapel Hill (P.P.).
A Richey Sharrett, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (S.K., A.R.S.).
Kevin J. Sullivan, Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M., K.J.S.).
Keenan A. Walker, National Institute on Aging Intramural Research Program, Baltimore, MD (K.A.W.).
Rebecca F. Gottesman, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD (R.F.G., R.C.G.).
Renee C. Groechel, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD (R.F.G., R.C.G.).

Document Type

Journal Article

Publication Date

8-28-2024

Journal

Stroke

DOI

10.1161/STROKEAHA.124.047455

Keywords

atherosclerosis; cognitive reserve; dementia; social isolation; white matter

Abstract

BACKGROUND: Associations between magnetic resonance imaging markers of cerebral small vessel disease (CSVD) and dementia risk in older adults have been established, but it remains unclear how lifestyle factors, including psychosocial health, may modify this association. METHODS: Social support and social isolation were assessed among participants of the community-based ARIC (Atherosclerosis Risk in Communities) Study, via self-reported questionnaires (1990-1992). Following categorization of both factors, participants were classified as having strong or poor mid-life social relationships. At visit 5 (2011-2013), participants underwent 3T brain magnetic resonance imaging quantifying CSVD measures: white matter hyperintensity volume, microbleeds (subcortical), infarcts (lacunar), and white matter integrity (diffusion tensor imaging). Incident dementia cases were identified from the time of imaging through December 31, 2020 with ongoing surveillance. Associations between CSVD magnetic resonance imaging markers and incident dementia were evaluated using Cox proportional-hazard regressions adjusted for demographic and additional risk factors (from visit 2). Effect modification by mid-life social relationships was evaluated. RESULTS: Of the 1977 participants with magnetic resonance imaging, 1617 participants (60.7% women; 26.5% Black participants; mean age at visit 2, 55.4 years) were examined. In this sample, mid-life social relationships significantly modified the association between white matter hyperintensity volume and dementia risk (P interaction=0.001). Greater white matter hyperintensity volume was significantly associated with risk of dementia in all participants, yet, more substantially in those with poor (hazard ratio, 1.84 [95% CI, 1.49-2.27]) versus strong (hazard ratio, 1.26 [95% CI, 1.08-1.47]) mid-life social relationships. Although not statistically significant, subcortical microbleeds in participants with poor mid-life social relationships were associated with a greater risk of dementia, relative to those with strong social relationships, in whom subcortical microbleeds were no longer associated with elevated dementia risk. CONCLUSIONS: The elevated risk of dementia associated with CSVD may be reduced in participants with strong mid-life social relationships. Future studies evaluating psychosocial health through the life course and the mechanisms by which they modify the relationship between CSVD and dementia are needed.

Department

Epidemiology

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