Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia
Background Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population‐based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known. Methods and Results Individuals aged ≥50 years enroll...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027672 |
| _version_ | 1797905049187254272 |
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| author | David M. Kent Lester Y. Leung Yichen Zhou Patrick H. Luetmer David F. Kallmes Jason Nelson Sunyang Fu Eric J. Puttock Chengyi Zheng Hongfang Liu Wansu Chen |
| author_facet | David M. Kent Lester Y. Leung Yichen Zhou Patrick H. Luetmer David F. Kallmes Jason Nelson Sunyang Fu Eric J. Puttock Chengyi Zheng Hongfang Liu Wansu Chen |
| author_sort | David M. Kent |
| collection | DOAJ |
| description | Background Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population‐based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known. Methods and Results Individuals aged ≥50 years enrolled in the Kaiser Permanente Southern California health system receiving head computed tomography (CT) or MRI for nonstroke indications from 2009 to 2019, without prior ischemic stroke/transient ischemic attack, dementia/Alzheimer disease, or visit reason/scan indication suggestive of cognitive decline or stroke were included. Natural language processing identified incidentally discovered covert brain infarction (id‐CBI) and white matter disease (id‐WMD) on the neuroimage report; white matter disease was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id‐CBI and id‐WMD. Among 241 050 qualified individuals, natural language processing identified 69 931 (29.0%) with id‐WMD and 11 328 (4.7%) with id‐CBI. Dementia incidence rates (per 1000 person‐years) were 23.5 (95% CI, 22.9–24.0) for patients with id‐WMD, 29.4 (95% CI, 27.9–31.0) with id‐CBI, and 6.0 (95% CI, 5.8–6.2) without id‐CCD. The association of id‐WMD with future dementia was stronger in younger (aged <70 years) versus older (aged ≥70 years) patients and for CT‐ versus MRI‐discovered lesions. For patients with versus without id‐WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58–3.19) for younger and 1.87 (95% CI, 1.79–1.95) for older patients. For patients with versus without id‐WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99–2.62) for younger and 1.48 (95% CI, 1.32–1.66) for older patients. The adjusted HR for id‐CBI was 2.02 (95% CI, 1.70–2.41) for younger and 1.22 (95% CI, 1.15–1.30) for older patients for either modality. Dementia risk was strongly correlated with id‐WMD severity; adjusted HRs compared with patients who were negative for id‐WMD by MRI ranged from 1.41 (95% CI, 1.25–1.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58–4.72) for those with severe disease on CT. Conclusions Incidentally discovered CCD is common and associated with a high risk of dementia, representing an opportunity for prevention. The association is strengthened when discovered at younger age, by increasing id‐WMD severity, and when id‐WMD is detected by CT scan rather than MRI. |
| first_indexed | 2024-04-10T09:58:53Z |
| format | Article |
| id | doaj.art-75fb17b7d7964ef9af89f40cc66760a0 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T09:58:53Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-75fb17b7d7964ef9af89f40cc66760a02023-02-16T10:55:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112110.1161/JAHA.122.027672Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future DementiaDavid M. Kent0Lester Y. Leung1Yichen Zhou2Patrick H. Luetmer3David F. Kallmes4Jason Nelson5Sunyang Fu6Eric J. Puttock7Chengyi Zheng8Hongfang Liu9Wansu Chen10Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center Boston MADepartment of Neurology Tufts Medical Center Boston MADepartment of Research and Evaluation Kaiser Permanente Southern California Pasadena CADepartment of Radiology Mayo Clinic Rochester MNDepartment of Radiology Mayo Clinic Rochester MNPredictive Analytics and Comparative Effectiveness Center, Tufts Medical Center Boston MADepartment of AI and Informatics Mayo Clinic Rochester MNDepartment of Research and Evaluation Kaiser Permanente Southern California Pasadena CADepartment of Research and Evaluation Kaiser Permanente Southern California Pasadena CADepartment of AI and Informatics Mayo Clinic Rochester MNDepartment of Research and Evaluation Kaiser Permanente Southern California Pasadena CABackground Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population‐based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known. Methods and Results Individuals aged ≥50 years enrolled in the Kaiser Permanente Southern California health system receiving head computed tomography (CT) or MRI for nonstroke indications from 2009 to 2019, without prior ischemic stroke/transient ischemic attack, dementia/Alzheimer disease, or visit reason/scan indication suggestive of cognitive decline or stroke were included. Natural language processing identified incidentally discovered covert brain infarction (id‐CBI) and white matter disease (id‐WMD) on the neuroimage report; white matter disease was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id‐CBI and id‐WMD. Among 241 050 qualified individuals, natural language processing identified 69 931 (29.0%) with id‐WMD and 11 328 (4.7%) with id‐CBI. Dementia incidence rates (per 1000 person‐years) were 23.5 (95% CI, 22.9–24.0) for patients with id‐WMD, 29.4 (95% CI, 27.9–31.0) with id‐CBI, and 6.0 (95% CI, 5.8–6.2) without id‐CCD. The association of id‐WMD with future dementia was stronger in younger (aged <70 years) versus older (aged ≥70 years) patients and for CT‐ versus MRI‐discovered lesions. For patients with versus without id‐WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58–3.19) for younger and 1.87 (95% CI, 1.79–1.95) for older patients. For patients with versus without id‐WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99–2.62) for younger and 1.48 (95% CI, 1.32–1.66) for older patients. The adjusted HR for id‐CBI was 2.02 (95% CI, 1.70–2.41) for younger and 1.22 (95% CI, 1.15–1.30) for older patients for either modality. Dementia risk was strongly correlated with id‐WMD severity; adjusted HRs compared with patients who were negative for id‐WMD by MRI ranged from 1.41 (95% CI, 1.25–1.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58–4.72) for those with severe disease on CT. Conclusions Incidentally discovered CCD is common and associated with a high risk of dementia, representing an opportunity for prevention. The association is strengthened when discovered at younger age, by increasing id‐WMD severity, and when id‐WMD is detected by CT scan rather than MRI.https://www.ahajournals.org/doi/10.1161/JAHA.122.027672covert brain infarctioncovert cerebrovascular diseasedementiadementia riskwhite matter disease |
| spellingShingle | David M. Kent Lester Y. Leung Yichen Zhou Patrick H. Luetmer David F. Kallmes Jason Nelson Sunyang Fu Eric J. Puttock Chengyi Zheng Hongfang Liu Wansu Chen Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease covert brain infarction covert cerebrovascular disease dementia dementia risk white matter disease |
| title | Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia |
| title_full | Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia |
| title_fullStr | Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia |
| title_full_unstemmed | Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia |
| title_short | Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia |
| title_sort | association of incidentally discovered covert cerebrovascular disease identified using natural language processing and future dementia |
| topic | covert brain infarction covert cerebrovascular disease dementia dementia risk white matter disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027672 |
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