Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions: Magnetic Resonance Imaging Substudy of the PreDIVA Trial (Prevention of Dementia by Intensive Vascular Care)

Jan Willem van Dalen; Eric P Moll van Charante; Matthan W A Caan; Philip Scheltens; Charles B L M Majoie; Aart J Nederveen; Willem A van Gool; Edo Richard

doi:10.1161/STROKEAHA.117.017207

Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions: Magnetic Resonance Imaging Substudy of the PreDIVA Trial (Prevention of Dementia by Intensive Vascular Care)

Stroke. 2017 Jul;48(7):1842-1848. doi: 10.1161/STROKEAHA.117.017207. Epub 2017 Jun 8.

Authors

Jan Willem van Dalen¹, Eric P Moll van Charante², Matthan W A Caan², Philip Scheltens², Charles B L M Majoie², Aart J Nederveen², Willem A van Gool², Edo Richard²

Affiliations

¹ From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.). j.vandalen@amc.nl.
² From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.).

PMID: 28596452
DOI: 10.1161/STROKEAHA.117.017207

Abstract

Background and purpose: This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension.

Methods: The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure ≥140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation.

Results: One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; P=0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes (P for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; P=0.36).

Conclusions: Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low.

Clinical trial information: URL: http://www.isrctn.com/ISRCTN29711771. Unique identifier: ISRCTN29711771.

Keywords: blood pressure; dementia; general practice; hypertension; magnetic resonance imaging.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cerebrovascular Disorders / diagnostic imaging
Cerebrovascular Disorders / epidemiology
Cerebrovascular Disorders / therapy
Cluster Analysis
Dementia / diagnostic imaging*
Dementia / epidemiology
Dementia / therapy
Disease Progression*
Female
Humans
Independent Living / trends
Long-Term Care / trends
Longitudinal Studies
Magnetic Resonance Imaging / trends*
Male
Nurse's Role*
Stroke, Lacunar / diagnostic imaging*
Stroke, Lacunar / epidemiology
Stroke, Lacunar / therapy
Treatment Outcome
White Matter / diagnostic imaging*