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Adults with symptoms of the metabolic syndrome have an increased incidence of leukoaraiosis on magnetic resonance imaging, researchers in Japan report in the September 4th issue of Neurology. Adults with symptoms of the metabolic syndrome have an increased incidence of leukoaraiosis on magnetic resonance imaging, researchers in Japan report in the September 4th issue of Neurology.

Dr. Kaechang Park and others at Kochi University note that varying degrees of leukoaraiosis (LA) have been associated with a risk of stroke, cognitive impairment and dementia of the Alzheimer type.

The researchers studied 1,030 healthy adults between the ages of 28 and 78 years (mean age of 52.7 years) who were undergoing routine physical examinations. The subjects were assessed for the metabolic syndrome based on the National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria, and for LA on MRI, using the rating scale of the Atherosclerosis Risk in Communities (ARIC) study.

A total of 296 patients (28.8 per cent) had LA on MRI. The metabolic syndrome was "significantly associated with the presence of LA," with an adjusted odds ratio of 3.33. The odds ratio was roughly the same regardless of the grade of LA, Dr. Park and colleagues report.

Among the components of the metabolic syndrome, an elevated blood pressure had an odds ratio of 2.16 for all grades of LA on MRI, impaired fasting glucose had an odds ratio of 1.64, and hypertriglyceridemia had an odds ratio of 1.56.

Dr. Park and colleagues conclude: "Specialists and family physicians should note that the metabolic syndrome may be an important factor for the occurrence of LA that is associated with the development of brain damages such as stroke and dementia."

Editorialists Dr. Karen L. Furie and Dr. Eric E. Smith, of Massachusetts General Hospital in Boston, comment that it has yet to be determined if "the pathology that accompanies LA is sufficient to impair the function of white matter tracts or whether LA is merely a marker of unidentified risk factors that cause cognitive impairment by other mechanisms."

Nonetheless, Drs. Smith and Furie advise, "Early adulthood and middle age are the appropriate time to intervene and prevent the manifestations of more advanced vascular disease, and possibly dementia and Alzheimer disease."

They say that longitudinal cohort studies and clinical trials will show whether or not treating metabolic syndrome aggressively will reduce the risk of LA progression and thereby reduce the risk of stroke and dementia.