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Hadine Joffe - One of the best experts on this subject based on the ideXlab platform.
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methods for the design of Vasomotor symptom trials the menopausal strategies finding lasting answers to symptoms and health network
Menopause, 2014Co-Authors: Katherine M Newton, Hadine Joffe, Lee S Cohen, Janet S Carpenter, Katherine A Guthrie, Garnet L Anderson, Bette J Caan, Kristine E Ensrud, Ellen W Freeman, Barbara SternfeldAbstract:This report describes the Menopausal Strategies: Finding Lasting Answers to Symptoms and Health network and methodological issues addressed in designing and implementing Vasomotor symptom trials.Established in response to a National Institutes of Health request for applications, the network was charged with conducting rapid throughput randomized trials of novel and understudied available interventions postulated to alleviate Vasomotor and other menopausal symptoms. Included are descriptions of and rationale for criteria used for interventions and study selection, common eligibility and exclusion criteria, common primary and secondary outcome measures, consideration of placebo response, establishment of a biorepository, trial duration, screening and recruitment, statistical methods, and quality control. All trial designs are presented, including the following: (1) a randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effectiveness of the selective serotonin reuptake inhibitor escitalopram in reducing Vasomotor symptom frequency and severity; (2) a two-by-three factorial design trial to test three different interventions (yoga, exercise, and ω-3 supplementation) for the improvement of Vasomotor symptom frequency and bother; and (3) a three-arm comparative efficacy trial of the serotonin-norepinephrine reuptake inhibitor venlafaxine and low-dose oral estradiol versus placebo for reducing Vasomotor symptom frequency. The network's structure and governance are also discussed.The methods used in and the lessons learned from the Menopausal Strategies: Finding Lasting Answers to Symptoms and Health trials are shared to encourage and support the conduct of similar trials and to encourage collaborations with other researchers.
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gains in body fat and Vasomotor symptom reporting over the menopausal transition the study of women s health across the nation
American Journal of Epidemiology, 2009Co-Authors: Rebecca C Thurston, Maryfran Sowers, Barbara Sternfeld, Ellen B Gold, Joyce T Bromberger, Yuefang Chang, Hadine Joffe, Carolyn J Crandall, Elaine L Waetjen, Karen A MatthewsAbstract:Most women living in the United States report Vasomotor symptoms (hot flashes and/or night sweats) during the menopausal transition (1). Vasomotor symptoms are sensations of intense heat accompanied by sweating and flushing. Usually experienced as bothersome (2), Vasomotor symptoms are associated with poorer quality of life (3), mood (4), memory performance (5), and sleep quality (6). Because hormone therapy, the most effective treatment for Vasomotor symptoms, has been linked to health risk among certain women (7), the etiology, risk factors, and nonhormonal approaches to managing Vasomotor symptoms are the subject of increased scientific interest (8). Obesity and its relation to Vasomotor symptoms have been of particular interest. Early work hypothesized that body fat protected against Vasomotor symptoms because of the aromatization of androgens to estrogens in fat tissue (9, 10). However, evidence indicates that higher body mass index (1, 11), and body fat in particular (12, 13), is associated with greater Vasomotor symptom reporting, primarily hot flashes. These findings are consistent with a thermoregulatory model of Vasomotor symptoms in which body fat acts as an insulator, rendering Vasomotor symptoms, a putative heat dissipation event, more likely (14). The existing research linking body fat to Vasomotor symptoms is cross-sectional, and the directionality or longitudinal nature of these associations is unclear. Of particular importance is whether fat gains are related to greater Vasomotor symptom reporting over time. Women typically show progressive gains in body fat over midlife (15, 16), but the influence of these gains on Vasomotor symptoms is unknown. Longitudinal research links higher body mass index to more reported Vasomotor symptoms (1) and increases in reported weight across 2 time points (17) to higher Vasomotor symptom reporting. However, body mass index, a ratio of weight to the square of height, is a rough proxy for body fat; reported weight is typically underestimated among women (18); and neither measure distinguishes between lean and fat mass. Given the importance of body fat to Vasomotor symptoms, research with more precise estimates of body fat is important. No investigations have evaluated whether fat gains are related to Vasomotor symptom reporting over time. We hypothesized that gains in body fat would be associated with an increased annual prevalence of reported hot flashes and night sweats. We also examined the role of reproductive hormones in these associations, particularly estradiol; follicle-stimulating hormone, a gonadotropin associated with both gains in body fat and Vasomotor symptoms (15, 19); and the free estradiol index, an estimate of the portion of estradiol circulating unbound to sex hormone-binding globulin (SHBG) and thereby biologically available. Given the variations in body composition and Vasomotor symptom reporting by race/ethnicity and menopausal stage (1, 15), interactions by race/ethnicity and menopausal stage were examined.
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beyond frequency who is most bothered by Vasomotor symptoms
Menopause, 2008Co-Authors: Rebecca C Thurston, Joyce T Bromberger, Yuefang Chang, Hadine Joffe, Carolyn J Crandall, Nancy E Avis, Rachel Hess, Robin Green, Karen A MatthewsAbstract:Objective: Most menopausal women report Vasomotor symptoms (hot flashes, night sweats). However, not all women with Vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of Vasomotor symptom bother beyond symptom frequency. Design: The Study of Women's Health Across the Nation participants reporting Vasomotor symptoms at annual visit 7 comprised the sample (N = 1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all- 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and Vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately. Results: In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR] = 1.27, 95% CI: 1.08-1.51), symptom sensitivity (OR = 1.18, 95% CI: 1.03-1.37), sleep problems (OR = 1.38, 95% CI: 1.04-1.85), poorer health (OR = 1.24, 95% CI: 1.03-1.48), duration of hot flashes (OR = 1.14, 95% CI: 1.06-1.23), younger age (OR = 0.94, 95% CI: 0.89-0.99), and African American race (vs white, OR = 1.59, 95% CI: 1.12-2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR = 1.84, 95% CI:1.33-2.55) and night sweats duration (OR = 1.10, 95% CI: 1.02-1.20) were associated with night sweats bother. Conclusions: Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for Vasomotor symptoms might consider addressing modifiable factors related to symptom bother.
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treatment of depression and menopause related symptoms with the serotonin norepinephrine reuptake inhibitor duloxetine
The Journal of Clinical Psychiatry, 2007Co-Authors: Hadine Joffe, Claudio N Soares, Laura F Petrillo, Adele C Viguera, Brittny Somley, Jennifer K Koch, Lee S CohenAbstract:BACKGROUND: Postmenopausal women with depression frequently have co-occurring symptoms of hot flashes (Vasomotor symptoms), sleep disturbance, anxiety, and pain. Treatment strategies that target all of these symptoms together have not been investigated to date. METHOD: Study participants were postmenopausal women, 40 to 60 years old, with major depressive disorder (DSM-IV criteria) and Vasomotor symptoms. The study design included a 2-week, single-blind placebo run-in phase followed by an 8-week open-label flexible-dosing (60-120 mg per day) study of duloxetine for women who did not respond to placebo. The primary outcome measure was change in Montgomery-Asberg Depression Rating Scale (MADRS) score during 8 weeks of duloxetine therapy. Secondary outcome measures included changes in Vasomotor symptoms, sleep quality, anxiety, and pain. Analyses were conducted using non-parametric methods. Patients were enrolled in the study from May 31, 2005, through May 22, 2006. RESULTS: Of 30 women eligible to participate in this study, 20 initiated treatment with open-label duloxetine. Fourteen (70.0%) of these women completed the study. There was a statistically significant decrease in MADRS scores after 8 weeks of treatment (p < .001), with scores declining from 19.0 (interquartile range [IQR] = 15.0-21.0) to 5.5 (IQR = 3.0-9.0). There was also a statistically significant improvement in Vasomotor symptoms (p = .003), anxiety (p = .002), sleep quality (p < .001), and pain (p < .05). CONCLUSIONS: Postmenopausal women with depression and Vasomotor symptoms had significant improvement in depression, Vasomotor symptoms, sleep, anxiety, and pain after 8 weeks of open-label duloxetine therapy. Given the common co-occurrence of these symptoms in postmenopausal women, duloxetine may offer important therapeutic benefits for postmenopausal women who have depression and menopause-related symptoms.
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physical activity and risk of Vasomotor symptoms in women with and without a history of depression results from the harvard study of moods and cycles
Menopause, 2006Co-Authors: Rebecca C Thurston, Hadine Joffe, Claudio N Soares, Bernard L HarlowAbstract:Objective: To examine whether physical activity was associated with decreased risk of Vasomotor symptoms in a prospective study of women transitioning through menopause. Design: Hypotheses were evaluated in the Harvard Study of Moods and Cycles, a longitudinal study of women with and without a history of major depression (N = 523). Ordinal logistic regression models were utilized to assess the odds of Vasomotor symptoms (none, mild, moderate/severe; Greene Climacteric Scale) associated with physical activity (quartiles of metabolic equivalent-hours per week) at study enrollment and over a 3- to 5-year follow-up period. Results: No significant associations between physical activity and Vasomotor symptoms were observed for the sample as a whole. However, exploratory analyses stratified by depression history revealed that among the 157 women with a lifetime history of major depression, high (odds ratio [OR] = 0.28, 95% CI: 0.09-0.83) or moderately high (OR = 0.33, 95% CI: 0.11-0.99) physical activity proximal to the Vasomotor assessment, as well as consistently high (OR = 0.27, 95% CI: 0.10-0.75) or increasing (OR = 0.33, 95% CI: 0.12-0.92) physical activity over the duration of the 3- to 5-year follow-up period was associated with decreased Vasomotor symptoms relative to sedentary behavior. No significant associations were observed for women without a history of depression. Conclusions: Physical activity may be associated with decreased risk of Vasomotor symptoms among women with a history of major depression.
Karen A Matthews - One of the best experts on this subject based on the ideXlab platform.
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gains in body fat and Vasomotor symptom reporting over the menopausal transition the study of women s health across the nation
American Journal of Epidemiology, 2009Co-Authors: Rebecca C Thurston, Maryfran Sowers, Barbara Sternfeld, Ellen B Gold, Joyce T Bromberger, Yuefang Chang, Hadine Joffe, Carolyn J Crandall, Elaine L Waetjen, Karen A MatthewsAbstract:Most women living in the United States report Vasomotor symptoms (hot flashes and/or night sweats) during the menopausal transition (1). Vasomotor symptoms are sensations of intense heat accompanied by sweating and flushing. Usually experienced as bothersome (2), Vasomotor symptoms are associated with poorer quality of life (3), mood (4), memory performance (5), and sleep quality (6). Because hormone therapy, the most effective treatment for Vasomotor symptoms, has been linked to health risk among certain women (7), the etiology, risk factors, and nonhormonal approaches to managing Vasomotor symptoms are the subject of increased scientific interest (8). Obesity and its relation to Vasomotor symptoms have been of particular interest. Early work hypothesized that body fat protected against Vasomotor symptoms because of the aromatization of androgens to estrogens in fat tissue (9, 10). However, evidence indicates that higher body mass index (1, 11), and body fat in particular (12, 13), is associated with greater Vasomotor symptom reporting, primarily hot flashes. These findings are consistent with a thermoregulatory model of Vasomotor symptoms in which body fat acts as an insulator, rendering Vasomotor symptoms, a putative heat dissipation event, more likely (14). The existing research linking body fat to Vasomotor symptoms is cross-sectional, and the directionality or longitudinal nature of these associations is unclear. Of particular importance is whether fat gains are related to greater Vasomotor symptom reporting over time. Women typically show progressive gains in body fat over midlife (15, 16), but the influence of these gains on Vasomotor symptoms is unknown. Longitudinal research links higher body mass index to more reported Vasomotor symptoms (1) and increases in reported weight across 2 time points (17) to higher Vasomotor symptom reporting. However, body mass index, a ratio of weight to the square of height, is a rough proxy for body fat; reported weight is typically underestimated among women (18); and neither measure distinguishes between lean and fat mass. Given the importance of body fat to Vasomotor symptoms, research with more precise estimates of body fat is important. No investigations have evaluated whether fat gains are related to Vasomotor symptom reporting over time. We hypothesized that gains in body fat would be associated with an increased annual prevalence of reported hot flashes and night sweats. We also examined the role of reproductive hormones in these associations, particularly estradiol; follicle-stimulating hormone, a gonadotropin associated with both gains in body fat and Vasomotor symptoms (15, 19); and the free estradiol index, an estimate of the portion of estradiol circulating unbound to sex hormone-binding globulin (SHBG) and thereby biologically available. Given the variations in body composition and Vasomotor symptom reporting by race/ethnicity and menopausal stage (1, 15), interactions by race/ethnicity and menopausal stage were examined.
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beyond frequency who is most bothered by Vasomotor symptoms
Menopause, 2008Co-Authors: Rebecca C Thurston, Joyce T Bromberger, Yuefang Chang, Hadine Joffe, Carolyn J Crandall, Nancy E Avis, Rachel Hess, Robin Green, Karen A MatthewsAbstract:Objective: Most menopausal women report Vasomotor symptoms (hot flashes, night sweats). However, not all women with Vasomotor symptoms, including frequent symptoms, are bothered by them. The primary aim was to identify correlates of Vasomotor symptom bother beyond symptom frequency. Design: The Study of Women's Health Across the Nation participants reporting Vasomotor symptoms at annual visit 7 comprised the sample (N = 1,042). Assessments included hot flash and night sweats frequency (number per week) and bother (1, not at all- 4, very much). Negative affect (index of depressive symptoms, anxiety, perceived stress, negative mood), symptom sensitivity, sleep problems, and Vasomotor symptom duration (number of years) were examined cross-sectionally in relation to bother in ordinal logistic regression models with symptom frequency and covariates. Hot flashes and night sweats were considered separately. Results: In multivariable models controlling for hot flash frequency, negative affect (odds ratio [OR] = 1.27, 95% CI: 1.08-1.51), symptom sensitivity (OR = 1.18, 95% CI: 1.03-1.37), sleep problems (OR = 1.38, 95% CI: 1.04-1.85), poorer health (OR = 1.24, 95% CI: 1.03-1.48), duration of hot flashes (OR = 1.14, 95% CI: 1.06-1.23), younger age (OR = 0.94, 95% CI: 0.89-0.99), and African American race (vs white, OR = 1.59, 95% CI: 1.12-2.26) were associated with hot flash bother. After controlling for night sweats frequency and covariates, sleep problems (OR = 1.84, 95% CI:1.33-2.55) and night sweats duration (OR = 1.10, 95% CI: 1.02-1.20) were associated with night sweats bother. Conclusions: Beyond frequency, factors associated with bothersome hot flashes include mood, symptom sensitivity, symptom duration, sleep problems, age, and race. Correlates of bothersome night sweats include sleep problems and symptom duration. In addition to reducing frequency, interventions for Vasomotor symptoms might consider addressing modifiable factors related to symptom bother.
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adiposity and reporting of Vasomotor symptoms among midlife women the study of women s health across the nation
American Journal of Epidemiology, 2007Co-Authors: Rebecca C Thurston, Maryfran Sowers, Barbara Sternfeld, Ellen B Gold, Yuefang Chang, Janet M. Johnston, Karen A MatthewsAbstract:It has long been hypothesized that increased adiposity would be associated with decreased Vasomotor symptoms during menopause because of conversion of androgens to estrogens in body fat. However, recent thermoregulatory models have postulated that increased adipose tissue would be associated with a greater likelihood of Vasomotor symptoms. The authors evaluated these hypotheses in the Study of Women's Health Across the Nation, a multiethnic, community-based observational study of US women transitioning through menopause. The sample included 1,776 women aged 47-59 years with an intact uterus and at least one ovary who completed bioelectrical impedance analysis for assessment of body composition at the sixth annual study visit (2002-2004). Assessments also included reported Vasomotor symptoms (hot flashes, night sweats) and serum levels of follicle-stimulating hormone, estradiol, and sex hormone-binding globulin-adjusted estradiol (free estradiol index). Results indicated that a higher percentage of body fat was associated with increased odds of reporting Vasomotor symptoms (per standard deviation increase in percent body fat, odds ratio = 1.27, 95% confidence interval: 1.14, 1.42) in age- and site-adjusted models. Associations persisted in fully adjusted models and were not reduced when models included reproductive hormones. These findings support a thermoregulatory model of Vasomotor symptoms.
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longitudinal analysis of the association between Vasomotor symptoms and race ethnicity across the menopausal transition study of women s health across the nation
American Journal of Public Health, 2006Co-Authors: Ellen B Gold, Barbara Sternfeld, Joyce T Bromberger, Nancy E Avis, Gail A Greendale, Alicia Colvin, Lynda H Powell, Karen A MatthewsAbstract:Objectives. We investigated whether Vasomotor symptom reporting or patterns of change in symptom reporting over the perimenopausal transition among women enrolled in a national study differed according to race/ethnicity. We also sought to determine whether racial/ethnic differences were explained by sociodemographic, health, or lifestyle factors.Methods. We followed 3198 women enrolled in the Study of Women’s Health Across the Nation during 1996 through 2002. We analyzed frequency of Vasomotor symptom reporting using longitudinal multiple logistic regressions.Results. Rates of Vasomotor symptom reporting were highest among African Americans (adjusted odds ratio [OR]=1.63; 95% confidence interval [CI]=1.21, 2.20). The transition to late perimenopause exhibited the strongest association with Vasomotor symptoms (adjusted OR = 6.64; 95% CI = 4.80, 9.20). Other risk factors were age (adjusted OR=1.17; 95% CI=1.13, 1.21), having less than a college education (adjusted OR = 1.91; 95% CI = 1.40, 2.61), increasing...
Monique M B Breteler - One of the best experts on this subject based on the ideXlab platform.
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cerebral Vasomotor reactivity and cerebral white matter lesions in the elderly
Neurology, 1999Co-Authors: S L M Bakker, Albert Hofman, Peter J Koudstaal, F E De Leeuw, J C De Groot, Monique M B BretelerAbstract:Objective: The pathogenesis of white matter lesions is still uncertain, but an ischemic-hypoxic cause has been suggested. Cerebral Vasomotor reactivity reflects the compensatory dilatory mechanism of the intracerebral arterioles to a vasodilatory stimulus and provides a more sensitive hemodynamic index than the level of resting flow. Methods: The authors determined the association between Vasomotor reactivity and white matter lesions in 73 consecutive individuals from the Rotterdam Scan Study who also participated in the Rotterdam Study, a large population-based prospective follow-up study of individuals ≥55 years old. Vasomotor reactivity was measured by means of CO 2 -enhanced transcranial Doppler, and in all individuals axial T1*-, T2*-, and proton density (PD)-weighted MRI scans (1.5 T) were obtained. White matter lesions were scored according to location, size, and number by two independent readers. Results: Vasomotor reactivity was inversely associated with the deep subcortical and total periventricular white matter lesions (OR 0.5, 95% CI 0.3 to 1.1; and OR 0.7, 95% CI 0.4 to 1.1, respectively). A strong association was found between impaired Vasomotor reactivity and periventricular white matter lesions adjacent to the lateral ventricular wall (OR 0.6, 95% CI 0.4 to 1.0; p = 0.001). No association was found with periventricular white matter lesions near the frontal and occipital horns. Conclusions: Our data confirm the association between Vasomotor reactivity and white matter lesions and support the hypothesis that some white matter lesions may be associated with hemodynamic ischemic injury to the brain.
Albert Hofman - One of the best experts on this subject based on the ideXlab platform.
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cerebral Vasomotor reactivity and risk of mortality the rotterdam study
Stroke, 2014Co-Authors: Marileen L P Portegies, Renee F A G De Bruijn, Albert Hofman, Peter J Koudstaal, Arfan M IkramAbstract:Background and Purpose—Accumulating vascular pathology in cerebral arteries leads to impaired cerebral Vasomotor reactivity. In turn, impaired cerebral Vasomotor reactivity is a risk factor for stroke in clinical populations. It remains unclear whether impaired cerebral Vasomotor reactivity also reflects more systemic vascular damage. We investigated whether cerebral Vasomotor reactivity is associated with the risk of mortality, focusing particularly on cardiovascular mortality independent from stroke. Methods—Between 1997 and 1999, 1695 participants from the Rotterdam Study underwent cerebral Vasomotor reactivity measurements using transcranial Doppler. Follow-up was complete until January 1, 2011. We assessed the associations between cerebral Vasomotor reactivity and mortality using Cox proportional hazards models, adjusting for age, sex, and blood pressure changes and subsequently for cardiovascular risk factors. We additionally censored for incident stroke. Results—During 17 004 person-years, 557 part...
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cerebral Vasomotor reactivity and cerebral white matter lesions in the elderly
Neurology, 1999Co-Authors: S L M Bakker, Albert Hofman, Peter J Koudstaal, F E De Leeuw, J C De Groot, Monique M B BretelerAbstract:Objective: The pathogenesis of white matter lesions is still uncertain, but an ischemic-hypoxic cause has been suggested. Cerebral Vasomotor reactivity reflects the compensatory dilatory mechanism of the intracerebral arterioles to a vasodilatory stimulus and provides a more sensitive hemodynamic index than the level of resting flow. Methods: The authors determined the association between Vasomotor reactivity and white matter lesions in 73 consecutive individuals from the Rotterdam Scan Study who also participated in the Rotterdam Study, a large population-based prospective follow-up study of individuals ≥55 years old. Vasomotor reactivity was measured by means of CO 2 -enhanced transcranial Doppler, and in all individuals axial T1*-, T2*-, and proton density (PD)-weighted MRI scans (1.5 T) were obtained. White matter lesions were scored according to location, size, and number by two independent readers. Results: Vasomotor reactivity was inversely associated with the deep subcortical and total periventricular white matter lesions (OR 0.5, 95% CI 0.3 to 1.1; and OR 0.7, 95% CI 0.4 to 1.1, respectively). A strong association was found between impaired Vasomotor reactivity and periventricular white matter lesions adjacent to the lateral ventricular wall (OR 0.6, 95% CI 0.4 to 1.0; p = 0.001). No association was found with periventricular white matter lesions near the frontal and occipital horns. Conclusions: Our data confirm the association between Vasomotor reactivity and white matter lesions and support the hypothesis that some white matter lesions may be associated with hemodynamic ischemic injury to the brain.
Peter J Koudstaal - One of the best experts on this subject based on the ideXlab platform.
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cerebral Vasomotor reactivity and risk of mortality the rotterdam study
Stroke, 2014Co-Authors: Marileen L P Portegies, Renee F A G De Bruijn, Albert Hofman, Peter J Koudstaal, Arfan M IkramAbstract:Background and Purpose—Accumulating vascular pathology in cerebral arteries leads to impaired cerebral Vasomotor reactivity. In turn, impaired cerebral Vasomotor reactivity is a risk factor for stroke in clinical populations. It remains unclear whether impaired cerebral Vasomotor reactivity also reflects more systemic vascular damage. We investigated whether cerebral Vasomotor reactivity is associated with the risk of mortality, focusing particularly on cardiovascular mortality independent from stroke. Methods—Between 1997 and 1999, 1695 participants from the Rotterdam Study underwent cerebral Vasomotor reactivity measurements using transcranial Doppler. Follow-up was complete until January 1, 2011. We assessed the associations between cerebral Vasomotor reactivity and mortality using Cox proportional hazards models, adjusting for age, sex, and blood pressure changes and subsequently for cardiovascular risk factors. We additionally censored for incident stroke. Results—During 17 004 person-years, 557 part...
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cerebral Vasomotor reactivity and cerebral white matter lesions in the elderly
Neurology, 1999Co-Authors: S L M Bakker, Albert Hofman, Peter J Koudstaal, F E De Leeuw, J C De Groot, Monique M B BretelerAbstract:Objective: The pathogenesis of white matter lesions is still uncertain, but an ischemic-hypoxic cause has been suggested. Cerebral Vasomotor reactivity reflects the compensatory dilatory mechanism of the intracerebral arterioles to a vasodilatory stimulus and provides a more sensitive hemodynamic index than the level of resting flow. Methods: The authors determined the association between Vasomotor reactivity and white matter lesions in 73 consecutive individuals from the Rotterdam Scan Study who also participated in the Rotterdam Study, a large population-based prospective follow-up study of individuals ≥55 years old. Vasomotor reactivity was measured by means of CO 2 -enhanced transcranial Doppler, and in all individuals axial T1*-, T2*-, and proton density (PD)-weighted MRI scans (1.5 T) were obtained. White matter lesions were scored according to location, size, and number by two independent readers. Results: Vasomotor reactivity was inversely associated with the deep subcortical and total periventricular white matter lesions (OR 0.5, 95% CI 0.3 to 1.1; and OR 0.7, 95% CI 0.4 to 1.1, respectively). A strong association was found between impaired Vasomotor reactivity and periventricular white matter lesions adjacent to the lateral ventricular wall (OR 0.6, 95% CI 0.4 to 1.0; p = 0.001). No association was found with periventricular white matter lesions near the frontal and occipital horns. Conclusions: Our data confirm the association between Vasomotor reactivity and white matter lesions and support the hypothesis that some white matter lesions may be associated with hemodynamic ischemic injury to the brain.
