Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia

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

Research output: Contribution to journalArticlepeer-review


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 re-ceiving 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 older and 1.87 (95% CI, 1.79–1.95) for younger 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 older and 1.48 (95% CI, 1.32–1.66) for younger patients. The adjusted HR for id-CBI was 2.02 (95% CI, 1.70– 2.41) for older and 1.22 (95% CI, 1.15–1.30) for younger 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 oppor-tunity 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.

Original languageEnglish (US)
Article numbere027672
JournalJournal of the American Heart Association
Issue number1
StatePublished - Jan 3 2023


  • covert brain infarction
  • covert cerebrovascular disease
  • dementia
  • dementia risk
  • white matter disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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