{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T08:53:39Z","timestamp":1779353619479,"version":"3.51.4"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,1,3]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population\u2010based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Individuals aged \u226550\u2009years 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\u2010CBI) and white matter disease (id\u2010WMD) on the neuroimage report;\n              <jats:sans-serif>white matter disease<\/jats:sans-serif>\n              was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id\u2010CBI and id\u2010WMD.\n            <\/jats:p>\n            <jats:p xml:lang=\"en\">\n              Among 241\u2009050 qualified individuals,\n              <jats:sans-serif>natural language processing<\/jats:sans-serif>\n              identified 69\u2009931 (29.0%) with id\u2010WMD and 11\u2009328 (4.7%) with id\u2010CBI. Dementia incidence rates (per 1000 person\u2010years) were 23.5 (95% CI, 22.9\u201324.0) for patients with id\u2010WMD, 29.4 (95% CI, 27.9\u201331.0) with id\u2010CBI, and 6.0 (95% CI, 5.8\u20136.2) without id\u2010CCD. The association of id\u2010WMD with future dementia was stronger in younger (aged &lt;70\u2009years) versus older (aged \u226570\u2009years) patients and for CT\u2010 versus MRI\u2010discovered lesions. For patients with versus without id\u2010WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58\u20133.19) for younger and 1.87 (95% CI, 1.79\u20131.95) for older patients. For patients with versus without id\u2010WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99\u20132.62) for younger and 1.48 (95% CI, 1.32\u20131.66) for older patients. The adjusted HR for id\u2010CBI was 2.02 (95% CI, 1.70\u20132.41) for younger and 1.22 (95% CI, 1.15\u20131.30) for older patients for either modality. Dementia risk was strongly correlated with id\u2010WMD severity; adjusted HRs compared with patients who were negative for id\u2010WMD by MRI ranged from 1.41 (95% CI, 1.25\u20131.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58\u20134.72) for those with severe disease on CT.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">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\u2010WMD severity, and when id\u2010WMD is detected by CT scan rather than MRI.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.122.027672","type":"journal-article","created":{"date-parts":[[2022,12,24]],"date-time":"2022-12-24T10:34:42Z","timestamp":1671878082000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9205-5070","authenticated-orcid":false,"given":"David M.","family":"Kent","sequence":"first","affiliation":[{"name":"Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lester Y.","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Neurology Tufts Medical Center Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yichen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4660-7644","authenticated-orcid":false,"given":"Patrick H.","family":"Luetmer","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David F.","family":"Kallmes","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1113-9326","authenticated-orcid":false,"given":"Jason","family":"Nelson","sequence":"additional","affiliation":[{"name":"Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1691-5179","authenticated-orcid":false,"given":"Sunyang","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of AI and Informatics Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3963-314X","authenticated-orcid":false,"given":"Eric J.","family":"Puttock","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4194-0029","authenticated-orcid":false,"given":"Chengyi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongfang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of AI and Informatics Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wansu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30367-6"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.23.2901"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022066"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.017357"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.27.8.1274"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.284"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2012.04.006"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/WNN.0b013e31805d859e"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.484147"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000131928.47478.44"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194971"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41687-019-0112-7"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000116"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211027002"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.2196\/12109"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-021-02221-9"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.7812\/tpp\/12-031"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/s0317167100037264"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1987.00520130013009"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0895-4356(02)00452-3"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.3233\/jad-2009-1099"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2007.00822.x"},{"key":"e_1_3_1_24_2","first-page":"69","article-title":"The validity of national hospital discharge register data on dementia: a comparative analysis using clinical data from a university medical centre","volume":"73","author":"van de Vorst IE","year":"2015","unstructured":"van de Vorst IE, Vaartjes I, Sinnecker LF, Beks LJ, Bots ML, Koek HL. The validity of national hospital discharge register data on dementia: a comparative analysis using clinical data from a university medical centre. Neth J Med. 2015;73:69\u201375.","journal-title":"Neth J Med."},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.018928"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.22.3.312"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-020-0799-5"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.05.150"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2010.01.005"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00033-9"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-140666"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007142"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2018.06.3061"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70236-4"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000012602"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c3666"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.52.suppl_1.P57"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011459.pub2"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.21442"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-180017"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.011889"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0119-0"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000132193.35955.69"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.024150"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12466"},{"key":"e_1_3_1_46_2","first-page":"149","article-title":"An information extraction framework for cohort identification using electronic health records","volume":"2013","author":"Liu H","year":"2013","unstructured":"Liu H, Bielinski SJ, Sohn S, Murphy S, Wagholikar KB, Jonnalagadda SR, KE KER, Wu ST, Kullo IJ, Chute CG. An information extraction framework for cohort identification using electronic health records. AMIA Summits Transl Sci Proc. 2013;2013:149\u2013153.","journal-title":"AMIA Summits Transl Sci Proc."},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1351324904003523"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-020-1072-9"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2020.103526"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511543333"}],"updated-by":[{"DOI":"10.1161\/jaha.122.027637","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000}}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.027672","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T13:00:25Z","timestamp":1715605225000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.027672"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":49,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,3]]}},"alternative-id":["10.1161\/JAHA.122.027672"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.027672","relation":{"correction":[{"id-type":"doi","id":"10.1161\/JAHA.122.027637","asserted-by":"object"}]},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,3]]},"assertion":[{"value":"2022-07-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-12-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e027672"}}