A 24-year follow-up of body mass index and cerebral atrophy
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To the Editor:
We read with great interest the article by Gustafson et al.1 on the relation between body mass index (BMI) and cerebral atrophy. There is an increasing interest regarding the role of vascular risk factors in the etiology of Alzheimer disease (AD) and the observation presented by the authors will possibly add another “weighty” underlying mechanism by which vascular risk factors may ultimately lead to AD.
It is still unclear whether representing a compound score for a cardiovascular risk profile is independently related to cerebral, and especially temporal, atrophy. It is possible that the relation is confounded by vascular cerebral lesions, including cerebral white matter lesions (WML) that are established risk factors for dementia.2
WML can act as a classical confounder since their presence is related both to the determinant the authors have investigated.3 It is also related to cortical atrophy and used as an outcome measure by the authors. Their finding of a relation …
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