A recent study has discovered that adults with sickle cell disease show brain characteristics that suggest an older age, which may clarify the cognitive difficulties these individuals face. Images of a healthy person’s brain (left) reveal a larger brain with greater white matter, in contrast to the brain of a sickle cell patient (right). Interestingly, healthy individuals who face economic hardship also exhibited brains that looked older than expected.
A recent study conducted by researchers at WashU Medicine has revealed that adults with sickle cell disease exhibit brain characteristics that appear older than their actual age, which may shed light on the cognitive difficulties they experience. The brain image from a healthy person (left) displays a larger brain with more white matter compared to that of a sickle cell patient (right). Additionally, healthy individuals facing economic hardship tend to have brains that look older as well.
Individuals affected by sickle cell disease—a persistent condition where abnormally shaped, sticky blood cells cluster together, hindering oxygen distribution to the body’s organs—are more susceptible to strokes and related cognitive impairments. Even without suffering a stroke, many patients find it hard to remember information, concentrate, learn new things, and solve problems, leading to difficulties in academic and professional settings.
A multidisciplinary group of researchers and physicians at Washington University School of Medicine in St. Louis has published findings that detail how sickle cell disease may influence cognitive abilities in patients without stroke history. Their study indicates that participants displayed brain features that seemed older than their chronological age. Similarly, individuals facing economic hardship, even if they do not have sickle cell disease, also showed signs of older-looking brains.
The research was published on January 17 in JAMA Network Open.
“Our research highlights the impact of chronic illness and low socioeconomic status on cognitive health,” said Andria Ford, MD, a professor of neurology and chief of the section of stroke and cerebrovascular diseases at WashU Medicine, who is the corresponding author of the study. “We discovered that these factors might influence brain development and aging, which eventually impacts cognitive functions like thinking, memory, and problem-solving abilities. Gaining insight into how sickle cell disease and economic hardship affect brain structure could lead to strategies for treatment and prevention that may help maintain cognitive capabilities.”
Over 200 young Black adults, both with and without sickle cell disease, participated in brain MRI scans and cognitive assessments in St. Louis and the surrounding areas of eastern Missouri and southwestern Illinois. The research team—including Yasheng Chen, DSc, an associate professor of neurology at WashU Medicine and the senior author of the study—utilized a brain-age prediction tool based on MRI scans from over 14,000 healthy individuals of diverse ages to estimate each participant’s brain age and compared it to their actual age.
The findings revealed that individuals with sickle cell disease had brain structures that appeared an average of 14 years older than their chronological age. Those with older-looking brains performed worse on cognitive assessments.
The study also established a connection between socioeconomic status and brain age. It was found that, on average, a seven-year disparity existed between the actual age and brain age of healthy participants experiencing poverty; the more severe the economic deprivation, the older their brains appeared.
While healthy brains typically shrink with age, premature shrinkage is a feature of neurodegenerative illnesses like Alzheimer’s disease. A smaller, older-appearing brain can also occur as a result of inhibited growth during early development. Sickle cell disease is congenital, consistently depriving the developing brain of oxygen and possibly affecting its growth from birth. Furthermore, children who endure long-term economic deprivation and poverty encounter cognitive challenges that impair their educational achievements, as explained by Ford.
As part of the same study, researchers plan to conduct further cognitive assessments and brain scans of the initial healthy and sickle cell participants three years after their first scan to determine whether the older-looking brains truly aged prematurely or if their development was merely stunted.
“A single brain scan provides a snapshot of the participants’ brain age at that moment,” noted Ford, who provides care at Barnes-Jewish Hospital. “However, conducting scans at multiple time points can help us understand whether the brain is stable, documenting differences observable since childhood, or if it is undergoing premature aging which could predict cognitive decline. Identifying individuals who are at a higher risk for future cognitive impairment through a single MRI scan could serve as a valuable tool in supporting patients with neurological issues.”
