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Camerino I, Sierpowska J, Reid A, Meyer NH, Tuladhar AM, Kessels RPC, de Leeuw FE, Piai V. White matter hyperintensities at critical crossroads for executive function and verbal abilities in small vessel disease. Hum Brain Mapp 2020; 42:993-1002. [PMID: 33231360 PMCID: PMC7856651 DOI: 10.1002/hbm.25273] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/30/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022] Open
Abstract
The presence of white matter lesions in patients with cerebral small vessel disease (SVD) is among the main causes of cognitive decline. We investigated the relation between white matter hyperintensity (WMH) locations and executive and language abilities in 442 SVD patients without dementia with varying burden of WMH. We used Stroop Word Reading, Stroop Color Naming, Stroop Color‐Word Naming, and Category Fluency as language measures with varying degrees of executive demands. The Symbol Digit Modalities Test (SDMT) was used as a control task, as it measures processing speed without requiring language use or verbal output. A voxel‐based lesion–symptom mapping (VLSM) approach was used, corrected for age, sex, education, and lesion volume. VLSM analyses revealed statistically significant clusters for tests requiring language use, but not for SDMT. Worse scores on all tests were associated with WMH in forceps minor, thalamic radiations and caudate nuclei. In conclusion, an association was found between WMH in a core frontostriatal network and executive‐verbal abilities in SVD, independent of lesion volume and processing speed. This circuitry underlying executive‐language functioning might be of potential clinical importance for elderly with SVD. More detailed language testing is required in future research to elucidate the nature of language production difficulties in SVD.
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Affiliation(s)
- Ileana Camerino
- Donders Institute for Brain, Cognition, and Behaviour, Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboud University, Nijmegen, The Netherlands
| | - Joanna Sierpowska
- Donders Institute for Brain, Cognition, and Behaviour, Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew Reid
- School of Psychology, University of Nottingham, Nottingham, UK
| | - Nathalie H Meyer
- Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Anil M Tuladhar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboud University, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition, and Behaviour, Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboud University, Nijmegen, The Netherlands
| | - Vitória Piai
- Donders Institute for Brain, Cognition, and Behaviour, Donders Centre for Cognition, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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52
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
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Moniruzzaman M, Kadota A, Segawa H, Kondo K, Torii S, Miyagawa N, Fujiyoshi A, Hisamatsu T, Watanabe Y, Shiino A, Nozaki K, Ueshima H, Miura K. Relationship Between Step Counts and Cerebral Small Vessel Disease in Japanese Men. Stroke 2020; 51:3584-3591. [PMID: 33148144 DOI: 10.1161/strokeaha.120.030141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (CSVD) is a common subclinical feature of the aging brain. Steps per day may contribute to its prevention. We herein investigated the association between step counts and CSVD in a healthy Japanese male population. METHODS We analyzed data from 680 men who were free of stroke and participated in this observational study. Seven-day step counts were assessed at baseline (2006-2008) using a pedometer. CSVD was assessed at follow-ups (2012-2015) based on deep and subcortical white matter hyperintensities (WMHs), periventricular hyperintensities, lacunar infarcts, and cerebral microbleeds on magnetic resonance imaging. Using a logistic regression analysis, we computed the adjusted odds ratios, with 95% CIs, of prevalent CSVD according to quartiles of step counts (reference: Q1). We also investigated the association between step counts and WMH volumes using a quantile regression. RESULTS Steps per day were significantly associated with lower odds ratios, with the lowest at Q3 (8175-10 614 steps/day), of higher (versus low or no burden) deep and subcortical WMHs (odds ratio, 0.52 [95% CI, 0.30-0.89]), periventricular hyperintensities (0.50 [95% CI, 0.29-0.86]), and lacunar infarcts (0.52 [95% CI, 0.30-0.91]) compared with Q1 (≤6060 steps/day) but not cerebral microbleeds. An inverse linear association was observed between step counts and WMH volumes. These associations were independent of age and smoking and drinking status and remained consistent when adjusted for vascular risk factors. CONCLUSIONS We found a J-shaped relationship between step counts and prevalent CSVD in healthy Japanese men, with the lowest risk being observed among participants with ≈8000 to 10 000 steps/day. Higher steps were also associated with lower WMH volumes.
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Affiliation(s)
- Mohammad Moniruzzaman
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Keiko Kondo
- Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Sayuki Torii
- Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Naoko Miyagawa
- International Center for Nutrition and Information, National Institute of Health and Nutrition, Shinjuku-ku, Tokyo, Japan (N.M.)
| | - Akira Fujiyoshi
- Department of Hygiene, School of Medicine, Wakayama Medical University, Japan (A.F.)
| | | | - Yoshiyuki Watanabe
- Department of Radiology (Y.W.), Shiga University of Medical Science, Otsu, Japan
| | - Akihiko Shiino
- Molecular Neuroscience Research Center (A.S.), Shiga University of Medical Science, Otsu, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery (K.N.), Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia (M.M., A.K., H.S., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan.,Department of Public Health (M.M., A.K., K.K., S.T., H.U., K.M.), Shiga University of Medical Science, Otsu, Japan
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Choi HI, Ryu CW, Kim S, Rhee HY, Jahng GH. Changes in Microvascular Morphology in Subcortical Vascular Dementia: A Study of Vessel Size Magnetic Resonance Imaging. Front Neurol 2020; 11:545450. [PMID: 33192974 PMCID: PMC7658467 DOI: 10.3389/fneur.2020.545450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Cerebral small vessel disease is the most common cause of subcortical vascular dementia (SVaD). Unfortunately, conventional imaging techniques do not always demonstrate the microvascular pathology that is associated with small vessel disease. The purpose of this study was to evaluate the changes in the microvascular structure of SVaD and to identify how the microvascular changes in vessel size, detected with imaging, affect the gray matter. Methods: Ten SVaD patients and 12 healthy controls underwent vessel size imaging with gradient-echo and spin-echo sequences before and after contrast agent injection. Four microvessel index maps, including total blood volume fraction (BVf), mean vessel density (Q), mean vessel diameter (mVD), and vessel size index (VSI) were calculated. ROI value of each microvessel parameter was compared between SVaD patients and controls. Voxel-wise comparison of microvessel parameters was also performed to assess the regional difference. The relationship between the microvessel parameters in white matter and total gray matter volume (TGV) were assessed. Results: Both mVD and VSI were significantly different between the SVaD and controls in the ROI-based comparisons (unpaired t-test, p < 0.05). mVD and VSI were significantly increased in the SVaD group at the subcortical, periventricular white matter, basal ganglia, and thalami compared with the controls (FDR corrected, p < 0.05). VSI in the white matter areas were significantly negatively correlated with TGV (r = −0.446, p < 0.05). Conclusions: The increase of mVD and VSI in SVaD patients reflects the damage of the microvessels in the white matter, and these changes may lead to the damage of the gray matter.
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Affiliation(s)
- Hyeon-Il Choi
- Department of Radiology, Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Chang-Woo Ryu
- Department of Radiology, Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.,College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Songvin Kim
- Department of Radiology, Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Hak Young Rhee
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Geon-Ho Jahng
- Department of Radiology, Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
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Low A, Ng KP, Chander RJ, Wong B, Kandiah N. Association of Asymmetrical White Matter Hyperintensities and Apolipoprotein E4 on Cognitive Impairment. J Alzheimers Dis 2020; 70:953-964. [PMID: 31306121 DOI: 10.3233/jad-190159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Asymmetrical patterns of cerebral damage have been widely observed in a range of neurodegenerative diseases, including Alzheimer's disease (AD). OBJECTIVE To elucidate the clinical associations of asymmetrical white matter hyperintensities (WMH) in mild cognitive impairment (MCI) and AD. METHODS Regional WMH asymmetry of 340 participants (90 healthy controls, 132 MCI, 118 AD) was calculated as the difference in normalized hemispheric WMH volume (WMH/ICV) adjusted for structural brain asymmetry of respective lobar regions and total WMH. WMH asymmetry was analyzed in relation to disease classification, cognition, and APOE4 status using ANCOVA and multiple regression analysis, controlling for gender, age, ethnicity, and correcting for multiple comparisons using Bonferroni correction. Moderation analysis examined interaction effects of APOE4 on associations between cognition and WMH asymmetry. RESULTS Greater left-dominant occipital WMH asymmetry was observed in AD, compared to healthy controls and MCI, and was associated with poorer global cognition, memory, language, and executive functions among cognitively impaired participants (MCI and AD). Cognitively impaired APOE4 carriers displayed greater left-dominant WMH asymmetry in the whole brain and frontal lobe, compared to non-carriers. Importantly, effects were independent of structural brain asymmetry, global cerebral atrophy, and overall WMH burden. Moderation analysis demonstrated associations between left-dominant WMH asymmetry and cognition in cognitively impaired APOE4 non-carriers, but not APOE4 carriers. CONCLUSION Leftward asymmetry of WMH may be more pathological in nature, compared to symmetrical WMH. Furthermore, the detrimental effects of WMH asymmetry was more relevant in APOE4-negative cognitive impairment, compared to APOE4-positive which may be driven primarily by AD pathology.
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Affiliation(s)
- Audrey Low
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Benjamin Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS, Singapore, Singapore
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Fasano A, Formichi P, Taglia I, Bianchi S, Di Donato I, Battisti C, Federico A, Dotti MT. HTRA1 expression profile and activity on TGF-β signaling in HTRA1 mutation carriers. J Cell Physiol 2020; 235:7120-7127. [PMID: 32017060 DOI: 10.1002/jcp.29609] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/13/2020] [Indexed: 11/06/2022]
Abstract
High temperature requirement A1 (HTRA1) is a serine protease playing a modulatory role in various cell processes, particularly in the regulation of transforming growth factor-β (TGF-β) signaling. A deleterious role in late-onset cerebral small vessel diseases (CSVDs) of heterozygous HTRA1 mutations, otherwise causative in homozygosity of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy, was recently suggested. However, the pathomechanism of these heterozygous mutations is still undefined. Our aim is to evaluate the expression profile and activity of HTRA1 on TGF-β signaling in fibroblasts from four subjects carrying the HTRA1 heterozygous mutations-p.E42Dfs*173, p.A321T, p.G295R, and p.Q151K. We found a 50% reduction of HTRA1 expression in HTRA1 mutation carriers compared to the control. Moreover, we showed no changes in TGF-β signaling pathway downstream intermediate, Phospho Smad2/3. However, we found overexpression of genes involved in the extracellular matrix formation in two heterozygous HTRA1 carriers. Our results suggest that each heterozygous HTRA1 missense mutation displays a different and peculiar HTRA1 expression pattern and that CSVD phenotype may also result from 50% of HTRA1 expression.
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Affiliation(s)
- Alessandro Fasano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Patrizia Formichi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Ilaria Taglia
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Silvia Bianchi
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Ilaria Di Donato
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Carla Battisti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Zheng K, Qian Y, Lin T, Han F, You H, Tao X, Hou B, Yuan J, Wang H, Zhang D, Lv K, Feng F, Zhu Y, Li X. Carotid intima-media thickness relative to cognitive impairment in dialysis patients, and their relationship with brain volume and cerebral small vessel disease. Ther Adv Chronic Dis 2020; 11:2040622320953352. [PMID: 32944208 PMCID: PMC7466901 DOI: 10.1177/2040622320953352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/06/2020] [Indexed: 01/27/2023] Open
Abstract
Background: Carotid intima–media thickness (cIMT) is considered a risk factor for and predictor of cerebrovascular disease. In this study, we explored the contribution of cIMT to cognitive impairment (CI) in dialysis patients and the role of cerebral small vascular disease (CSVD) and brain atrophy in this process. Methods: Cognitive function was assessed using a comprehensive cognitive test battery. CSVD and brain volume were assessed by magnetic resonance imaging, and cIMT was measured by ultrasonography. Multivariable analysis and mediation were used to explore the relevant relationships among cIMT, CI, CSVD and brain volume. Results: Seventy-three dialysis patients were enrolled. Approximately 54.8% were diagnosed with increased cIMT. The increased cIMT group was older and had lower serum albumin and creatinine levels than the normal cIMT group. There was no difference in the CSVD prevalence between the different cIMT groups. Patients in the normal, unilaterally and bilaterally increased cIMT subgroups demonstrated a gradual decrease in brain-matter volume and degenerate cognitive function. cIMT was related to cognitive function and gray-/white-matter volume. Increased cIMT was associated with a significantly increased risk of a reduced Mini Mental State Examination/Montreal Cognitive Assessment score and Trail A/B time delay. Mediation analysis showed that CI was mediated by brain-matter volume but not by CSVD. Conclusion: Increased cIMT was an independent risk factor for impairment of global cognitive function, memory, and executive function. The impact of cIMT on cognition was not induced by CSVD but by brain atrophy. cIMT may be a useful tool for screening patients at high risk of CI in the dialysis population.
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Affiliation(s)
- Ke Zheng
- Department of Nephrology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujun Qian
- Department of Nephrology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tiaye Lin
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Han
- Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xixi Tao
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Yuan
- Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyun Wang
- Department of Nephrology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Central Research Laboratory, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Lv
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Dongcheng-qu, Beijing 100730, China
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Petrea RE, O'Donnell A, Beiser AS, Habes M, Aparicio H, DeCarli C, Seshadri S, Romero JR. Mid to Late Life Hypertension Trends and Cerebral Small Vessel Disease in the Framingham Heart Study. Hypertension 2020; 76:707-714. [PMID: 32755403 DOI: 10.1161/hypertensionaha.120.15073] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The duration and lifetime pattern of hypertension is related to risk of stroke and dementia. In turn, cerebral small vessel disease (CSVD) is the most frequent form of cerebrovascular disease underlying dementia and stroke. Thus, study of the relation of mid to late life hypertension trends with CSVD late in life will help understand hypertension's role and inform preventive efforts of CSVD consequences. We studied 1686 Framingham Heart Study Offspring cohort participants free of stroke and dementia, who were examined in mid and late life, and had available brain magnetic resonance imaging during late life. We related hypertension trends between mid and late life (normotension-normotension N-N, normotension-hypertension N-H, hypertension-hypertension H-H) to cerebral microbleeds and covert brain infarcts (CBI), overall and stratified by brain topography. We used multivariable logistic regression analyses to calculate odds ratio and 95% CIs for CSVD measures. The prevalence of CSVD in late life was 8% for cerebral microbleeds and 13% for covert brain infarcts and increased with longer hypertension exposure across all brain regions. Compared with the trend pattern of N-N, both N-H and H-H trends had higher odds of mixed cerebral microbleeds (2.71 [1.08-6.80], and 3.44 [1.39-8.60], respectively); H-H also had higher odds of any cerebral microbleeds or covert brain infarcts (1.54 [1.12-2.20]), and any covert brain infarcts (1.55 [1.08-2.20]). The burden of CSVD also increased with longer hypertension exposure. Our results highlight hypertension having a major role in subclinical CSVD, across subtypes and brain regions, and call attention to improve recognition and treatment of hypertension early in life.
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Affiliation(s)
- Rodica Elena Petrea
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
| | - Adrienne O'Donnell
- NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Department of Biostatistics, Boston University School of Public Health, MA (A.O., A.S.B.)
| | - Alexa S Beiser
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Department of Biostatistics, Boston University School of Public Health, MA (A.O., A.S.B.)
| | - Mohammad Habes
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX (M.H., S.S.)
| | - Hugo Aparicio
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
| | - Charles DeCarli
- Department of Neurology, University of California-Davis (C.D.)
| | - Sudha Seshadri
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.).,Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX (M.H., S.S.)
| | - Jose Rafael Romero
- From the Department of Neurology, Boston University School of Medicine, MA (R.E.P., A.S.B., H.A., S.S., J.R.R.).,NHLBI's Framingham Heart Study, MA (R.E.P., A.O., A.S.B., H.A., S.S., J.R.R.)
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Abstract
Background and Purpose- Cerebral small vessel disease (SVD) is associated with increased stroke risk and poor stroke outcomes. We aimed to evaluate whether chronic SVD burden is associated with poor recruitment of collaterals in large-vessel occlusive stroke. Methods- Consecutive patients with middle cerebral artery or internal carotid artery occlusion presenting within 6 hours after stroke symptom onset who underwent thrombectomy from 2012 to 2017 were included. The prespecified primary outcome was poor collateral flow, which was assessed on baseline computed tomographic angiography (poor, ≤50% filling; good, >50% filling). Markers of chronic SVD on brain magnetic resonance imaging were rated for the extent of white matter hyperintensities, enlarged perivascular spaces, chronic lacunar infarctions and cerebral microbleeds using the Standards for Reporting Vascular Changes on Neuroimaging criteria. Severity of SVD was quantified by adding the presence of each SVD feature, with a total possible score of 0 to 4; each SVD type was also evaluated separately. Multivariable logistic regression analyses were performed to evaluate the relationships between SVD and poor collaterals, with adjustment for potential confounders. Results- Of the 100 eligible patients, the mean age was 65±16 years, median National Institutes of Health Stroke Scale score was 15, and 68% had any SVD. Poor collaterals were observed in 46%, and those with SVD were more likely to have poor collaterals than patients without SVD (aOR, 1.9 [95% CI, 1.1-3.2]). Of the SVD types, poor collaterals were significantly associated with white matter hyperintensities (aOR, 2.9 per Fazekas increment [95% CI, 1.6-5.3]) but not with enlarged perivascular spaces (adjusted odds ratio [aOR], 1.3 [95% CI, 0.4-4.0]), lacunae (aOR, 2.1 [95% CI, 0.6-7.1]), or cerebral microbleeds (aOR, 2.1 [95% CI, 0.6-7.8]). Having a greater number of different SVD markers was associated with a higher odds of poor collaterals (crude trend P<0.001; adjusted P=0.056). There was a dose-dependent relationship between white matter hyperintensity burden and poor collaterals: adjusted odds of poor collaterals were 1.5, 3.0, and 9.7 across Fazekas scores of 1 to 3 (Ptrend=0.015). No patient with an SVD score of 4 had good collaterals. Conclusions- Chronic cerebral SVD is associated with poor recruitment of collaterals in large vessel occlusive stroke. A prospective study to elucidate the potential mechanism of how SVD may impair the recruitment of collaterals is ongoing.
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Affiliation(s)
- Michelle P Lin
- From the Department of Neurology, Mayo Clinic, Jacksonville, FL (M.P.L., T.G.B., J.F.M.)
| | - Thomas G Brott
- From the Department of Neurology, Mayo Clinic, Jacksonville, FL (M.P.L., T.G.B., J.F.M.)
| | - David S Liebeskind
- Department of Neurology, University of California in Los Angeles (D.S.L.)
| | - James F Meschia
- From the Department of Neurology, Mayo Clinic, Jacksonville, FL (M.P.L., T.G.B., J.F.M.)
| | - Kevin Sam
- Department of Radiology (K.S.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
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60
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Affiliation(s)
- M. Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Ii Y, Ishikawa H, Matsuyama H, Shindo A, Matsuura K, Yoshimaru K, Satoh M, Taniguchi A, Matsuda K, Umino M, Maeda M, Tomimoto H. Hypertensive Arteriopathy and Cerebral Amyloid Angiopathy in Patients with Cognitive Decline and Mixed Cerebral Microbleeds. J Alzheimers Dis 2020; 78:1765-1774. [PMID: 33185609 PMCID: PMC11062589 DOI: 10.3233/jad-200992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA) may contribute to the development of mixed cerebral microbleeds (CMBs). Recently, the total small vessel disease (SVD) scores for HA and CAA were proposed, which are determined by a combination of MRI markers to reflect overall severity of these microangiopathies. OBJECTIVE We investigated whether or not total HA-SVD and CAA-SVD scores could be used to predict overlap of HA and CAA in patients with mixed CMBs. METHODS Fifty-three subjects with mixed CMBs were retrospectively analyzed. MRI markers (CMBs, lacunes, perivascular space, white matter hyperintensity [WMH] and cortical superficial siderosis [cSS]) were assessed. The HA-SVD score and CAA-SVD score were obtained for each subject. Anterior or posterior WMH was also assessed using the age-related white matter changes scale. RESULTS The two scores were positively correlated (ρ= 0.449, p < 0.001). The prevalence of lobar dominant CMB distribution (p < 0.001) and lacunes in the centrum semiovale (p < 0.001) and the severity of WMH in the parieto-occipital lobes (p = 0.004) were significantly higher in the high CAA-SVD score group. cSS was found in four patients with high CAA-SVD score who showed lobar-dominant CMB distribution and severe posterior WMH. CONCLUSION Mixed CMBs are mainly due to HA. Assessing both two scores may predict the overlap of HA and CAA in individuals with mixed CMBs. Patients with a high CAA-SVD score may have some degree of advanced CAA, especially when lobar predominant CMBs, severe posterior WMH, lobar lacunes, or cSS are observed.
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Affiliation(s)
- Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kimiko Yoshimaru
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Maki Umino
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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62
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Affiliation(s)
- Sandro Marini
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher D. Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
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63
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Tully PJ, Alpérovitch A, Soumaré A, Mazoyer B, Debette S, Tzourio C. Association Between Cerebral Small Vessel Disease With Antidepressant Use and Depression: 3C Dijon Magnetic Resonance Imaging Study. Stroke 2019; 51:402-408. [PMID: 31826735 DOI: 10.1161/strokeaha.119.026712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Evidence links antidepressant use with cerebral small vessel disease; however, it remains unclear whether people with depression face comparable risk. This study aims to determine the association between antidepressant drug use and depression with markers of cerebral small vessel disease. Methods- One thousand nine hundred five participants (mean age, 72.5 years; 60% women) without stroke or dementia history underwent brain magnetic resonance imaging at baseline, and 1402 individuals underwent a second magnetic resonance imaging at 4 years. Outcomes were lacunes 3 to 15 mm and white matter hyperintensity volume (cm3) at baseline and follow-up. Exposure to antidepressants was grouped as (1) selective serotonin reuptake inhibitors (n=68), (2) tricyclics (n=40), (3) atypicals (n=24), (4) depressed nonusers (n=303), and (5) nondepressed/nonuser group (reference group, n=1470). Statistical analyses adjusted for propensity scores due to the nonrandomized exposure to antidepressant drugs. Results- There was an association between use of atypical antidepressants with lacunes at baseline (adjusted rate ratio, 2.59 [95% CI, 1.14-5.88]; P=0.023) and follow-up (adjusted rate ratio, 3.05 [95% CI, 1.25-7.43]; P=0.014). Lacunes at baseline were also associated with depressed nonusers (adjusted rate ratio, 1.53 [95% CI, 1.06-2.21]; P=0.023). Selective serotonin reuptake inhibitor users and depressed nonusers displayed higher total, periventricular, and deep white matter hyperintensity volumes at baseline. Selective serotonin reuptake inhibitor users had higher deep white matter hyperintensity volumes at follow-up. Conclusions- Users of atypical antidepressants, selective serotonin reuptake inhibitors, and depressed people without any antidepressant exposure all displayed markers of cerebral small vessel disease higher than the nondepressed/nonuser group. The findings suggest that cerebral small vessel disease is associated with depression and exposure to antidepressants.
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Affiliation(s)
- Phillip J Tully
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
- Discipline of Medicine, School of Medicine, The University of Adelaide, Australia (P.J.T.)
| | - Annick Alpérovitch
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
| | - Aicha Soumaré
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293 (B.M.), University of Bordeaux, France
- Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, UMR5293, Bordeaux, France (B.M.)
- Commissariat à l'Énergie atomique et aux énergies alternatives, Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293, Bordeaux, France (B.M.)
| | - Stephanie Debette
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
- Department of Neurology, Bordeaux University Hospital, France (S.D.)
- Department of Neurology, Framingham Heart Study, Boston University School of Medicine, MA (S.D.)
| | - Christophe Tzourio
- From the Inserm, Bordeaux Population Health Research Center, UMR 1219 (P.J.T., A.A., A.S., S.D., C.T.), University of Bordeaux, France
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64
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Ma Y, Song A, Viswanathan A, Blacker D, Vernooij MW, Hofman A, Papatheodorou S. Blood Pressure Variability and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis of Population-Based Cohorts. Stroke 2019; 51:82-89. [PMID: 31771460 DOI: 10.1161/strokeaha.119.026739] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background and Purpose- Blood pressure (BP) variability may increase the risk of stroke and dementia. It remains inconclusive whether BP variability is associated with cerebral small vessel disease, a common and potentially devastating subclinical disease that contributes significantly to both stroke and dementia. Methods- A systematic review and meta-analysis of prospective cohort studies that examined the association between BP variability and the presence or progression of established markers of cerebral small vessel disease, including white matter hyperintensities, lacunes, and microbleeds on magnetic resonance imaging. We searched MEDLINE, EMBASE, and Web of Science. Ten studies met the criteria for qualitative synthesis and 7 could be included in the meta-analysis. Data were synthetized using random-effect models. Results- These studies included a total of 2796 individuals aged 74 (mean) ±4 (SD) years, with a median follow-up of 4.0 years. A one SD increase in systolic BP variability was associated with increased odds of the presence or progression of white matter hyperintensities (odds ratio, 1.26 [95% CI, 1.06-1.50]). The association of systolic BP variability with the presence of lacunes (odds ratio, 0.93 [95% CI, 0.74-1.16]) and the presence of microbleeds (odds ratio, 1.13 [95% CI, 0.89-1.44]) were not statistically significant. Conclusions- A larger BP variability may be associated with a higher risk of having a higher burden of white matter hyperintensities. Targeting large BP variability has the potential to prevent cerebral small vessel disease and thereby reducing the risk of stroke and dementia. The potential issue of reverse causation and the heterogeneity in the assessment of cerebral small vessel disease markers should be better addressed in future studies.
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Affiliation(s)
- Yuan Ma
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., D.B., A.H., S.P.)
| | - Alex Song
- Department of Biology, Brown University, Providence, RI (A.S.)
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (A.V.)
| | - Deborah Blacker
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., D.B., A.H., S.P.).,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (D.B.)
| | - Meike W Vernooij
- Department of Epidemiology (M.W.V., A.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (M.W.V.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., D.B., A.H., S.P.).,Department of Epidemiology (M.W.V., A.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stefania Papatheodorou
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (Y.M., D.B., A.H., S.P.)
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65
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Affiliation(s)
- M Edip Gurol
- From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Geert J Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands (G.J.B.)
| | - Jonathan R Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown (J.R.P.).,Department of Radiology, Harvard Medical School, Boston, MA (J.R.P.).,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA (J.P.R.)
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66
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Affiliation(s)
- Eric E Smith
- From the Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.)
| | - Hugh S Markus
- Department of Clinical Neurosciences, Cambridge University, United Kingdom (H.S.M.)
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67
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Nam KW, Kwon HM, Jeong HY, Park JH, Kwon H, Jeong SM. Cerebral Small Vessel Disease and Stage 1 Hypertension Defined by the 2017 American College of Cardiology/American Heart Association Guidelines. Hypertension 2019; 73:1210-1216. [PMID: 31067203 DOI: 10.1161/hypertensionaha.119.12830] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although the American College of Cardiology/American Heart Association guidelines have introduced a novel definition of hypertension in their 2017 hypertension guidelines, the influence of novel stage 1 hypertension on cerebrovascular diseases remains unclear. In this study, we evaluated the relationship between stage 1 hypertension, as defined by the 2017 American College of Cardiology/American Heart Association guidelines and cerebral small vessel disease in a healthy population. We assessed consecutive health checkup participants without the use of antihypertensive medication between 2006 and 2013. White matter hyperintensity volumes were rated using semiautomated quantitative methods. The presence of lacunes, cerebral microbleeds, and enlarged perivascular spaces was also measured as cerebral small vessel disease lesions. We classified the blood pressure of all participants according to the 2017 American College of Cardiology/American Heart Association guidelines. A total of 2460 participants were evaluated. In adjusted linear and logistic regression analyses, stage 1 hypertension was independently associated with white matter hyperintensity volume (β=0.158; 95% CI, 0.046-0.269; P=0.006), presence of lacune (adjusted odds ratio, 1.66; 95% CI, 1.00-2.73; P=0.048), and deep cerebral microbleeds (adjusted odds ratio, 2.50, 95% CI, 1.08-5.79; P=0.033). Stage 2 hypertension showed higher coefficients or adjusted odds ratio values and lower P values in all analyses of white matter hyperintensity volumes, lacunes, and deep cerebral microbleeds, indicating dose-response effects across blood pressure categories. Stage 1 hypertension according to the 2017 American College of Cardiology/American Heart Association guidelines is associated with cerebral small vessel disease lesions, especially in white matter hyperintensity lesions, lacunes, and deep cerebral microbleeds.
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Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Korea (H.-M.K.)
| | - Han-Yeong Jeong
- From the Department of Neurology (K.-W.N., H.-Y.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Jin-Ho Park
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Hyuktae Kwon
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
| | - Su-Min Jeong
- Department of Family Medicine (J.-H.P., H.K., S.-M.J.), Seoul National University College of Medicine, Seoul National University Hospital, Korea
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68
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Jokinen H, Koikkalainen J, Laakso HM, Melkas S, Nieminen T, Brander A, Korvenoja A, Rueckert D, Barkhof F, Scheltens P, Schmidt R, Fazekas F, Madureira S, Verdelho A, Wallin A, Wahlund LO, Waldemar G, Chabriat H, Hennerici M, O'Brien J, Inzitari D, Lötjönen J, Pantoni L, Erkinjuntti T. Global Burden of Small Vessel Disease-Related Brain Changes on MRI Predicts Cognitive and Functional Decline. Stroke 2019; 51:170-178. [PMID: 31699021 PMCID: PMC6924941 DOI: 10.1161/strokeaha.119.026170] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. Cerebral small vessel disease is characterized by a wide range of focal and global brain changes. We used a magnetic resonance imaging segmentation tool to quantify multiple types of small vessel disease–related brain changes and examined their individual and combined predictive value on cognitive and functional abilities.
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Affiliation(s)
- Hanna Jokinen
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Juha Koikkalainen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Faculty of Health Sciences, University of Eastern Finland (J.K.)
| | - Hanna M Laakso
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Susanna Melkas
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
| | | | - Antti Brander
- Department of Radiology, Medical Imaging Center, Tampere University Hospital, Finland (A.B.)
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital (A.K.), Finland
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, United Kingdom (D.R.)
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine (F.B.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.)
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology (P.S.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, University College London, United Kingdom (F.B.)
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Sofia Madureira
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Ana Verdelho
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Anders Wallin
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section for Psychiatry and Neurochemistry, University of Gothenburg, Sweden (A.W.)
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Sweden (L.-O.W.)
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark (G.W.)
| | - Hugues Chabriat
- Department of Neurology, Hopital Lariboisiere, APHP and INSERM U1161-University Denis Diderot (DHU NeuroVasc), France (H.C.)
| | | | - John O'Brien
- Department of Psychiatry, University of Cambridge, United Kingdom (J.O.)
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council (D.I.).,Department NEUROFARBA, University of Florence, Italy (D.I.)
| | - Jyrki Lötjönen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Finland (J.L.)
| | - Leonardo Pantoni
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P.)
| | - Timo Erkinjuntti
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
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69
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Liang Y, Chen YK, Liu YL, Mok VCT, Ungvari GS, Chu WCW, Seo SW, Tang WK. Cerebral Small Vessel Disease Burden Is Associated With Accelerated Poststroke Cognitive Decline: A 1-Year Follow-Up Study. J Geriatr Psychiatry Neurol 2019; 32:336-343. [PMID: 31480986 DOI: 10.1177/0891988719862630] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study investigated the association between small vessel disease (SVD) burden, a combination of multiple SVD markers and cognitive dysfunction after stroke. METHODS The study sample comprised 451 patients with first-ever acute ischemic stroke. Cognitive functions were assessed with the Mini-Mental State Examination (MMSE) at 3, 9, and 15 months after the index stroke. Cognitive impairment was defined as an MMSE score of ≤26. A total SVD score, indicating SVD burden, was constructed by summing the scores of the 4 SVD markers (white matter hyperintensities [WMHs], lacunes, cerebral microbleeds, and perivascular spaces) ascertained by magnetic resonance imaging (range: 0-4). The association between SVD burden and cognitive dysfunction was assessed with linear mixed models or generalized estimating equation models, as appropriate. RESULTS The majority of patients had mild-to-moderate stroke and at least one identifiable SVD marker. Cognitive impairment was found in about one-third of patients. After adjusting for confounding factors, the SVD burden was associated with MMSE scores (β = -0.37, P = .003) and cognitive impairment (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.02-1.42). SVD burden was specifically associated with the performance of MMSE subscores including orientation to place and time, calculation, and word recall. Of the SVD markers, WMHs was the most robust predictor of decrease in MMSE scores (β = -0.25, P = .01) and cognitive impairment (OR = 1.14, 95% CI = 1.01-1.29). CONCLUSION Cerebral SVD burden is associated with decreased MMSE scores, suggesting cognitive dysfunction during the first year after mild-to-moderate acute ischemic stroke.
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Affiliation(s)
- Yan Liang
- 1 Department of Neurology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China.,2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yang-Kun Chen
- 3 Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Yong-Lin Liu
- 3 Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Vincent C T Mok
- 4 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Gabor S Ungvari
- 5 University of Notre Dame Australia/Graylands Hospital, Perth, Australia
| | - Winnie C W Chu
- 6 Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Sang Won Seo
- 7 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Wai-Kwong Tang
- 2 Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, SAR, China
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70
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Oudeman EA, Greving JP, Van den Berg-Vos RM, Biessels GJ, Bron EE, van Oostenbrugge R, de Bresser J, Kappelle LJ. Nonfocal Transient Neurological Attacks Are Associated With Cerebral Small Vessel Disease. Stroke 2019; 50:3540-3544. [PMID: 31637974 DOI: 10.1161/strokeaha.119.025328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Nonfocal transient neurological attacks (TNAs), such as unsteadiness, bilateral weakness, or confusion, are associated with an increased risk of stroke and dementia. Cerebral ischemia plays a role in their pathogenesis, but the precise mechanisms are unknown. We hypothesized that cerebral small vessel disease is involved in the pathogenesis of TNAs and assessed the relation between TNAs and manifestations of cerebral small vessel disease on magnetic resonance imaging. Methods- We included participants from the HBC (Heart-Brain Connection) study. In this study, hemodynamic and cardiovascular contributions to cognitive impairment have been studied in patients with heart failure, carotid artery occlusion, or possible vascular cognitive impairment, as well as in a reference group. We excluded participants with a history of stroke or transient ischemic attacks. The occurrence of the following 8 TNAs was assessed with a standardized interview: unconsciousness, confusion, amnesia, unsteadiness, bilateral leg weakness, blurred vision, nonrotatory dizziness, and paresthesias. The occurrence of TNAs was related to the presence of lacunes or white matter hyperintensities (Fazekas score, ≥2; early confluent or confluent lesions) in logistic regression analysis, adjusted for age, sex, and hypertension. Results- Of 304 participants (60% men; mean age, 67±9 years), 63 participants (21%) experienced ≥1 TNAs. Lacunes and early confluent or confluent white matter hyperintensities were more common in participants with TNAs than in participants without TNAs (35% versus 20%; adjusted odds ratio, 2.32 [95% CI, 1.22-4.40] and 48% versus 27%; adjusted odds ratio, 2.65 [95% CI, 1.44-4.90], respectively). Conclusions- In our study, TNAs are associated with the presence of lacunes and early confluent or confluent white matter hyperintensities of presumed vascular origin, which indicates that cerebral small vessel disease might play a role in the pathogenesis of TNAs.
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Affiliation(s)
- Eline A Oudeman
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (E.A.O., G.J.B., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands.,Department of Neurology, OLVG West, Amsterdam, the Netherlands (E.A.O., R.M.V.d.B.-V.)
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Geert Jan Biessels
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (E.A.O., G.J.B., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Esther E Bron
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine (E.E.B.), Erasmus MC, the Netherlands
| | | | - Jeroen de Bresser
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (R.v.O.)
| | - L Jaap Kappelle
- From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (E.A.O., G.J.B., L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
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71
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Noz MP, Ter Telgte A, Wiegertjes K, Joosten LAB, Netea MG, de Leeuw FE, Riksen NP. Trained Immunity Characteristics Are Associated With Progressive Cerebral Small Vessel Disease. Stroke 2019; 49:2910-2917. [PMID: 30571420 DOI: 10.1161/strokeaha.118.023192] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose- Cerebral small vessel disease (cSVD) is the major vascular cause of cognitive decline and dementia. The pathogenesis of cSVD remains largely unknown, although several studies suggest a role for systemic inflammation. In certain pathophysiological situations, monocytes can reprogram toward a long-term proinflammatory phenotype, which has been termed trained immunity. We hypothesize that trained immunity contributes to the progression of cSVD. Methods- Individuals with mild-to-severe cSVD participated in the study. Severity of cSVD was determined by the white matter hyperintensities (WMH) volume (mL) on magnetic resonance imaging in 2006, 2015, and the progression between 2006 and 2015 (ΔWMH). Cytokine production was assessed after ex vivo stimulation of peripheral blood mononuclear cells and monocytes. Additionally, monocyte subsets were identified by flow cytometry. Results- Fifty-one subjects (70±6 years, 60% men, 5.1±6.4 mL ΔWMH) were included. Circulating hsIL (high-sensitivity interleukin)-6 correlated with cSVD ( P=0.005, rs=0.40). Cytokine production capacity by monocytes was associated with cSVD progression. Basal IL-8 and IL-17 production ( P=0.08, rs=0.25; P=0.03, rs=0.30) and IL-6 production after Pam3Cys stimulation in monocytes was associated with cSVD (n=35: P=0.008, rs=0.44). Conversely, interferon (IFN)-γ production in Candida albicans stimulated peripheral blood mononuclear cells was negatively correlated with cSVD ( P=0.009, rs=-0.36). Flow cytometry revealed a correlation of the intermediate monocyte subset with cSVD ( P=0.01, rs=0.36). Conclusions- Severity and progression of cSVD are not only correlated with systemic inflammation (hsIL-6) but also with trained immunity characteristics of circulating monocytes, in terms of an altered cytokine production capacity and a shift toward the proinflammatory intermediate monocyte subset.
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Affiliation(s)
- Marlies P Noz
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
| | - Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Leo A B Joosten
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
| | - Mihai G Netea
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands.,Department for Genomics and Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Germany (M.G.N.)
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Niels P Riksen
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
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Bergkamp MI, Wissink JGJ, van Leijsen EMC, Ghafoorian M, Norris DG, van Dijk EJ, Platel B, Tuladhar AM, de Leeuw FE. Risk of Nursing Home Admission in Cerebral Small Vessel Disease. Stroke 2019; 49:2659-2665. [PMID: 30355195 DOI: 10.1161/strokeaha.118.021993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Since cerebral small vessel disease (SVD) is associated with cognitive and motor impairment and both might ultimately lead to nursing home admission, our objective was to investigate the association of SVD markers with nursing home admission. Methods- The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort of 503 independent living individuals with SVD. Date of nursing home admission was retrieved from the Dutch municipal personal records database. Risk of nursing home admission was calculated using a competing risk analysis, with mortality as a competing risk. Results- During follow-up (median 8.7 years, interquartile range 8.5-8.9), 31 participants moved to a nursing home. Before nursing home admission, 19 participants were diagnosed with dementia, 6 with parkinsonism, and 10 with stroke. Participants with the lowest white matter volume had an 8-year risk of nursing home admission of 13.3% (95% CI, 8.6-18.9), which was significantly different from participants with middle or highest white matter volume (respectively, 4.8% [95% CI, 2.3-8.8] and 0%; P<0.001). After adjusting for baseline age and living condition, the association of white matter volume and total brain volume with nursing home admission was significant, with, respectively, hazard ratios of 0.88 [95% CI, 0.84-0.95] ( P value 0.025) and 0.92 [95% CI, 0.85-0.98] ( P<0.001) per 10 mL. The association of white matter hyperintensities and lacunes with nursing home admission was not significant. Conclusions- This study demonstrates that in SVD patients, independent from age and living condition, a lower white matter volume and a lower total brain volume is associated with an increased risk of nursing home admission. Nursing home admission is a relevant outcome in SVD research since it might be able to combine both cognitive and functional consequences of SVD in 1 outcome.
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Affiliation(s)
- Mayra I Bergkamp
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost G J Wissink
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Esther M C van Leijsen
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences, (M.G.), Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Ewoud J van Dijk
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
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Schreiber S, Wilisch-Neumann A, Schreiber F, Assmann A, Scheumann V, Perosa V, Jandke S, Mawrin C, Carare RO, Werring DJ. Invited Review: The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and nonamyloid vasculopathies. Neuropathol Appl Neurobiol 2019; 46:219-239. [PMID: 31386773 DOI: 10.1111/nan.12576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that 'pure' DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. We also suggest a need for new biomarkers (e.g. high-resolution imaging) to deepen understanding of the complex relationships between DPA and CAA.
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Affiliation(s)
- S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.,Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - A Wilisch-Neumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - F Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - A Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - V Scheumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - V Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - S Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - C Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - R O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Uniken Venema SM, Marini S, Lena UK, Morotti A, Jessel M, Moomaw CJ, Kourkoulis C, Testai FD, Kittner SJ, Brouwers HB, James ML, Woo D, Anderson CD, Rosand J. Impact of Cerebral Small Vessel Disease on Functional Recovery After Intracerebral Hemorrhage. Stroke 2019; 50:2722-2728. [PMID: 31446887 DOI: 10.1161/strokeaha.119.025061] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- In this study, we aim to investigate the association of computed tomography-based markers of cerebral small vessel disease with functional outcome and recovery after intracerebral hemorrhage. Methods- Computed tomographic scans of patients in the ERICH study (Ethnic and Racial Variations of Intracerebral Hemorrhage) were evaluated for the extent of leukoaraiosis and cerebral atrophy using visual rating scales. Poor functional outcome was defined as a modified Rankin Scale (mRS) of ≥3. Multivariable logistic and linear regression models were used to explore the associations of cerebral small vessel disease imaging markers with poor functional outcome at discharge and, as a measure of recovery, change in mRS from discharge to 90 days poststroke. Results- After excluding in-hospital deaths, data from 2344 patients, 583 (24.9%) with good functional outcome (mRS of 0-2) at discharge and 1761 (75.1%) with poor functional outcome (mRS of 3-5) at discharge, were included. Increasing extent of leukoaraiosis (P for trend, 0.01) and only severe (grade 4) global atrophy (odds ratio, 2.02; 95% CI, 1.22-3.39, P=0.007) were independently associated with poor functional outcome at discharge. Mean (SD) mRS change from discharge to 90-day follow-up was 0.57 (1.18). Increasing extent of leukoaraiosis (P for trend, 0.002) and severe global atrophy (β [SE], -0.23 [0.115]; P=0.045) were independently associated with less improvement in mRS from discharge to 90 days poststroke. Conclusions- In intracerebral hemorrhage survivors, the extent of cerebral small vessel disease at the time of intracerebral hemorrhage is associated with poor functional outcome at hospital discharge and impaired functional recovery from discharge to 90 days poststroke.
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Affiliation(s)
- Simone M Uniken Venema
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Sandro Marini
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Umme K Lena
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Andrea Morotti
- Stroke Unit, Instituto Neurologico Nazionale a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, Italy (A.M.)
| | - Michael Jessel
- J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Charles J Moomaw
- Department Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (C.J.M., D.W.)
| | - Christina Kourkoulis
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago (F.D.T.)
| | - Steven J Kittner
- Department of Neurology, Baltimore Veterans Administration Medical Center, University of Maryland School of Medicine (S.J.K.)
| | - H Bart Brouwers
- Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (H.B.B.)
| | - Michael L James
- Departments of Anesthesiology (M.L.J.), Brain Injury Translational Research Center, Duke University, Durham, NC.,Neurology (M.L.J.), Brain Injury Translational Research Center, Duke University, Durham, NC
| | - Daniel Woo
- Department Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (C.J.M., D.W.)
| | - Christopher D Anderson
- Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Center for Genomic Medicine (S.M.U.V., S.M., U.K.L., C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Henry and Allison McCance Center for Brain Health (C.K., C.D.A., J.R.), Massachusetts General Hospital, Boston.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology (S.M., C.D.A., J.R.).,J.P. Kistler Stroke Research Center (S.M., M.J., C.D.A., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston
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Liu H, Liu J, Liu H, Peng L, Feng Z, Rong P, Shen H, Hu D, Zeng LL, Wang W. Pathological Between-Network Positive Connectivity in Early Type 2 Diabetes Patients Without Cerebral Small Vessel Diseases. Front Neurosci 2019; 13:731. [PMID: 31379485 PMCID: PMC6646694 DOI: 10.3389/fnins.2019.00731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/01/2019] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose Previous neuroimaging studies have demonstrated type 2 diabetes (T2D)-related brain structural and functional changes are partly associated with cognitive decline. However, less is known about the underlying mechanisms. Chronic hyperglycemia and microvascular complications are the two of most important risk factors related to cognitive decline in diabetes. Cerebral small vessel diseases (CSVDs), such as those defined by lacunar infarcts, white matter hyperintensities (WMHs) and microhemorrhages, are also associated with an increased risk of cognitive decline and dementia. In this study, we examined brain magnetic resonance imaging (MRI) changes in patients in the early stages of T2D without CSVDs to focus on glucose metabolism factors and to avoid the interference of vascular risk factors on T2D-related brain damage. Methods T2D patients with disease durations of less than 5 years and without any signs of CSVDs (n = 34) were compared with healthy control subjects (n = 24). Whole-brain region-based functional connectivity was analyzed with network-based statistics (NBS), and brain surface morphology was examined. In addition, the Montreal Cognitive Assessment (MoCA) was conducted for all subjects. Results At the whole-brain region-based functional connectivity level, thirty-three functional connectivities were changed in T2D patients relative to those in controls, mostly manifested as pathological between-network positive connectivity and located mainly between the sensory-motor network and auditory network. Some of the connectivities were positively correlated with blood glucose level, insulin resistance, and MoCA scores in the T2D group. The network-level analysis showed between-network hyperconnectivity in T2D patients, but no significant changes in within-network connectivity. In addition, there were no significant differences in MoCA scores or brain morphology measures, including cortical thickness, surface area, mean curvature, and gray/white matter volume, between the two groups. Conclusion The findings indicate that pathological between-network positive connectivity occurs in the early stages of T2D without CSVDs. The abnormal connectivity may indicate that the original balance of mutual antagonistic/cooperative relationships between the networks is broken, which may be a neuroimaging basis for predicting cognitive decline in early T2D patients.
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Affiliation(s)
- Huanghui Liu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jun Liu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huasheng Liu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Limin Peng
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, China
| | - Zhichao Feng
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Pengfei Rong
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Hui Shen
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, China
| | - Dewen Hu
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, China
| | - Ling-Li Zeng
- College of Mechatronics and Automation, National University of Defense Technology, Changsha, China
| | - Wei Wang
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
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Lu T, Liang J, Wei N, Pan L, Yang H, Weng B, Zeng J. Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins. Front Neurol 2019; 10:243. [PMID: 30949118 PMCID: PMC6437037 DOI: 10.3389/fneur.2019.00243] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose: Extracranial artery stenosis (ECAS) is related to individual imaging markers of cerebral small vessel disease (cSVD). However, little has been reported on the association between ECAS and the total burden of cSVD as assessed by magnetic resonance imaging (MRI). The purpose of this study was to investigate the relationship between ECAS and cSVD burden in patients with ischemic stroke of suspected small or large artery origin. Methods: We reviewed consecutive patients with ischemic stroke of suspected small or large artery origin who underwent color Doppler ultrasonography and brain MRI. Bilateral extracranial cerebral arteries including common carotid artery, internal carotid artery (ICA), and proximal vertebral artery (VA, ostium, V2–3 segments) were assessed using color Doppler ultrasonography. ECAS severity was classified as no/mild stenosis, moderate stenosis, severe stenosis, or occlusion. The total cSVD score was assessed by awarding one point according to the load of each of these cSVD markers as determined using MRI; lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces. The relationship between ECAS severity and cSVD burden according to MRI was examined. Results: Two hundred and twenty one patients were included in this study (mean age 61 ± 12 years, 75.6% male). Hypertension, current smoking, hyperlipidaemia, and diabetic mellitus were frequent among the patients (67.4, 45.7, 43.9, and 36.7%, respectively), while the other vascular risk factors including previous stroke or TIA and alcohol excess were less frequent (19.0 and 15.4%, respectively). Patients with higher total cSVD burden was significantly older and had severer ECAS. The frequency of hypertension was significantly higher in patients with higher total cSVD burden. This analysis indicated that that increasing ECAS severity (from no stenosis through to 100%) was independently associated with increasing total cSVD score after adjusting for other vascular risk factors (odds ratio 1.76, 95% CI [1.16–2.69]). Conclusions: In this study, high levels of ECAS from ultrasound evidence were associated with coexisting advanced cerebral cSVD in ischemic stroke patients of suspected small or large artery origin. Further studies are required to determine if and how extracranial arterial imaging helps reduce cSVD burden or improves cognitive function.
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Affiliation(s)
- Tao Lu
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.,Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiahui Liang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ninglin Wei
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Liya Pan
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Hong Yang
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Baohui Weng
- Department of Neurology and Stroke Center, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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77
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de la Cruz-Cosme C, Dawid-Milner MS, Ojeda-Burgos G, Gallardo-Tur A, Segura T. Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018. [PMID: 30185397 DOI: 10.1016/j.jstrokecerebrovascdis.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION AND GOAL Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. MATERIAL AND METHODS We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. RESULTS The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). CONCLUSIONS Doppler ultrasound is a useful technique for determining the LO of acute stroke.
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Affiliation(s)
| | - Marc Stefan Dawid-Milner
- Neurophysiology of the Autonomic Nervous System Unit, CIMES, Universidad de Málaga, Málaga, Spain
| | - Guillermo Ojeda-Burgos
- Internal Medicine Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain
| | - Alejandro Gallardo-Tur
- Neurology Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain; FIMABIS (Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud [Andalusian Public Research Foundation]), Málaga, Spain
| | - Tomás Segura
- Neurology Department, Hospital Universitario de Albacete (Albacete), Albacete, Spain
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de la Cruz-Cosme C, Dawid-Milner MS, Ojeda-Burgos G, Gallardo-Tur A, Segura T. Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:3425-3435. [PMID: 30185397 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND GOAL Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. MATERIAL AND METHODS We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. RESULTS The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). CONCLUSIONS Doppler ultrasound is a useful technique for determining the LO of acute stroke.
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Affiliation(s)
| | - Marc Stefan Dawid-Milner
- Neurophysiology of the Autonomic Nervous System Unit, CIMES, Universidad de Málaga, Málaga, Spain
| | - Guillermo Ojeda-Burgos
- Internal Medicine Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain
| | - Alejandro Gallardo-Tur
- Neurology Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain; FIMABIS (Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud [Andalusian Public Research Foundation]), Málaga, Spain
| | - Tomás Segura
- Neurology Department, Hospital Universitario de Albacete (Albacete), Albacete, Spain
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Lee YC, Chung CP, Chao NC, Fuh JL, Chang FC, Soong BW, Liao YC. Characterization of Heterozygous HTRA1 Mutations in Taiwanese Patients With Cerebral Small Vessel Disease. Stroke 2018; 49:1593-1601. [PMID: 29895533 DOI: 10.1161/strokeaha.118.021283] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Homozygous and compound heterozygous mutations in the high temperature requirement serine peptidase A1 gene (HTRA1) cause cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy. However, heterozygous HTRA1 mutations were recently identified to be associated with autosomal dominant cerebral small vessel disease (SVD). The present study aims at investigating the clinical features, frequency, and spectrum of HTRA1 mutations in a Taiwanese cohort with SVD. METHODS Mutational analyses of HTRA1 were performed by Sanger sequencing in 222 subjects, selected from a cohort of 337 unrelated patients with SVD after excluding those harboring a NOTCH3 mutation. The influence of these mutations on HTRA1 protease activities was characterized. RESULTS Seven novel heterozygous mutations in HTRA1 were identified, including p.Gly120Asp, p.Ile179Asn, p.Ala182Profs*33, p.Ile256Thr, p.Gly276Ala, p.Gln289Ter, and p.Asn324Thr, and each was identified in 1 single index patient. All mutations significantly compromise the HTRA1 protease activities. For the 7 index cases and another 2 affected siblings carrying a heterozygous HTRA1 mutation, the common clinical presentations include lacunar infarction, intracerebral hemorrhage, cognitive decline, and spondylosis at the fifth to sixth decade of life. Among the 9 patients, 4 have psychiatric symptoms as delusion, depression, and compulsive behavior, 3 have leukoencephalopathy in anterior temporal poles, and 2 patients have alopecia. CONCLUSIONS Heterozygous HTRA1 mutations account for 2.08% (7 of 337) of SVD in Taiwan. The clinical and neuroradiological features of HTRA1-related SVD and sporadic SVD are similar. These findings broaden the mutational spectrum of HTRA1 and highlight the pathogenic role of heterozygous HTRA1 mutations in SVD.
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Affiliation(s)
- Yi-Chung Lee
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
- Taipei Veterans General Hospital, Taiwan; and Department of Neurology (Y.-C.L., C.-P.C., J.-L.F., B.-W.S., Y.-C.L.)
- Brain Research Center (Y.-C.L., J.-L.F., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chih-Ping Chung
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
- Taipei Veterans General Hospital, Taiwan; and Department of Neurology (Y.-C.L., C.-P.C., J.-L.F., B.-W.S., Y.-C.L.)
| | - Nai-Chen Chao
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
| | - Jong-Ling Fuh
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
- Taipei Veterans General Hospital, Taiwan; and Department of Neurology (Y.-C.L., C.-P.C., J.-L.F., B.-W.S., Y.-C.L.)
- Brain Research Center (Y.-C.L., J.-L.F., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan
| | | | - Bing-Wing Soong
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
- Taipei Veterans General Hospital, Taiwan; and Department of Neurology (Y.-C.L., C.-P.C., J.-L.F., B.-W.S., Y.-C.L.)
- Brain Research Center (Y.-C.L., J.-L.F., B.-W.S.), National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yi-Chu Liao
- From the Departments of Neurology (Y.-C.L., C.-P.C., N.-C.C., J.-L.F., B.-W.S., Y.-C.L.)
- Taipei Veterans General Hospital, Taiwan; and Department of Neurology (Y.-C.L., C.-P.C., J.-L.F., B.-W.S., Y.-C.L.)
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Wardlaw JM. William M. Feinberg Award for Excellence in Clinical Stroke: Small Vessel Disease; a Big Problem, But Fixable. Stroke 2018; 49:1770-1775. [PMID: 29895535 DOI: 10.1161/strokeaha.118.021184] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Joanna M Wardlaw
- From the Division of Neuroimaging Science, Centre for Clinical Brain Science, Edinburgh Imaging and UK Dementia Research Institute at the University of Edinburgh.
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Rutten-Jacobs LC, Tozer DJ, Duering M, Malik R, Dichgans M, Markus HS, Traylor M. Genetic Study of White Matter Integrity in UK Biobank (N=8448) and the Overlap With Stroke, Depression, and Dementia. Stroke 2018; 49:1340-1347. [PMID: 29752348 PMCID: PMC5976227 DOI: 10.1161/strokeaha.118.020811] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Structural integrity of the white matter is a marker of cerebral small vessel disease, which is the major cause of vascular dementia and a quarter of all strokes. Genetic studies provide a way to obtain novel insights in the disease mechanism underlying cerebral small vessel disease. The aim was to identify common variants associated with microstructural integrity of the white matter and to elucidate the relationships of white matter structural integrity with stroke, major depressive disorder, and Alzheimer disease. METHODS This genome-wide association analysis included 8448 individuals from UK Biobank-a population-based cohort study that recruited individuals from across the United Kingdom between 2006 and 2010, aged 40 to 69 years. Microstructural integrity was measured as fractional anisotropy- (FA) and mean diffusivity (MD)-derived parameters on diffusion tensor images. White matter hyperintensity volumes (WMHV) were assessed on T2-weighted fluid-attenuated inversion recovery images. RESULTS We identified 1 novel locus at genome-wide significance (VCAN [versican]: rs13164785; P=3.7×10-18 for MD and rs67827860; P=1.3×10-14 for FA). LD score regression showed a significant genome-wide correlation between FA, MD, and WMHV (FA-WMHV rG 0.39 [SE, 0.15]; MD-WMHV rG 0.56 [SE, 0.19]). In polygenic risk score analysis, FA, MD, and WMHV were significantly associated with lacunar stroke, MD with major depressive disorder, and WMHV with Alzheimer disease. CONCLUSIONS Genetic variants within the VCAN gene may play a role in the mechanisms underlying microstructural integrity of the white matter in the brain measured as FA and MD. Mechanisms underlying white matter alterations are shared with cerebrovascular disease, and inherited differences in white matter microstructure impact on Alzheimer disease and major depressive disorder.
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Affiliation(s)
- Loes C.A. Rutten-Jacobs
- From the Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (L.C.A.R.-J., D.J.T., H.S.M., M.T.),German Center for Neurodegenerative Diseases, Population Health Sciences, Bonn, Germany (L.C.A.R.-J.)
| | - Daniel J. Tozer
- From the Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (L.C.A.R.-J., D.J.T., H.S.M., M.T.)
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Germany (M. Duering, R.M., M. Dichgans)
| | - Rainer Malik
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Germany (M. Duering, R.M., M. Dichgans)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Germany (M. Duering, R.M., M. Dichgans)
| | - Hugh S. Markus
- From the Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (L.C.A.R.-J., D.J.T., H.S.M., M.T.)
| | - Matthew Traylor
- From the Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (L.C.A.R.-J., D.J.T., H.S.M., M.T.)
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van Leijsen EMC, Bergkamp MI, van Uden IWM, Ghafoorian M, van der Holst HM, Norris DG, Platel B, Tuladhar AM, de Leeuw FE. Progression of White Matter Hyperintensities Preceded by Heterogeneous Decline of Microstructural Integrity. Stroke 2018; 49:1386-1393. [PMID: 29724890 DOI: 10.1161/strokeaha.118.020980] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMH) are frequently seen on neuroimaging of elderly and are associated with cognitive decline and the development of dementia. Yet, the temporal dynamics of conversion of normal-appearing white matter (NAWM) into WMH remains unknown. We examined whether and when progression of WMH was preceded by changes in fluid-attenuated inversion recovery and diffusion tensor imaging values, thereby taking into account differences between participants with mild versus severe baseline WMH. METHODS From 266 participants of the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort), we semiautomatically segmented WMH at 3 time points for 9 years. Images were registered to standard space through a subject template. We analyzed differences in baseline fluid-attenuated inversion recovery, fractional anisotropy, and mean diffusivity (MD) values and changes in MD values over time between 4 regions: (1) remaining NAWM, (2) NAWM converting into WMH in the second follow-up period, (3) NAWM converting into WMH in the first follow-up period, and (4) WMH. RESULTS NAWM converting into WMH in the first or second time interval showed higher fluid-attenuated inversion recovery and MD values than remaining NAWM. MD values in NAWM converting into WMH in the first time interval were similar to MD values in WMH. When stratified by baseline WMH severity, participants with severe WMH had higher fluid-attenuated inversion recovery and MD and lower fractional anisotropy values than participants with mild WMH, in all areas including the NAWM. MD values in WMH and in NAWM that converted into WMH continuously increased over time. CONCLUSIONS Impaired microstructural integrity preceded conversion into WMH and continuously declined over time, suggesting a continuous disease process of white matter integrity loss that can be detected using diffusion tensor imaging even years before WMH become visible on conventional neuroimaging. Differences in microstructural integrity between participants with mild versus severe WMH suggest heterogeneity of both NAWM and WMH, which might explain the clinical variability observed in patients with similar small vessel disease severity.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mayra I Bergkamp
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Ingeborg W M van Uden
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences (M.G.)
| | - Helena M van der Holst
- Department of Neurology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands (H.M.v.d.H.)
| | - David G Norris
- Donders Institute for Brain, Cognition, and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Donders Center for Medical Neuroscience (E.M.C.v.L., M.I.B., I.W.M.v.U., A.M.T., F.-E.d.L.)
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83
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Tsai HH, Pasi M, Tsai LK, Chen YF, Lee BC, Tang SC, Fotiadis P, Huang CY, Yen RF, Gurol ME, Jeng JS. Distribution of Lacunar Infarcts in Asians With Intracerebral Hemorrhage: A Magnetic Resonance Imaging and Amyloid Positron Emission Tomography Study. Stroke 2018; 49:1515-1517. [PMID: 29695464 DOI: 10.1161/strokeaha.118.021539] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/19/2018] [Accepted: 03/30/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated whether lacunes in centrum semiovale (lobar lacunes) were associated with cerebral amyloid angiopathy (CAA) markers in an Asian intracerebral hemorrhage (ICH) population. METHODS One hundred ten patients with primary ICH were classified as CAA-ICH (n=24; mean age, 70.9±13.9) or hypertensive ICH (n=86; mean age, 59.3±13.0) according to the presence of strictly lobar (per modified Boston criteria) or strictly deep bleeds (both ICH and cerebral microbleeds), respectively. Lacunes were evaluated in the supratentorial area and classified as lobar or classical deep based on the location. A subgroup of 36 patients also underwent Pittsburgh Compound B positron emission tomography to measure cerebral amyloid deposition and global standardized uptake value ratio were calculated. RESULTS Lobar lacunes were more frequent in CAA-ICH than hypertensive ICH (29.2 versus 11.6%; P=0.036). In multivariable models, lobar lacunes were associated with lobar cerebral microbleed (odds ratio, 6.8; 95% confidence interval, 1.6-29.9; P=0.011) after adjustment for age, sex, hypertension, and white matter hyperintensity. In 15 CAA-ICH and 21 hypertensive ICH patients with Pittsburgh Compound B positron emission tomography, correlation analyses between lobar lacune counts and global standardized uptake value ratio showed positive association (ρ=0.40; P=0.02) and remained significant after adjustment for age (r=0.34; P=0.04). CONCLUSIONS Our findings expand on recent work showing that lobar lacunes are more frequent in CAA-ICH than hypertensive ICH. Their independent association with lobar cerebral microbleeds and brain amyloid deposition suggests a relationship with CAA even in an Asian cohort with overall higher hypertensive load.
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Affiliation(s)
- Hsin-Hsi Tsai
- From the Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei (H.-H.T.).,Department of Neurology (H.-H.T., L.-K.T., S.-C.T., J.-S.J.)
| | - Marco Pasi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.P., P.F., M.E.G.)
| | - Li-Kai Tsai
- Department of Neurology (H.-H.T., L.-K.T., S.-C.T., J.-S.J.)
| | - Ya-Fang Chen
- Department of Medical Imaging (Y.-F.C., B.-C.L.)
| | - Bo-Ching Lee
- Department of Medical Imaging (Y.-F.C., B.-C.L.)
| | - Sung-Chun Tang
- Department of Neurology (H.-H.T., L.-K.T., S.-C.T., J.-S.J.)
| | - Panagiotis Fotiadis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.P., P.F., M.E.G.)
| | - Chen-Yu Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei (C.-Y.H.)
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.P., P.F., M.E.G.)
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Loos CMJ, Makin SDJ, Staals J, Dennis MS, van Oostenbrugge RJ, Wardlaw JM. Long-Term Morphological Changes of Symptomatic Lacunar Infarcts and Surrounding White Matter on Structural Magnetic Resonance Imaging. Stroke 2018; 49:1183-1188. [PMID: 29567763 PMCID: PMC5916475 DOI: 10.1161/strokeaha.117.020495] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging. Methods— From 2 nonoverlapping, single-center, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural magnetic resonance imaging and with follow-up magnetic resonance imaging available at 1 to 5 years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter. Results— We included 79 patients of whom 32 (41%) had complete and 40 (51%) had partial cavitation of the index lesion at median follow-up of 403 (range, 315–1781) days. In 42 of 79 (53%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity cap, n=17), inferior (white matter hyperintensity track, n=13), or both (n=12). Conclusions— Half of the sporadic symptomatic lacunar infarcts developed secondary changes in superior and inferior white matter. These white matter hyperintensity caps and tracks may reflect another aspect of cerebral small vessel-related disease progression. The clinical and prognostic values remain to be determined.
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Affiliation(s)
- Caroline M J Loos
- From the Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
- Department of Neurology, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
- Department of Neurology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (C.M.J.L.)
| | - Stephen D J Makin
- Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, United Kingdom (S.D.J.M., M.S.D., J.M.W.)
| | - Julie Staals
- From the Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
- Department of Neurology, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
| | - Martin S Dennis
- Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, United Kingdom (S.D.J.M., M.S.D., J.M.W.)
| | - Robert J van Oostenbrugge
- From the Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
- Department of Neurology, Maastricht University Medical Centre, Maastricht University, the Netherlands (C.M.J.L., J.S., R.J.v.O.)
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Scotland, United Kingdom (S.D.J.M., M.S.D., J.M.W.)
- UK Dementia Research Institute, University of Edinburgh, Scotland, United Kingdom (J.M.W.)
- Scottish Imaging Network, A Platform for Scientific Excellence Collaboration, Scotland, United Kingdom (J.M.W.)
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van Leijsen EMC, Kuiperij HB, Kersten I, Bergkamp MI, van Uden IWM, Vanderstichele H, Stoops E, Claassen JAHR, van Dijk EJ, de Leeuw FE, Verbeek MM. Plasma Aβ (Amyloid-β) Levels and Severity and Progression of Small Vessel Disease. Stroke 2018. [PMID: 29540613 DOI: 10.1161/strokeaha.117.019810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) is a frequent pathology in aging and contributor to the development of dementia. Plasma Aβ (amyloid β) levels may be useful as early biomarker, but the role of plasma Aβ in SVD remains to be elucidated. We investigated the association of plasma Aβ levels with severity and progression of SVD markers. METHODS We studied 487 participants from the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort) of whom 258 participants underwent 3 MRI assessments during 9 years. We determined baseline plasma Aβ38, Aβ40, and Aβ42 levels using ELISAs. We longitudinally assessed volume of white matter hyperintensities semiautomatically and manually rated lacunes and microbleeds. We analyzed associations between plasma Aβ and SVD markers by ANCOVA adjusted for age, sex, and hypertension. RESULTS Cross-sectionally, plasma Aβ40 levels were elevated in participants with microbleeds (mean, 205.4 versus 186.4 pg/mL; P<0.01) and lacunes (mean, 194.8 versus 181.2 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with severe white matter hyperintensities (Aβ38, 25.3 versus 22.7 pg/mL; P<0.01; Aβ40, 201.8 versus 183.3 pg/mL; P<0.05). Longitudinally, plasma Aβ40 levels were elevated in participants with white matter hyperintensity progression (mean, 194.6 versus 182.9 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with incident lacunes (Aβ38, 24.5 versus 22.5 pg/mL; P<0.05; Aβ40, 194.9 versus 181.2 pg/mL; P<0.01) and Aβ42 in participants with incident microbleeds (62.8 versus 60.4 pg/mL; P<0.05). CONCLUSIONS Plasma Aβ levels are associated with both presence and progression of SVD markers, suggesting that Aβ pathology might contribute to the development and progression of SVD. Plasma Aβ levels might thereby serve as inexpensive and noninvasive measure for identifying individuals with increased risk for progression of SVD.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - H Bea Kuiperij
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Iris Kersten
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Mayra I Bergkamp
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ingeborg W M van Uden
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Hugo Vanderstichele
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Erik Stoops
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Jurgen A H R Claassen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ewoud J van Dijk
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Marcel M Verbeek
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.).
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Benjamin P, Trippier S, Lawrence AJ, Lambert C, Zeestraten E, Williams OA, Patel B, Morris RG, Barrick TR, MacKinnon AD, Markus HS. Lacunar Infarcts, but Not Perivascular Spaces, Are Predictors of Cognitive Decline in Cerebral Small-Vessel Disease. Stroke 2018; 49:586-593. [PMID: 29438074 PMCID: PMC5832012 DOI: 10.1161/strokeaha.117.017526] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Cerebral small-vessel disease is a major cause of cognitive impairment. Perivascular spaces (PvS) occur in small-vessel disease, but their relationship to cognitive impairment remains uncertain. One reason may be difficulty in distinguishing between lacunes and PvS. We determined the relationship between baseline PvS score and PvS volume with change in cognition over a 5-year follow-up. We compared this to the relationship between baseline lacune count and total lacune volume with cognition. In addition, we examined change in PvS volume over time. Methods— Data from the prospective SCANS study (St Georges Cognition and Neuroimaging in Stroke) of patients with symptomatic lacunar stroke and confluent leukoaraiosis were used (n=121). Multimodal magnetic resonance imaging was performed annually for 3 years and neuropsychological testing annually for 5 years. Lacunes were manually identified and distinguished from PvS. PvS were rated using a validated visual rating scale, and PvS volumes calculated using T1-weighted images. Linear mixed-effect models were used to determine the impact of PvS and lacunes on cognition. Results— Baseline PvS scores or volumes showed no association with cognitive indices. No change was detectable in PvS volumes over the 3 years. In contrast, baseline lacunes associated with all cognitive indices and predicted cognitive decline over the 5-year follow-up. Conclusions— Although a feature of small-vessel disease, PvS are not a predictor of cognitive decline, in contrast to lacunes. This study highlights the importance of carefully differentiating between lacunes and PvS in studies investigating vascular cognitive impairment.
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Affiliation(s)
- Philip Benjamin
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M).
| | - Sarah Trippier
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew J Lawrence
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Christian Lambert
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Eva Zeestraten
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Owen A Williams
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Bhavini Patel
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Robin G Morris
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Thomas R Barrick
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Andrew D MacKinnon
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
| | - Hugh S Markus
- From the Department of Radiology, Imperial College NHS Trust, London, United Kingdom (P.B.); Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, London, United Kingdom (S.T., A.D.M.); Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University of London, United Kingdom (C.L., E.Z., O.A.W., B.P., T.R.B.); Department of Psychology, King's College Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom (A.J.L., R.G.M.); and Stroke Research Group, Clinical Neurosciences, University of Cambridge, United Kingdom (H.S.M)
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87
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Wijesinghe P, Shankar SK, Yasha TC, Gorrie C, Amaratunga D, Hulathduwa S, Kumara KS, Samarasinghe K, Suh YH, Steinbusch HWM, De Silva KRD. Vascular Contributions in Alzheimer's Disease-Related Neuropathological Changes: First Autopsy Evidence from a South Asian Aging Population. J Alzheimers Dis 2018; 54:1607-1618. [PMID: 27589527 DOI: 10.3233/jad-160425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence from various consortia on vascular contributions has been inconsistent in determining the etiology of sporadic Alzheimer's disease (AD). OBJECTIVE To investigate vascular risk factors and cerebrovascular pathologies associated in manifestation of AD-related neuropathological changes of an elderly population. METHODS Postmortem brain samples from 76 elderly subjects (≥50 years) were used to study genetic polymorphisms, intracranial atherosclerosis of the circle of Willis (IASCW), and microscopic infarcts in deep white matters. From this cohort, 50 brains (≥60 years) were subjected to neuropathological diagnosis using immunohistopathological techniques. RESULTS Besides the association with age, the apolipoprotein E ɛ4 allele was significantly and strongly associated with Thal amyloid-β phases ≥1 [odds ratio (OR) = 6.76, 95% confidence interval (CI) 1.37-33.45] and inversely with Braak neurofibrillary tangle (NFT) stages ≥III (0.02, 0.0-0.47). Illiterates showed a significant positive association for Braak NFT stages ≥IV (14.62, 1.21-176.73) and a significant negative association for microscopic infarcts (0.15, 0.03-0.71) in deep white matters. With respect to cerebrovascular pathologies, cerebral small vessel lesions (white matter hyperintensities and cerebral amyloid angiopathy) showed a higher degree of associations among them and with AD-related neuropathological changes (p < 0.05) compared to large vessel pathology (IASCW), which showed a significant association only with Braak NFT stages ≥I (p = 0.050). CONCLUSION These findings suggest that besides age, education, and genetic factors, other vascular risk factors were not associated with AD-related neuropathological changes and urge prompt actions be taken against cerebral small vessel diseases since evidence for effective prevention is still lacking.
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Affiliation(s)
- Printha Wijesinghe
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - S K Shankar
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - T C Yasha
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Catherine Gorrie
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, Australia
| | | | - Sanjayah Hulathduwa
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - K Sunil Kumara
- Department of Judicial Medical Office, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Kamani Samarasinghe
- Department of Pathology, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - Yoo-Hun Suh
- Department of Pharmacology, College of Medicine, Seoul National University, Seoul, Korea.,NRI, Gachon University, Incheon, South Korea
| | - Harry W M Steinbusch
- Department of Translational Neuroscience, Faculty Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - K Ranil D De Silva
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
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88
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Chimelli L. The role of biopsies and autopsies in the diagnosis of cognitive impairment, with emphasis on small vessel diseases: A critical appraisal enriched by personal experience. Dement Neuropsychol 2018; 11:356-363. [PMID: 29354215 PMCID: PMC5769993 DOI: 10.1590/1980-57642016dn11-040004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acquired and hereditary microangiopathies cause cerebral small vessel diseases (CSVD) that impair cognition. The most frequent is primary angiitis of the CNS (PACNS), whose diagnosis remains challenging, requiring a multidisciplinary approach. Secondary vasculitis, CADASIL, miscellaneous microangiopathies and lymphomas, also cause cognitive impairment. Despite the fact that the need for biopsy has decreased in the era of new neuroimaging methods, biopsies that include small leptomeningeal and parenchymal arterial vessels still remain the gold standard to diagnose PACNS and other CSVD, and to exclude mimics such as infections and malignancies. New approaches for pathological consequences relevant to vascular cognitive impairment such as silent brain lesions, microinfarcts, microbleeds and subtle loss of microstructural integrity, may be detected in autopsies. This article addresses the role of biopsies and autopsies for the diagnosis of cognitive impairment related to small vessel diseases or other inflammatory/ischemic processes, and presents a critical appraisal based on personal experience.
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Affiliation(s)
- Leila Chimelli
- Instituto Estadual do Cérebro Paulo Niemeyer - Laboratory of Neuropathology and Universidade Federal do Rio de Janeiro - Pathology Department, Rio de Janeiro, RJ - Brazil
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89
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Duperron MG, Tzourio C, Sargurupremraj M, Mazoyer B, Soumaré A, Schilling S, Amouyel P, Chauhan G, Zhu YC, Debette S. Burden of Dilated Perivascular Spaces, an Emerging Marker of Cerebral Small Vessel Disease, Is Highly Heritable. Stroke 2018; 49:282-287. [PMID: 29311265 DOI: 10.1161/strokeaha.117.019309] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The genetic contribution to dilated perivascular space (dPVS) burden-an emerging MRI marker of cerebral small vessel disease-is unknown. We measured the heritability of dPVS burden and its shared heritability with other MRI markers of cerebral small vessel disease. METHODS The study sample comprised 1597 participants from the population-based Three City (3C) Dijon Study, with brain MRI and genome-wide genotyping (mean age, 72.8±4.1 years; 61% women). dPVS burden and lacunar brain infarcts were rated on a semiquantitative scale, whereas an automated algorithm generated white matter hyperintensity volume (WMHV). We estimated dPVS burden heritability and shared heritability with WMHV and lacunar brain infarcts using the genome-wide complex trait analysis tool, on unrelated participants, adjusting for age, sex, intracranial volume, and principal components of population stratification. RESULTS dPVS burden was significantly correlated with WMHV and lacunar brain infarcts, the strongest correlation being found between WMHV and dPVS in basal ganglia. Heritability estimates were h2=0.59±0.24 (P=0.007) for dPVS burden, h2=0.54±0.24 (P=0.010) for WMHV, and h2=0.48±0.81 (P=0.278) for lacunar brain infarcts. We found a nonsignificant trend toward shared heritability between dPVS and WMHV (rg=0.41±0.28; P=0.096), which seemed driven by dPVS in basal ganglia (rg=0.72±0.61; P=0.126) and not dPVS in white matter (rg=-0.10±0.36; P=0.393). A genetic risk score for WMHV based on published loci was associated with increased dPVS burden in basal ganglia (P=0.031). CONCLUSIONS We provide evidence for important genetic contribution to dPVS burden in older community-dwelling people, some of which may be shared with WMHV. Differential heritability patterns for dPVS in white matter and basal ganglia suggest at least partly distinct underlying biological processes.
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Affiliation(s)
- Marie-Gabrielle Duperron
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Christophe Tzourio
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Muralidharan Sargurupremraj
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Bernard Mazoyer
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Aïcha Soumaré
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Sabrina Schilling
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Philippe Amouyel
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Ganesh Chauhan
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Yi-Cheng Zhu
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.)
| | - Stéphanie Debette
- From the Inserm, Bordeaux Population Health Research Center (M-G.D., C.T., M.S., A.S., S.S., G. C., S.D.) and Institut des Maladies Neurodégénératives, CNRS-CEA UMR 5293 (B.M.), University of Bordeaux, France; Pole de santé publique (C.T.) and Department of Neurology (S.D.), Centre Hospitalier Universitaire de Bordeaux, France; Inserm U1167, Lille, France (P.A.); Department of Epidemiology and Public Health, Pasteur Institute of Lille, France (P.A.); Department of Public Health, Lille University Hospital, France (P.A.); Centre for Brain Research, Indian Institute of Science, Bangalore, India (G.C.); and Department of Neurology, Pekin Union Medical College Hospital, Beijing, China (Y.-C.Z.).
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Banerjee G, Wilson D, Ambler G, Osei-Bonsu Appiah K, Shakeshaft C, Lunawat S, Cohen H, Yousry T, Lip GYH, Muir KW, Brown MM, Al-Shahi Salman R, Jäger HR, Werring DJ. Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy. Stroke 2017; 49:40-45. [PMID: 29247143 PMCID: PMC5753815 DOI: 10.1161/strokeaha.117.019409] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 11/22/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Although the association between cerebral amyloid angiopathy (CAA) and cognitive impairment is increasingly recognized, it is not clear whether this is because of the impact of recurrent intracerebral hemorrhage (ICH) events, disruptions caused by cerebral small vessel damage, or both. We investigated this by considering whether cognitive impairment before ICH was associated with neuroimaging features of CAA on magnetic resonance imaging. Methods— We studied 166 patients with neuroimaging-confirmed ICH recruited to a prospective multicentre observational study. Preexisting cognitive impairment was determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Magnetic resonance imaging markers of cerebral small vessel disease, including CAA, were rated by trained observers according to consensus guidelines. Results— The prevalence of cognitive impairment before ICH was 24.7% (n=41) and, in adjusted analyses, was associated with fulfilling the modified Boston criteria for probable CAA at presentation (odds ratio, 4.01; 95% confidence interval, 1.53–10.51; P=0.005) and a higher composite CAA score (for each point increase, odds ratio, 1.42; 95% confidence interval, 1.03–1.97; P=0.033). We also found independent associations between pre-ICH cognitive decline and the presence of cortical superficial siderosis, strictly lobar microbleeds, and lobar ICH location, but not with other neuroimaging markers, or a composite small vessel disease score. Conclusions— CAA (defined using magnetic resonance imaging markers) is associated with cognitive decline before symptomatic ICH. This provides evidence that small vessel disruption in CAA makes an independent contribution to cognitive impairment, in addition to effects due to brain injury caused directly by ICH. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT02513316.
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Affiliation(s)
- Gargi Banerjee
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Duncan Wilson
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Gareth Ambler
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Karen Osei-Bonsu Appiah
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Clare Shakeshaft
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Surabhika Lunawat
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Hannah Cohen
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Tarek Yousry
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Gregory Y H Lip
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Keith W Muir
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Martin M Brown
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Rustam Al-Shahi Salman
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - Hans Rolf Jäger
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.)
| | - David J Werring
- From the UCL Stroke Research Centre (G.B., D.W., K.O.-B.A., C.S., S.L., M.M.B., D.J.W.) and Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit (T.Y., H.R.J.), Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Statistical Science (G.A.) and Haemostasis Research Unit, Department of Haematology (H.C.), University College London, United Kingdom; University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.); and Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, United Kingdom (R.A.-S.S.).
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Wang Y, Meng R, Song H, Liu G, Hua Y, Cui D, Zheng L, Feng W, Liebeskind DS, Fisher M, Ji X. Remote Ischemic Conditioning May Improve Outcomes of Patients With Cerebral Small-Vessel Disease. Stroke 2017; 48:3064-3072. [PMID: 29042490 DOI: 10.1161/strokeaha.117.017691] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the efficacy of remote ischemic conditioning (RIC) in patients with cerebral small-vessel disease. METHODS Thirty patients with cerebral small-vessel disease-related mild cognitive impairment were enrolled in this prospective, randomized controlled study for 1 year. Besides routine medical treatment, participants were randomized into the experimental group (n=14) undergoing 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on both upper limbs twice daily for 1 year or the control group (n=16) who were treated with sham ischemia-reperfusion cycles. The primary outcome was the change of brain lesions, and secondary outcomes were changes of cognitive function, plasma biomarkers, and cerebral hemodynamic parameters both at baseline and at the end of 1-year follow-up. RESULTS Compared with pretreatment, the post-treatment white matter hyperintensities volume in the RIC group was significantly reduced (9.10±7.42 versus 6.46±6.05 cm3; P=0.020), whereas no significant difference was observed in the sham-RIC group (8.99±6.81 versus 8.07±6.56 cm3; P=0.085). The reduction of white matter hyperintensities volume in the RIC group was more substantial than that in sham group (-2.632 versus -0.935 cm3; P=0.049). No significant difference was found in the change of the number of lacunes between 2 groups (0 versus 0; P=0.694). A significant treatment difference at 1 year on visuospatial and executive ability was found between the 2 groups (0.639 versus 0.191; P=0.048). RIC showed greater effects compared with sham-RIC on plasma triglyceride (-0.433 versus 0.236 mmol/L; P=0.005), total cholesterol (-0.975 versus 0.134 mmol/L; P<0.001), low-density lipoprotein (-0.645 versus -0.029 mmol/L; P=0.034), and homocysteine (-4.737 versus -1.679 µmol/L; P=0.044). Changes of the pulsation indices of middle cerebral arteries from the baseline to 1 year were different between the 2 groups (right: -0.075 versus 0.043; P=0.030; left: -0.085 versus 0.043; P=0.010). CONCLUSIONS RIC seems to be potentially effective in patients with cerebral small-vessel disease in slowing cognition decline and reducing white matter hyperintensities. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01658306.
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Affiliation(s)
- Yuan Wang
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Ran Meng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Haiqing Song
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Gang Liu
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Yang Hua
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Dehua Cui
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Lemin Zheng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Wuwei Feng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - David S Liebeskind
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Marc Fisher
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Xunming Ji
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.).
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Zwanenburg JJM, van Osch MJP. Targeting Cerebral Small Vessel Disease With MRI. Stroke 2017; 48:3175-3182. [PMID: 28970280 DOI: 10.1161/strokeaha.117.016996] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/28/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Jaco J M Zwanenburg
- From the Deptartment of Radiology, University Medical Center Utrecht, the Netherlands (J.J.M.Z.); and Department of Radiology, Leiden University Medical Center, the Netherlands (M.J.P.v.O.).
| | - Matthias J P van Osch
- From the Deptartment of Radiology, University Medical Center Utrecht, the Netherlands (J.J.M.Z.); and Department of Radiology, Leiden University Medical Center, the Netherlands (M.J.P.v.O.)
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Reijmer YD, Fotiadis P, Charidimou A, van Veluw SJ, Xiong L, Riley GA, Martinez-Ramirez S, Schwab K, Viswanathan A, Gurol ME, Greenberg SM. Relationship between white matter connectivity loss and cortical thinning in cerebral amyloid angiopathy. Hum Brain Mapp 2017; 38:3723-3731. [PMID: 28462514 DOI: 10.1002/hbm.23629] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/08/2017] [Accepted: 04/17/2017] [Indexed: 02/07/2023] Open
Abstract
Patients with cerebral amyloid angiopathy (CAA) show loss of white matter connectivity and cortical thinning on MRI, primarily in posterior brain regions. Here we examined whether a potential causal relationship exists between these markers of subcortical and cortical brain injury by examining whether changes in cortical thickness progress in tandem with changes in their underlying connections. Thirty-one patients with probable CAA with brain MRI at two time points were included (follow-up time: 1.3 ± 0.4 years). Brain networks were reconstructed using diffusion MRI-based fiber tractography. Of each network node, we calculated the change in fractional anisotropy-weighted connectivity strength over time and the change in cortical thickness. The association between change in connectivity strength and cortical thickness was assessed with (hierarchical) linear regression models. Our results showed that decline in posterior network connectivity over time was strongly related to thinning of the occipital cortex (β = 0.65 (0.35-0.94), P < 0.001), but not to thinning of the other posterior or frontal cortices. However, at the level of individual network nodes, we found no association between connectivity strength and cortical thinning of the corresponding node (β = 0.009 ± 0.04, P = 0.80). Associations were independent of age, sex, and other brain MRI markers of CAA. To conclude, CAA patients with greater progressive loss of posterior white matter connectivity also have greater progression of occipital cortical thinning, but our results do not support a direct causal relationship between them. The association can be better explained by a shared underlying mechanism, which may form a potential target for future treatments. Hum Brain Mapp 38:3723-3731, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yael D Reijmer
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Panagiotis Fotiadis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susanne J van Veluw
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Li Xiong
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grace A Riley
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kristin Schwab
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Cleutjens FAHM, Ponds RWHM, Spruit MA, Burgmans S, Jacobs HIL, Gronenschild EHBM, Staals J, Franssen FME, Dijkstra JB, Vanfleteren LEGW, Hofman PA, Wouters EFM, Janssen DJA. The Relationship between Cerebral Small Vessel Disease, Hippocampal Volume and Cognitive Functioning in Patients with COPD: An MRI Study. Front Aging Neurosci 2017; 9:88. [PMID: 28424613 PMCID: PMC5371656 DOI: 10.3389/fnagi.2017.00088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
The neural correlates of cognitive impairment in chronic obstructive pulmonary disease (COPD) are not yet understood. Structural brain abnormalities could possibly be associated with the presence of cognitive impairment through cigarette smoke, inflammation, vascular disease, or hypoxemia in these patients. This study aimed to investigate whether macrostructural brain magnetic resonance imaging (MRI) features of cerebral small vessel disease (SVD) and hippocampal volume (HCV) are related to cognitive performance in patients with COPD. A subgroup of cognitively high and low-performing COPD patients of the COgnitive-PD study, underwent a brain 3T MRI. SVD as a marker of vascular damage was assessed using qualitative visual rating scales. HCV as a marker of neurodegeneration was assessed using the learning embedding for atlas propagation (LEAP) method. Features of SVD and HCV were compared between cognitively high and low-performing individuals using Mann Whitney U tests and independent samples t-tests, respectively. No group differences were reported between 25 high-performing (mean age 60.3 (standard deviation [SD] 9.7) years; 40.0% men; forced expiratory volume in first second [FEV1] 50.1% predicted) and 30 low-performing patients with COPD (mean age 60.6 (SD 6.8) years; 53.3% men; FEV1 55.6% predicted) regarding demographics, clinical characteristics, comorbidities and the presence of the SVD features and HCV. To conclude, the current study does not provide evidence for a relationship between cerebral SVD and HCV and cognitive functioning in patients with COPD. Additional studies will be needed to determine other possible mechanisms of cognitive impairment in patients with COPD, including microstructural brain changes and inflammatory-, hormonal-, metabolic- and (epi)genetic factors.
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Affiliation(s)
- Fiona A H M Cleutjens
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands
| | - Rudolf W H M Ponds
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)Maastricht, Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht, Netherlands
| | - Saartje Burgmans
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht UniversityMaastricht, Netherlands
| | - Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht UniversityMaastricht, Netherlands
| | - Ed H B M Gronenschild
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht UniversityMaastricht, Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical CentreMaastricht, Netherlands
| | - Frits M E Franssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands
| | - Jeanette B Dijkstra
- Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS)Maastricht, Netherlands
| | - Lowie E G W Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands
| | - Paul A Hofman
- Department of Radiology, Maastricht University Medical CentreMaastricht, Netherlands
| | - Emiel F M Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands.,Department of Respiratory Medicine, Maastricht UMC+Maastricht, Netherlands
| | - Daisy J A Janssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO)Horn, Netherlands
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95
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Nakagawa K, Ito CS, King SL. Ethnic Comparison of Clinical Characteristics and Ischemic Stroke Subtypes Among Young Adult Patients With Stroke in Hawaii. Stroke 2016; 48:24-29. [PMID: 27879449 DOI: 10.1161/strokeaha.116.014618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/05/2016] [Accepted: 11/03/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Native Hawaiians and other Pacific Islanders (NHOPI) with ischemic stroke have younger age of stroke onset compared with whites. However, ethnic differences in stroke subtypes in this population have been inadequately studied. METHODS Consecutive young adult patients (aged ≤55 years) who were hospitalized for ischemic stroke between 2006 and 2012 at a tertiary center in Honolulu were studied. Clinical characteristics and stroke subtypes based on pathophysiological TOAST classification (Trial of Org 10172) of NHOPI and Asians were compared with whites. RESULTS A total of 427 consecutive young adult (mean age, 46.7±7.8 years) patients (NHOPI 45%, Asians 38%, and whites 17%) were studied. NHOPI had a higher prevalence of hypertension, diabetes mellitus, prosthetic valve, higher body mass index, hemoglobin A1c, and lower high-density lipoprotein than whites (all P<0.05). Stroke subtype distribution was not different between the ethnic groups. Specifically, the prevalence of small-vessel disease was similar between NHOPI (26.6%), whites (28.4%), and Asians (24.8%). In the univariate analyses, the use of intravenous tissue-type plasminogen activator was lower among NHOPI (4.7%; P=0.01) and Asians (3.1%; P=0.002) than among whites (12.5%). In the multivariable model, NHOPI (odds ratio, 0.35; 95% confidence interval, 0.12-0.98) and Asians (odds ratio, 0.23; 95% confidence interval, 0.07-0.74) were less likely to be treated with intravenous tissue-type plasminogen activator than whites. CONCLUSIONS NHOPI have greater cardiovascular risk factors than whites, but there were no differences in stroke subtypes between the ethnic groups. Furthermore, NHOPI and Asians may be less likely to be treated with intravenous tissue-type plasminogen activator than whites.
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Affiliation(s)
- Kazuma Nakagawa
- From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N., C.S.I., S.L.K.); and Division of Neurology, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu (K.N.).
| | - Cherisse S Ito
- From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N., C.S.I., S.L.K.); and Division of Neurology, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu (K.N.)
| | - Sage L King
- From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N., C.S.I., S.L.K.); and Division of Neurology, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu (K.N.)
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96
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Baron-Menguy C, Domenga-Denier V, Ghezali L, Faraci FM, Joutel A. Increased Notch3 Activity Mediates Pathological Changes in Structure of Cerebral Arteries. Hypertension 2016; 69:60-70. [PMID: 27821617 DOI: 10.1161/hypertensionaha.116.08015] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/07/2016] [Accepted: 08/26/2016] [Indexed: 01/24/2023]
Abstract
CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy), the most frequent genetic cause of stroke and vascular dementia, is caused by highly stereotyped mutations in the NOTCH3 receptor, which is predominantly expressed in vascular smooth muscle. The well-established TgNotch3R169C mouse model develops characteristic features of the human disease, with deposition of NOTCH3 and other proteins, including TIMP3 (tissue inhibitor of metalloproteinase 3), on brain vessels, as well as reduced maximal dilation, and attenuated myogenic tone of cerebral arteries, but without elevated blood pressure. Increased TIMP3 levels were recently shown to be a major determinant of altered myogenic tone. In this study, we investigated the contribution of TIMP3 and Notch3 signaling to the impairment of maximal vasodilator capacity caused by the archetypal R169C mutation. Maximally dilated cerebral arteries in TgNotch3R169C mice exhibited a decrease in lumen diameter over a range of physiological pressures that occurred before myogenic tone deficits. This defect was not prevented by genetic reduction of TIMP3 in TgNotch3R169C mice and was not observed in mice overexpressing TIMP3. Knock-in mice with the R169C mutation (Notch3R170C/R170C) exhibited similar reductions in arterial lumen, and both TgNotch3R169C and Notch3R170C/R170C mice showed increased cerebral artery expression of Notch3 target genes. Reduced maximal vasodilation was prevented by conditional reduction of Notch activity in smooth muscle of TgNotch3R169C mice and mimicked by conditional activation of Notch3 in smooth muscle, an effect that was blood pressure-independent. We conclude that increased Notch3 activity mediates reduction in maximal dilator capacity of cerebral arteries in CADASIL and may contribute to reductions in cerebral blood flow.
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Affiliation(s)
- Celine Baron-Menguy
- From the Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, UMRS 1161, and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); DHU NeuroVasc Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); and Departments of Internal Medicine and Pharmacology, Francois M. Abboud Cardiovascular Center, The University of Iowa Carver College of Medicine, Iowa City Veterans Affairs Healthcare System (F.M.F.)
| | - Valérie Domenga-Denier
- From the Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, UMRS 1161, and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); DHU NeuroVasc Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); and Departments of Internal Medicine and Pharmacology, Francois M. Abboud Cardiovascular Center, The University of Iowa Carver College of Medicine, Iowa City Veterans Affairs Healthcare System (F.M.F.)
| | - Lamia Ghezali
- From the Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, UMRS 1161, and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); DHU NeuroVasc Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); and Departments of Internal Medicine and Pharmacology, Francois M. Abboud Cardiovascular Center, The University of Iowa Carver College of Medicine, Iowa City Veterans Affairs Healthcare System (F.M.F.)
| | - Frank M Faraci
- From the Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, UMRS 1161, and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); DHU NeuroVasc Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); and Departments of Internal Medicine and Pharmacology, Francois M. Abboud Cardiovascular Center, The University of Iowa Carver College of Medicine, Iowa City Veterans Affairs Healthcare System (F.M.F.)
| | - Anne Joutel
- From the Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, UMRS 1161, and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); DHU NeuroVasc Sorbonne Paris Cité, Paris, France (C.B.-M., V.D.-D., L.G., A.J.); and Departments of Internal Medicine and Pharmacology, Francois M. Abboud Cardiovascular Center, The University of Iowa Carver College of Medicine, Iowa City Veterans Affairs Healthcare System (F.M.F.).
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97
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Wang N, Allali G, Kesavadas C, Noone ML, Pradeep VG, Blumen HM, Verghese J. Cerebral Small Vessel Disease and Motoric Cognitive Risk Syndrome: Results from the Kerala-Einstein Study. J Alzheimers Dis 2016; 50:699-707. [PMID: 26757037 DOI: 10.3233/jad-150523] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The contribution of cerebral small vessel disease to cognitive decline, especially in non-Caucasian populations, is not well established. OBJECTIVE We examined the relationship between cerebral small vessel disease and motoric cognitive risk syndrome (MCR), a recently described pre-dementia syndrome, in Indian seniors. METHODS 139 participants (mean age 66.6 ± 5.4 y, 33.1% female) participating in the Kerala-Einstein study in Southern India were examined in a cross-sectional study. The presence of cerebral small vessel disease (lacunar infarcts and cerebral microbleeds (CMB)) and white matter hyperintensities on MRI was ascertained by raters blinded to clinical information. MCR was defined by the presence of cognitive complaints and slow gait in older adults without dementia or mobility disability. RESULTS Thirty-eight (27.3%) participants met MCR criteria. The overall prevalence of lacunar infarcts and CMB was 49.6% and 9.4% , respectively. Lacunar infarcts in the frontal lobe, but no other brain regions, were associated with MCR even after adjusting for vascular risk factors and presence of white matter hyperintensities (adjusted Odds Ratio (aOR): 4.67, 95% CI: 1.69-12.94). Frontal lacunar infarcts were associated with slow gait (aOR: 3.98, 95% CI: 1.46-10.79) and poor performance on memory test (β: -1.24, 95% CI: -2.42 to -0.05), but not with cognitive complaints or non-memory tests. No association of CMB was found with MCR, individual MCR criterion or cognitive tests. CONCLUSIONS Frontal lacunar infarcts are associated with MCR in Indian seniors, perhaps, by contributing to slow gait and poor memory function.
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Affiliation(s)
- Nan Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gilles Allali
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chandrasekharan Kesavadas
- Department of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mohan L Noone
- Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Vayyattu G Pradeep
- Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Helena M Blumen
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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98
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Patti J, Helenius J, Puri AS, Henninger N. White Matter Hyperintensity-Adjusted Critical Infarct Thresholds to Predict a Favorable 90-Day Outcome. Stroke 2016; 47:2526-33. [PMID: 27633020 DOI: 10.1161/strokeaha.116.013982] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There is increasing interest in defining stroke lesion volume thresholds to predict poststroke outcome. However, there is a paucity of data on factors that impact the association between critical infarct thresholds volume and outcome. We sought to determine whether lesion thresholds best predicting outcome depend on the degree of preexisting white matter hyperintensity (WMH) lesion burden. METHODS Magnetic resonance imaging infarct volumes were quantified in 414 consecutive patients with anterior circulation ischemic strokes evaluated between January 2014 and December 2014. The WMH lesion volume was graded according to the Fazekas scale and dichotomized to absent to mild versus moderate to severe. Receiver operator characteristics curves were calculated to determine the infarct volume threshold best predicting the 90-day outcome. Multivariable logistic regression was used to determine whether the critical lesion thresholds independently predicted a favorable 90-day outcome after adjusting for pertinent confounders. RESULTS The infarct volumes thresholds predicting the 90-day outcome for the entire cohort (standard thresholds) were ≤29.5 mL (modified Rankin scale [mRS] 0-1), ≤29.9 mL (mRS 0-2), and ≤34.1 mL (mRS 0-3). For patients with absent-to-mild WMH lesion burden, WMH-adjusted critical infarct thresholds were significantly greater than the standard infarct thresholds. In the fully adjusted multivariable regression models, the WMH-adjusted infarct thresholds correctly predicted the outcome to a similar degree as the standard thresholds. CONCLUSIONS In this proof-of-concept study, the WMH lesion burden impacted the critical outcome-predicting infarct thresholds. If confirmed, using a WMH-adjusted infarct threshold could allow defining patients that have a favorable outcome despite having relatively large infarct volumes.
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Affiliation(s)
- Jatinder Patti
- From the Department of Neurology (J.P., J.H., N.H.), Department of Radiology (A.S.P.), Department of Neurosurgery (A.S.P.), and Department of Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, MA
| | - Johanna Helenius
- From the Department of Neurology (J.P., J.H., N.H.), Department of Radiology (A.S.P.), Department of Neurosurgery (A.S.P.), and Department of Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, MA
| | - Ajit S Puri
- From the Department of Neurology (J.P., J.H., N.H.), Department of Radiology (A.S.P.), Department of Neurosurgery (A.S.P.), and Department of Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, MA
| | - Nils Henninger
- From the Department of Neurology (J.P., J.H., N.H.), Department of Radiology (A.S.P.), Department of Neurosurgery (A.S.P.), and Department of Psychiatry (N.H.), University of Massachusetts Medical School, Worcester, MA.
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99
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Traylor M, Rutten-Jacobs LCA, Thijs V, Holliday EG, Levi C, Bevan S, Malik R, Boncoraglio G, Sudlow C, Rothwell PM, Dichgans M, Markus HS. Genetic Associations With White Matter Hyperintensities Confer Risk of Lacunar Stroke. Stroke 2016; 47:1174-9. [PMID: 27073246 PMCID: PMC4839546 DOI: 10.1161/strokeaha.115.011625] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/09/2016] [Indexed: 01/05/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— White matter hyperintensities (WMH) are increased in patients with lacunar stroke. Whether this is because of shared pathogenesis remains unknown. Using genetic data, we evaluated whether WMH-associated genetic susceptibility factors confer risk of lacunar stroke, and therefore whether they share pathogenesis. Methods— We used a genetic risk score approach to test whether single nucleotide polymorphisms associated with WMH in community populations were associated with magnetic resonance imaging–confirmed lacunar stroke (n=1,373), as well as cardioembolic (n=1,331) and large vessel (n=1,472) Trial of Org 10172 in Acute Stroke Treatment subtypes, against 9,053 controls. Second, we separated lacunar strokes into those with WMH (n=568) and those without (n=787) and tested for association with the risk score in these 2 groups. In addition, we evaluated whether WMH-associated single nucleotide polymorphisms are associated with lacunar stroke, or in the 2 groups. Results— The WMH genetic risk score was associated with lacunar stroke (odds ratio [OR; 95% confidence interval [CI]]=1.14 [1.06–1.22]; P=0.0003), in patients both with and without WMH (WMH: OR [95% CI]=1.15 [1.05–1.26]; P=0.003 and no WMH: OR [95% CI]=1.11 [1.02–1.21]; P=0.019). Conversely, the risk score was not associated with cardioembolic stroke (OR [95% CI]=1.03 [0.97–1.09]; P=0.63) or large vessel stroke (OR [95% CI]=0.99 [0.93,1.04]; P=0.39). However, none of the WMH-associated single nucleotide polymorphisms passed Bonferroni-corrected significance for association with lacunar stroke. Conclusions— Genetic variants that influence WMH are associated with an increased risk of lacunar stroke but not cardioembolic or large vessel stroke. Some genetic susceptibility factors seem to be shared across different radiological manifestations of small vessel disease.
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Affiliation(s)
- Matthew Traylor
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.).
| | - Loes C A Rutten-Jacobs
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Vincent Thijs
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Elizabeth G Holliday
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Chris Levi
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Steve Bevan
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Rainer Malik
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Giorgio Boncoraglio
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Cathie Sudlow
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Peter M Rothwell
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Martin Dichgans
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Hugh S Markus
- From the Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (M.T., L.C.A.R.-J., H.S.M.); Department of Medical and Molecular Genetics, King's College London, London, United Kingdom (M.T.); Laboratory of Neurobiology, Vesalius Research Center, VIB, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease, University of Leuven, Leuven, Belgium (V.T.); Department of Neurology, Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (V.T.); School of Medicine and Public Health (E.G.H.) and Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute and School of Medicine and Public Health (C.L.), University of Newcastle, Newcastle, NSW, Australia; Clinical Research Design, IT and Statistical Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia (E.G.H.); School of Life Science, University of Lincoln, Lincoln, United Kingdom (S.B.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany (R.M., M.D.); Department of Cerebrovascular Disease, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy (G.B.); Division of Clinical Neurosciences, Neuroimaging Sciences and Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom (C.S.); Stroke Prevention Research Unit, Nuffield Department of Neuroscience, University of Oxford, Oxford, United Kingdom (P.M.R.); and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
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Gesierich B, Duchesnay E, Jouvent E, Chabriat H, Schmidt R, Mangin JF, Duering M, Dichgans M. Features and Determinants of Lacune Shape: Relationship With Fiber Tracts and Perforating Arteries. Stroke 2016; 47:1258-64. [PMID: 27048698 DOI: 10.1161/strokeaha.116.012779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Lacunes are a major manifestation of cerebral small vessel disease. Although still debated, the morphological features of lacunes may offer mechanistic insights. We systematically analyzed the shape of incident lacunes in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, a genetically defined small vessel disease. METHODS A total of 88 incident lacunes from 57 patients were segmented from 3-dimensional T1 magnetic resonance images and 3 dimensionally reconstructed. Anatomic location, diameter, volume, surface area, and compactness of lacunes were assessed. The shape was analyzed using a size, orientation, and position invariant spectral shape descriptor. We further investigated the relationship with perforating arteries and fiber tracts. RESULTS Lacunes were most abundant in the centrum semiovale and the basal ganglia. Diameter, volume, and surface area of lacunes in the basal ganglia and centrum semiovale were larger than in other brain regions. The spectral shape descriptor revealed a continuum of shapes with no evidence for distinct classes of lacunes. Shapes varied mostly in elongation and planarity. The main axis and plane of lacunes were found to align with the orientation of perforating arteries but not with fiber tracts. CONCLUSIONS Elongation and planarity are the primary shape principles of lacunes. Their main axis and plane align with perforating arteries. Our findings add to current concepts on the mechanisms of lacunes.
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Affiliation(s)
- Benno Gesierich
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Edouard Duchesnay
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Eric Jouvent
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Hugues Chabriat
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Reinhold Schmidt
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Jean-Francois Mangin
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Marco Duering
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans)
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany (B.G., M. Duering, M. Dichgans); Neurospin, CEA Saclay, Paris, France (E.D., J.-F.M.); Department of Neurology, DHU NeuroVasc, Hopital Lariboisiere, APHP, Paris, France (E.J., H.C.); Department of Neurology, Medical University of Graz, Austria (R.S.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M. Dichgans); and German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M. Dichgans).
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