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Vazquez JP, Verghese J, Barzilai N, Milman S, Blumen HM. White Matter Hyperintensities Are Associated with Slower Gait Speed in Older Adults without Dementia. NEURODEGENER DIS 2024:1-9. [PMID: 39025052 DOI: 10.1159/000538944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/08/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Slow gait speed is associated with poor health outcomes in aging, but the relationship between cerebral small vessel disease (CSVD) pathologies and gait speed in aging is not well understood. We investigated the relationships between CSVD imaging markers and gait speed during simple (normal pace walking [NPW]) and complex (walking while talking [WWT]) as both measures are associated with shared health outcomes such as falls, frailty, disability, mortality, and dementia. METHODS A total of 113 Ashkenazi Jewish adults over 65 (M age = 78.6 ± 6.3 years, 45.8% women) and without dementia were examined. Established rating systems were used to quantify white matter hyperintensities (WMHs) and lacunes of presumed vascular origin from fluid-attenuated inversion recovery (FLAIR) images. Linear regression models adjusted for age, sex, global health, and total intracranial volume were used to examine associations between CSVD markers and gait speed during NPW and WWT. Student t tests were used to contrast gait speed in those with "confluent-diffuse" WMH and those with "mild or no" WMH. RESULTS The number of WMH in the basal ganglia (β = -3.274 cm/s p = 0.047) and temporal lobes (β = -3.113 cm/s p = 0.048) were associated with slower NPW speed in adjusted models. Participants with higher CSVD burden (confluent-diffuse pattern) in the frontal lobe (94.65 cm/s vs. 105.21 cm/s, p = 0.018) and globally (98.98 cm/s vs. 107.24 cm/s, p = 0.028) also had lower NPW speed. WMHs were not associated with WWT speeds. Lacunes were not associated with NPW or WWT speed. CONCLUSION Adjusted models found higher CSVD burden as measured by the presence of WMH in the basal ganglia and temporal lobes were associated with slower normal pace gait speed in older adults, but not with complex walking speeds. Participants with confluent-diffuse WMHs in the frontal lobes were found to have slower average normal gait speed. Further studies are needed to establish the temporality of WMH and gait speed decline as well as mechanistic links between the two.
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Affiliation(s)
- Juan P Vazquez
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA,
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Helena M Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Chen J, Li J, Wang X, Fu X, Ke J, Li J, Wen J, Cheng K, Li S, Shi Z. Heme Oxygenase-1 Gene (GT)n Polymorphism Linked to Deep White Matter Hyperintensities, Not Periventricular Hyperintensities. J Am Heart Assoc 2024; 13:e033981. [PMID: 38818928 PMCID: PMC11255616 DOI: 10.1161/jaha.123.033981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Oxidative stress plays a principal role in the pathogenesis of white matter hyperintensities (WMHs). The induction of heme oxygenase-1 (HO-1) gene in the brain represents 1 of the pivotal mechanisms to counteract the noxious effects of reactive oxygen species, and the transcriptional modulation of HO-1 induction depends on the length of a GT-repeat (GT)n in the promoter region. We investigated whether the HO-1 gene (GT)n polymorphism is associated with the risk of WMHs. METHODS AND RESULTS A total of 849 subjects from the memory clinic were consecutively enrolled, and the HO-1 (GT)n genotype was determined. WMHs were assessed with the Fazekas scale and further divided into periventricular WMHs and deep WMHs (DWMHs). Allelic HO-1 (GT)n polymorphisms were classified as short (≤24 (GT)n), median (25≤[GT]n<31), or long (31≤[GT]n). Multivariate logistic regression analysis was used to evaluate the effect of the HO-1 (GT)n variants on WMHs. The number of repetitions of the HO-1 gene (GT)n ranged from 15 to 39 with a bimodal distribution at lengths 23 and 30. The proportion of S/S genotypes was higher for moderate/severe DWMHs than none/mild DWMHs (22.22% versus 12.44%; P=0.001), but the association for periventricular WMHs was not statistically significant. Logistic regression suggested that the S/S genotype was significantly associated with moderate/severe DWMHs (S/S versus non-S/S: odds ratio, 2.001 [95% CI, 1.323-3.027]; P<0.001). The HO-1 gene (GT)n S/S genotype and aging synergistically contributed to the progression of DWMHs (relative excess risk attributable to interaction, 6.032 [95% CI, 0.149-11.915]). CONCLUSIONS Short (GT)n variants in the HO-1 gene may confer susceptibility to rather than protection from DWMHs, but not periventricular WMHs. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100045869.
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Affiliation(s)
- Junting Chen
- Department of Neurology and Memory CenterThe 10th Affiliate Hospital, Southern Medical UniversityDongguanChina
- Postgraduate SchoolGuangdong Medical UniversityZhanjiangGuangdongChina
| | - Jinrui Li
- Department of Neurology and Memory CenterThe 10th Affiliate Hospital, Southern Medical UniversityDongguanChina
- The 1st Clinical Medical SchoolSouthern Medical UniversityDongguanChina
| | - Xiaomian Wang
- Postgraduate SchoolGuangdong Medical UniversityZhanjiangGuangdongChina
| | - Xiaoli Fu
- Department of Neurology and Memory CenterThe 10th Affiliate Hospital, Southern Medical UniversityDongguanChina
| | - Jianxia Ke
- The 1st Clinical Medical SchoolSouthern Medical UniversityDongguanChina
| | - Jintao Li
- The 1st Clinical Medical SchoolSouthern Medical UniversityDongguanChina
| | - Jia Wen
- Postgraduate SchoolGuangdong Medical UniversityZhanjiangGuangdongChina
| | - Kailin Cheng
- Postgraduate SchoolGuangdong Medical UniversityZhanjiangGuangdongChina
| | - Shuen Li
- Department of Neurology and Memory CenterThe 10th Affiliate Hospital, Southern Medical UniversityDongguanChina
| | - Zhu Shi
- Department of Neurology and Memory CenterThe 10th Affiliate Hospital, Southern Medical UniversityDongguanChina
- Postgraduate SchoolGuangdong Medical UniversityZhanjiangGuangdongChina
- The 1st Clinical Medical SchoolSouthern Medical UniversityDongguanChina
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Xu W, Chen K, Yuan Y, Guo M, Dong Q, Cui M. Ring finger protein 216 loss-of-function induces white matter hyperintensities by inhibiting oligodendroglia proliferation. Cell Biochem Funct 2024; 42:e4057. [PMID: 38853469 DOI: 10.1002/cbf.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/12/2024] [Accepted: 05/12/2024] [Indexed: 06/11/2024]
Abstract
White matter hyperintensities (WMHs) refer to a group of diseases with numerous etiologies while oligodendrocytes remain the centerpiece in the pathogenesis of WMHs. Ring Finger Protein 216 (RNF216) encodes a ubiquitin ligase, and its mutation begets WMHs, ataxia, and cognitive decline in patients. Yet no study has revealed the function of RNF216 in oligodendroglia and WHIs before. In this study, we summarized the phenotypes of RNF216-mutation cases and explored the normal distribution of RNF216 in distinct brain regions and neuronal cells by bioinformatic analysis. Furthermore, MO3.13, a human oligodendrocyte cell line, was applied to study the function alteration after RNF216 knockdown. As a result, WMHs were the most common symptom in RNF216-mutated diseases, and RNF216 was indeed relatively enriched in corpus callosum and oligodendroglia in humans. The downregulation of RNF216 in oligodendroglia remarkably hampered cell proliferation by inhibiting the Akt pathway while having no significant effect on cell injury and oligodendrocyte maturation. Combining clinical, bioinformatical, and experimental evidence, our study implied the pivotal role of RNF216 in WMHs which might serve as a potent target in the therapy of WMHs.
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Affiliation(s)
- Wenqing Xu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Keliang Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwen Yuan
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Guo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Flack KA, Rainey ES, Urasa SJ, Koipapi S, Kalaria RN, Howlett WP, Mukaetova-Ladinska EB, Dekker MCJ, Gray WK, Walker RW, Dotchin CL, Mtwaile H, Lewis TCD, Stone LG, McNally RJQ, Makupa PC, Paddick SM. Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania. Viruses 2024; 16:819. [PMID: 38932112 PMCID: PMC11209468 DOI: 10.3390/v16060819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.
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Affiliation(s)
- Katherine A. Flack
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Emma S. Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Sarah J. Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Rajesh N. Kalaria
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - William P. Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Elizabeta B. Mukaetova-Ladinska
- Department of Neuroscience, Behaviour and Psychology, University of Leicester, Leicester LE1 7HA, UK
- The Evington Centre, Leicester General Hospital, Leicester LE5 4QF, UK
| | - Marieke C. J. Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - William K. Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Richard W. Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Catherine L. Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Himidi Mtwaile
- Department of Radiology, NSK Hospital, Arusha P.O. Box 3114, Tanzania
| | - Thomas C. D. Lewis
- Department of Old Age Psychiatry, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 6BE, UK
| | - Lydia G. Stone
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - Philip C. Makupa
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro P.O Box 3054, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Gateshead NE8 4YL, UK
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Schramm SH, Tenhagen I, Jokisch M, Gronewold J, Moebus S, Caspers S, Katsarava Z, Erbel R, Stang A, Schmidt B. Migraine or any headaches and white matter hyperintensities and their progression in women and men. J Headache Pain 2024; 25:78. [PMID: 38745272 PMCID: PMC11094904 DOI: 10.1186/s10194-024-01782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Cross-sectional and longitudinal studies have been conducted to investigate the association between migraine and any headache and white matter hyperintensities (WMH). However, studies are inconsistent regarding the strength of the association and its clinical significance. The aim of our study was to investigate the association between headache and its subtypes (migraine with aura (MigA+), migraine without aura (MigA-), non-migraine headache (nonMigHA)) and WMH and its course in the population-based 1000BRAINS study using state-of-the-art imaging techniques and migraine classification according to modified international classification of headache disorders. METHODS Data from 1062 participants (45% women, 60.9 ± 13.0 years) with ever or never headache (neverHA) and complete quantitative (WMH volume) and qualitative (Fazekas classification) WMH data at first imaging and after 3.7 ± 0.7 years (393 participants) were analyzed. The sex-specific association between headache and its subtypes and WMH volume and its change was evaluated by linear regression, between headache and its subtypes and Fazekas score high vs. low (2-3 vs. 0-1) by log-binomial regression, adjusted for confounders. RESULTS The lifetime prevalence of headache was 77.5% (10.5% MigA+, 26.9% MigA-, 40.1% nonMigHA). The median WMH volume was 4005 (IQR: 2454-6880) mm3 in women and 4812 (2842-8445) mm3 in men. Women with any headaches (all headache types combined) had a 1.23 [1.04; 1.45]-fold higher WMH volume than women who reported never having had a headache. There was no indication of higher Fazekas grading or more WMH progression in women with migraine or any headaches. Men with migraine or any headaches did not have more WMH or WMH progression compared to men without migraine or men who never had headache. CONCLUSIONS Our study demonstrated no increased occurrence or progression of WMH in participants with mgiraine. But, our results provide some evidence of greater WMH volume in women with headache of any type including migraine. The underlying pathomechanisms and the reasons why this was not shown in men are unclear and require further research.
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Affiliation(s)
- Sara Helena Schramm
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, D-45122, Essen, Germany.
| | - I Tenhagen
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, D-45122, Essen, Germany
| | - M Jokisch
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - J Gronewold
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Moebus
- Institute for Urban Public Health, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - S Caspers
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Jülich, Germany
| | - Z Katsarava
- Department of Neurology, Christian Hospital Unna, Holbeinstr. 10, 59423, Unna, Germany
- EVEX Medical Corporation, 40 Vazha-Pshavela Avenue, Tbilisi, 0177, Georgia
| | - R Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, D-45122, Essen, Germany
| | - A Stang
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, D-45122, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, USA
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr. 55, D-45122, Essen, Germany
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Huang WQ, Lin Q, Tzeng CM. Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities. J Stroke 2024; 26:131-163. [PMID: 38836265 PMCID: PMC11164597 DOI: 10.5853/jos.2023.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Leukoaraiosis (LA) manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue. Clinically, it is generally detected in the early 40s and is highly prevalent globally in individuals aged >60 years. From the imaging perspective, LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign. Given its potential of having deleterious effects on normal brain function and the resulting increase in public health burden, considerable effort has been focused on investigating the associations between various risk factors and LA risk, and developing its associated clinical interventions. However, study results have been inconsistent, most likely due to potential differences in study designs, neuroimaging methods, and sample sizes as well as the inherent neuroimaging heterogeneity and multi-factorial nature of LA. In this article, we provided an overview of LA and summarized the current knowledge regarding its epidemiology, neuroimaging classification, pathological characteristics, risk factors, and potential intervention strategies.
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Affiliation(s)
- Wen-Qing Huang
- Department of Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lin
- Department of Neurology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Clinical Research Center for Brain Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian, China
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Nociti V, Romozzi M, Mirabella M. Challenges in Diagnosis and Therapeutic Strategies in Late-Onset Multiple Sclerosis. J Pers Med 2024; 14:400. [PMID: 38673027 PMCID: PMC11051411 DOI: 10.3390/jpm14040400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative demyelinating disease of the central nervous system of unknown etiology, which affects individuals in their early adulthood. However, nearly 5-10% of people with MS can be diagnosed at ages above 50 years old, referred to as late-onset multiple sclerosis (LOMS). Some studies have reported a distinctive presentation, clinical course, and prognosis for LOMS, implicating a different diagnostic and therapeutic approach for this population. Furthermore, similar manifestations between LOMS and other age-related conditions may lead to potential misdiagnosis and diagnostic delays, and a higher burden of multimorbidity associated with aging can further complicate the clinical picture. This review aims to explore the clinical characteristics, the disease course, and the differential diagnosis of LOMS and addresses therapeutic considerations for this population.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Massimiliano Mirabella
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
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Zhou R, Cai Q, Liu C, Hui J, Kang M, Gou Y, Liu Y, Shi P, Wang B, Zhang F. Association between white matter hyperintensity and anxiety/depression. Cereb Cortex 2024; 34:bhae149. [PMID: 38602744 DOI: 10.1093/cercor/bhae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Although previous studies have explored the associations of white matter hyperintensity with psychiatric disorders, the sample size is small and the conclusions are inconsistent. The present study aimed to further systematically explore the association in a larger sample. All data were extracted from the UK Biobank. First, general linear regression models and logistic regression models were used to assess the association between white matter hyperintensity volume and anxiety/depression. White matter hyperintensity has been classified into periventricular white matter hyperintensity and deep white matter hyperintensity. Anxiety was determined by General Anxiety Disorder-7 score (n = 17,221) and self-reported anxiety (n = 15,333), depression was determined by Patient Health Questionnaire-9 score (n = 17,175), and self-reported depression (n = 14,519). Moreover, we employed Cox proportional hazard models to explore the association between white matter hyperintensity volume and anxiety/depression. The covariates included in fully adjusted model are age, gender, body mass index, Townsend deprivation index, healthy physical activity, cigarette consumption, alcohol consumption, educational attainment, diabetes, hypertension, and coronary heart disease. The results of the fully adjusted model showed that white matter hyperintensity volume was significantly associated with General Anxiety Disorder-7 score (periventricular white matter hyperintensity: β = 0.152, deep white matter hyperintensity: β = 0.094) and Patient Health Questionnaire-9 score (periventricular white matter hyperintensity: β = 0.168). Logistic regression analysis results indicated that periventricular white matter hyperintensity volume (odds ratio = 1.153) was significantly associated with self-reported anxiety. After applying the Cox proportional hazard models, we found that larger white matter hyperintensity volume was associated with increased risk of depression (periventricular white matter hyperintensity: hazard ratio = 1.589, deep white matter hyperintensity: hazard ratio = 1.200), but not anxiety. In summary, our findings support a positive association between white matter hyperintensity volume and depression.
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Affiliation(s)
- Ruixue Zhou
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Qingqing Cai
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Chen Liu
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Jingni Hui
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Meijuan Kang
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Yifan Gou
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Ye Liu
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Panxing Shi
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Bingyi Wang
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, P. R. China
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Van Etten EJ, Bharadwaj PK, Grilli MD, Raichlen DA, Hishaw GA, Huentelman MJ, Trouard TP, Alexander GE. Impact of age and apolipoprotein E ε4 status on regional white matter hyperintensity volume and cognition in healthy aging. J Int Neuropsychol Soc 2024:1-11. [PMID: 38515367 DOI: 10.1017/s1355617724000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE White matter hyperintensity (WMH) volume is a neuroimaging marker of lesion load related to small vessel disease that has been associated with cognitive aging and Alzheimer's disease (AD) risk. METHOD The present study sought to examine whether regional WMH volume mediates the relationship between APOE ε4 status, a strong genetic risk factor for AD, and cognition and if this association is moderated by age group differences within a sample of 187 healthy older adults (APOE ε4 status [carrier/non-carrier] = 56/131). RESULTS After we controlled for sex, education, and vascular risk factors, ANCOVA analyses revealed significant age group by APOE ε4 status interactions for right parietal and left temporal WMH volumes. Within the young-old group (50-69 years), ε4 carriers had greater right parietal and left temporal WMH volumes than non-carriers. However, in the old-old group (70-89 years), right parietal and left temporal WMH volumes were comparable across APOE ε4 groups. Further, within ε4 non-carriers, old-old adults had greater right parietal and left temporal WMH volumes than young-old adults, but there were no significant differences across age groups in ε4 carriers. Follow-up moderated mediation analyses revealed that, in the young-old, but not the old-old group, there were significant indirect effects of ε4 status on memory and executive functions through left temporal WMH volume. CONCLUSIONS These findings suggest that, among healthy young-old adults, increased left temporal WMH volume, in the context of the ε4 allele, may represent an early marker of cognitive aging with the potential to lead to greater risk for AD.
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Affiliation(s)
- Emily J Van Etten
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Pradyumna K Bharadwaj
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
| | - Matthew D Grilli
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
- Department of Neurology, University of Arizona, Tucson, AZ, USA
| | - David A Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA
| | - Georg A Hishaw
- Department of Neurology, University of Arizona, Tucson, AZ, USA
| | - Matthew J Huentelman
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
- Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Theodore P Trouard
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Gene E Alexander
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, USA
- Arizona Alzheimer's Consortium, Phoenix, AZ, USA
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
- Neuroscience Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, USA
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, USA
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Van Etten EJ, Bharadwaj PK, Grilli MD, Raichlen DA, Hishaw GA, Huentelman MJ, Trouard TP, Alexander GE. Regional covariance of white matter hyperintensity volume patterns associated with hippocampal volume in healthy aging. Front Aging Neurosci 2024; 16:1349449. [PMID: 38524117 PMCID: PMC10957632 DOI: 10.3389/fnagi.2024.1349449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Hippocampal volume is particularly sensitive to the accumulation of total brain white matter hyperintensity volume (WMH) in aging, but how the regional distribution of WMH volume differentially impacts the hippocampus has been less studied. In a cohort of 194 healthy older adults ages 50-89, we used a multivariate statistical method, the Scaled Subprofile Model (SSM), to (1) identify patterns of regional WMH differences related to left and right hippocampal volumes, (2) examine associations between the multimodal neuroimaging covariance patterns and demographic characteristics, and (3) investigate the relation of the patterns to subjective and objective memory in healthy aging. We established network covariance patterns of regional WMH volume differences associated with greater left and right hippocampal volumes, which were characterized by reductions in left temporal and right parietal WMH volumes and relative increases in bilateral occipital WMH volumes. Additionally, we observed lower expression of these hippocampal-related regional WMH patterns were significantly associated with increasing age and greater subjective memory complaints, but not objective memory performance in this healthy older adult cohort. Our findings indicate that, in cognitively healthy older adults, left and right hippocampal volume reductions were associated with differences in the regional distribution of WMH volumes, which were exacerbated by advancing age and related to greater subjective memory complaints. Multivariate network analyses, like SSM, may help elucidate important early effects of regional WMH volume on brain and cognitive aging in healthy older adults.
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Affiliation(s)
- Emily J. Van Etten
- Department of Psychology, University of Arizona, Tucson, AZ, United States
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Pradyumna K. Bharadwaj
- Department of Psychology, University of Arizona, Tucson, AZ, United States
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
| | - Matthew D. Grilli
- Department of Psychology, University of Arizona, Tucson, AZ, United States
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - David A. Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA, United States
- Department of Anthropology, University of Southern California, Los Angeles, CA, United States
| | - Georg A. Hishaw
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Matthew J. Huentelman
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
- Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
| | - Theodore P. Trouard
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, United States
| | - Gene E. Alexander
- Department of Psychology, University of Arizona, Tucson, AZ, United States
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ, United States
- Arizona Alzheimer’s Consortium, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
- Neuroscience Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, United States
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, United States
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11
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Ang PS, Zhang DM, Azizi SA, Norton de Matos SA, Brorson JR. The glymphatic system and cerebral small vessel disease. J Stroke Cerebrovasc Dis 2024; 33:107557. [PMID: 38198946 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Cerebral small vessel disease is a group of pathologies in which alterations of the brain's blood vessels contribute to stroke and neurocognitive changes. Recently, a neurotoxic waste clearance system composed of perivascular spaces abutting the brain's blood vessels, termed the glymphatic system, has been identified as a key player in brain homeostasis. Given that small vessel disease and the glymphatic system share anatomical structures, this review aims to reexamine small vessel disease in the context of the glymphatic system and highlight novel aspects of small vessel disease physiology. MATERIALS AND METHODS This review was conducted with an emphasis on studies that examined aspects of small vessel disease and on works characterizing the glymphatic system. We searched PubMed for relevant articles using the following keywords: glymphatics, cerebral small vessel disease, arterial pulsatility, hypertension, blood-brain barrier, endothelial dysfunction, stroke, diabetes. RESULTS Cerebral small vessel disease and glymphatic dysfunction are anatomically connected and significant risk factors are shared between the two. These include hypertension, type 2 diabetes, advanced age, poor sleep, obesity, and neuroinflammation. There is clear evidence that CSVD hinders the effective functioning of glymphatic system. CONCLUSION These shared risk factors, as well as the model of cerebral amyloid angiopathy pathogenesis, hint at the possibility that glymphatic dysfunction could independently contribute to the pathogenesis of cerebral small vessel disease. However, the current evidence supports a model of cascading dysfunction, wherein concurrent small vessel and glymphatic injury hinder glymphatic-mediated recovery and promote the progression of subclinical to clinical disease.
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Affiliation(s)
- Phillip S Ang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Douglas M Zhang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Saara-Anne Azizi
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | | | - James R Brorson
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States; Department of Neurology, The University of Chicago, Chicago, IL 60637, United States.
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12
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Switzer AR, Graff-Radford J, Gunter JL, Elder BD, Jones DT, Huston J, Jack CR, Cogswell PM. Patients with normal pressure hydrocephalus have fewer enlarged perivascular spaces in the centrum semiovale compared to cognitively unimpaired individuals. Clin Neurol Neurosurg 2024; 237:108123. [PMID: 38262154 DOI: 10.1016/j.clineuro.2024.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Enlarged perivascular spaces (ePVS) may be an indicator of glymphatic dysfunction. Limited studies have evaluated the role of ePVS in idiopathic normal pressure hydrocephalus (iNPH). We aimed to characterize the distribution and number of ePVS in iNPH compared to controls. METHODS Thirty-eight patients with iNPH and a pre-shunt MRI were identified through clinical practice. Age- and sex-matched controls who had negative MRIs screening for intracranial metastases were identified through a medical record linkage system. The number of ePVS were counted in the basal nuclei (BN) and centrum semiovale (CS) using the Wardlaw method blinded to clinical diagnosis. Imaging features of disproportionately enlarged subarachnoid space hydrocephalus (DESH), callosal angle, Fazekas white matter hyperintensity (WMH) grade, and the presence of microbleeds and lacunes were also evaluated. RESULTS Both iNPH patients and controls had a mean age of 74 ± 7 years and were 34% female with equal distributions of hypertension, dyslipidemia, diabetes, stroke, and history of smoking. There were fewer ePVS in the CS of patients with iNPH compared to controls (12.66 vs. 20.39, p < 0.001) but the same in the BN (8.95 vs. 11.11, p = 0.08). This remained significant in models accounting for vascular risk factors (p = 0.002) and MRI features of DESH and WMH grade (p = 0.03). CONCLUSIONS Fewer centrum semiovale ePVS may be a biomarker for iNPH. This pattern may be caused by mechanical obstruction due to upward displacement of the brain leading to reduced glymphatic clearance.
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Affiliation(s)
- Aaron R Switzer
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA; Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
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13
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Ye X, Jia Y, Song G, Liu X, Wu C, Li G, Zhao X, Wang X, Huang S, Zhu S. Apolipoprotein E ɛ2 Is Associated with the White Matter Hyperintensity Multispot Pattern in Spontaneous Intracerebral Hemorrhage. Transl Stroke Res 2024; 15:101-109. [PMID: 36495423 DOI: 10.1007/s12975-022-01113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
The white matter hyperintensity (WMH) multispot pattern, as multiple punctate subcortical foci, could differentiate cerebral amyloid angiopathy (CAA) from hypertensive arteriolopathy. Nevertheless, the pathophysiology underlying the multispot sign is still inexplicit. We aimed to explore risk factors for multispot patterns in cerebral small vessel disease (CSVD)-related intracerebral hemorrhage (ICH). Between June 2018 and January 2020, we retrospectively rated the WMH multispot pattern while blinded to our prospective spontaneous ICH cohort's clinical data. Demographic, genetic, and neuroimaging characteristics were applied in establishing the multispot pattern models via multiple logistic regression. In total, 268 participants were selected from our cohort. The possession of apolipoprotein E (APOE) ε2 (P = 0.051) was associated with multispot WMH in univariate analysis. Multispot WMHs were accompanied by multiple CAA features, such as centrum semiovale (CSO)-perivascular space (PVS) predominance (P = 0.032) and severe CSO-PVS (P < 0.001). After adjusting for confounding factors, APOE ε2 possession (OR 2.99, 95% CI [1.07, 8.40]; P = 0.037), severe CSO-PVS (OR 2.39, 95% CI [1.09, 5.26]; P = 0.031), and large posterior subcortical patches (P = 0.001) were independently correlated with the multispot pattern in multivariate analysis. Moreover, APOE ε2 possession (OR 4.34, 95% CI [1.20, 15.62]; P = 0.025) and severe CSO-PVS (OR 3.39, 95% CI [1.23, 9.34]; P = 0.018) remained statistically significant among the participants older than 55 years of age and with categorizable CSVD. APOE ε2 and severe CSO-PVS contribute to the presence of WMH multispot patterns. Because the multispot pattern is a potential diagnostic biomarker in CAA, genetics-driven effects shed light on its underlying vasculopathy. Clinical Trial Registration: URL- http://www.chictr.org.cn . Unique identifier: ChiCTR-ROC-2000039365. Registration date 2020/10/24 (retrospectively registered).
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Affiliation(s)
- Xiaodong Ye
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Yuchao Jia
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Guini Song
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Xiaoyan Liu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Chuyue Wu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Guo Li
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China
| | - Xu Zhao
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiong Wang
- Department of Laboratory Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jie Fang Avenue, Hankou, Wuhan, 430030, Hubei, People's Republic of China.
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14
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Tu MC. Editorial: White matter hyperintensities: the messages beneath and beyond. Front Aging Neurosci 2024; 16:1367024. [PMID: 38313437 PMCID: PMC10834768 DOI: 10.3389/fnagi.2024.1367024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Affiliation(s)
- Min-Chien Tu
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan
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15
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Fisher DW, Dunn JT, Dong H. Distinguishing features of depression in dementia from primary psychiatric disease. DISCOVER MENTAL HEALTH 2024; 4:3. [PMID: 38175420 PMCID: PMC10767128 DOI: 10.1007/s44192-023-00057-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
Depression is a common and devastating neuropsychiatric symptom in the elderly and in patients with dementia. In particular, nearly 80% of patients with Alzheimer's Disease dementia experience depression during disease development and progression. However, it is unknown whether the depression in patients with dementia shares the same molecular mechanisms as depression presenting as primary psychiatric disease or occurs and persists through alternative mechanisms. In this review, we discuss how the clinical presentation and treatment differ between depression in dementia and as a primary psychiatric disease, with a focus on major depressive disorder. Then, we hypothesize several molecular mechanisms that may be unique to depression in dementia such as neuropathological changes, inflammation, and vascular events. Finally, we discuss existing issues and future directions for investigation and treatment of depression in dementia.
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Affiliation(s)
- Daniel W Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, USA
| | - Jeffrey T Dunn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
- Department of Neurology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
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16
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Zakharov VV, Chernousov PA, Vekhova KA, Bogolepova AN. [Cognitive impairment in patients with arterial hypertension]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:41-48. [PMID: 38696150 DOI: 10.17116/jnevro202412404241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Arterial hypertension (AH) is a leading risk factor for cardiovascular diseases including cerebrovascular complications. Strokes and/or vascular cognitive impairment (VCI) are considered as a clinical sign of brain damage as a target organ in hypertension. To identify and assess the severity of VCI, patients with hypertension should undergo a neuropsychological assessment. Neuroimaging confirm the vascular origin of cognitive impairment. Patient management should include antihypertensive therapy along with neuroprotection. Among different neuroprotective therapy, ethylmethylhydroxypyridine succinate (mexidol) is one of medication with serious evidence of clinical efficacy.
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Affiliation(s)
- V V Zakharov
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
| | - P A Chernousov
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
| | - K A Vekhova
- Sechenov First Moscow Medical University (Sechenov University), Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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17
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Nakase T, Thyreau B, Tatewaki Y, Tomita N, Takano Y, Muranaka M, Taki Y. Association between Gray and White Matter Lesions and Its Involvement in Clinical Symptoms of Alzheimer's-Type Dementia. J Clin Med 2023; 12:7642. [PMID: 38137710 PMCID: PMC10744158 DOI: 10.3390/jcm12247642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Not only gray matter lesions (GMLs) but also white matter lesions (WMLs) can play important roles in the pathology of Alzheimer's disease (AD). The progression of cognitive impairment (CI) and behavioral and psychological symptoms of dementia (BPSD) might be caused by a concerted effect of both GML and WML. OBJECTIVE This study aimed to investigate the association between GML and WML and how they are involved in the symptoms of CI and BPSD in dementia patients by means of imaging technology. METHODS Patients in our memory clinic, who were diagnosed with AD-type dementia or amnestic mild cognitive impairment (aMCI) and had undergone both single-photon emission computed tomography (SPECT) and brain MRI, were consecutively enrolled (n = 156; 61 males and 95 females; 79.8 ± 7.4 years old). Symptoms of CI and BPSD were obtained from patients' medical records. For the analysis of GMLs and WMLs, SPECT data and MRI T1-weighted images were used, respectively. This study followed the Declaration of Helsinki, and all procedures were approved by the institutional ethics committee. RESULTS According to a multivariate analysis, disorientation and disturbed attention demonstrated a relationship between the precuneus and WMLs in both hemispheres. Hyperactivity in BPSD showed multiple correlations between GMLs on both sides of the frontal cortex and WMLs. Patients with aMCI presented more multiple correlations between GMLs and WMLs compared with those with AD-type dementia regarding dementia symptoms including BPSD. CONCLUSION The interaction between GMLs and WMLs may vary depending on the symptoms of CI and BPSD. Hyperactivity in BPSD may be affected by the functional relationship between GMLs and WMLs in the left and right hemispheres. The correlation between GMLs and WMLs may be changing in AD-type dementia and aMCI.
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Affiliation(s)
- Taizen Nakase
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
| | - Benjamin Thyreau
- Smart Aging Research Center, Tohoku University, Sendai 980-8575, Japan;
| | - Yasuko Tatewaki
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
| | - Naoki Tomita
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
| | - Yumi Takano
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
| | - Michiho Muranaka
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
| | - Yasuyuki Taki
- Department of Aging Research & Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan; (Y.T.); (N.T.); (Y.T.)
- Smart Aging Research Center, Tohoku University, Sendai 980-8575, Japan;
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18
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Caçoilo A, Dortdivanlioglu B, Rusinek H, Weickenmeier J. A multiphysics model to predict periventricular white matter hyperintensity growth during healthy brain aging. BRAIN MULTIPHYSICS 2023; 5:100072. [PMID: 37546181 PMCID: PMC10399513 DOI: 10.1016/j.brain.2023.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Periventricular white matter hyperintensities (WMH) are a common finding in medical images of the aging brain and are associated with white matter damage resulting from cerebral small vessel disease, white matter inflammation, and a degeneration of the lateral ventricular wall. Despite extensive work, the etiology of periventricular WMHs remains unclear. We pose that there is a strong coupling between age-related ventricular expansion and the degeneration of the ventricular wall which leads to a dysregulated fluid exchange across this brain-fluid barrier. Here, we present a multiphysics model that couples cerebral atrophy-driven ventricular wall loading with periventricular WMH formation and progression. We use patient data to create eight 2D finite element models and demonstrate the predictive capabilities of our damage model. Our simulations show that we accurately capture the spatiotemporal features of periventricular WMH growth. For one, we observe that damage appears first in both the anterior and posterior horns and then spreads into deeper white matter tissue. For the other, we note that it takes up to 12 years before periventricular WMHs first appear and derive an average annualized periventricular WMH damage growth rate of 15.2 ± 12.7 mm2/year across our models. A sensitivity analysis demonstrated that our model parameters provide sufficient sensitivity to rationalize subject-specific differences with respect to onset time and damage growth. Moreover, we show that the septum pellucidum, a membrane that separates the left and right lateral ventricles, delays the onset of periventricular WMHs at first, but leads to a higher WMH load in the long-term.
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Affiliation(s)
- Andreia Caçoilo
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States of America
| | - Berkin Dortdivanlioglu
- Civil, Architectural, and Environmental Engineering, The University of Texas at Austin, Austin, TX 78712, United States of America
| | - Henry Rusinek
- Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, United States of America
| | - Johannes Weickenmeier
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States of America
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Wang R, Wu X, Zhang Z, Cao L, Kwapong WR, Wang H, Tao W, Ye C, Liu J, Wu B. Retinal ganglion cell-inner plexiform layer, white matter hyperintensities, and their interaction with cognition in older adults. Front Aging Neurosci 2023; 15:1240815. [PMID: 38035269 PMCID: PMC10685347 DOI: 10.3389/fnagi.2023.1240815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose We explored the interaction of optical coherence tomography (OCT) parameters and white matter hyperintensities with cognitive measures in our older adult cohort. Methods This observational study enrolled participants who underwent a comprehensive neuropsychological battery, structural 3-T brain magnetic resonance imaging (MRI), visual acuity examination, and OCT imaging. Cerebral small vessel disease (CSVD) markers were read on MR images; lacune, cerebral microbleeds (CMB), white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS), were defined according to the STRIVE standards. Retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thicknesses (μm) were measured on the OCT tool. Results Older adults with cognitive impairment (CI) showed lower RNFL (p = 0.001), GCIPL (p = 0.009) thicknesses, and lower hippocampal volume (p = 0.004) when compared to non-cognitively impaired (NCI). RNFL (p = 0.006) and GCIPL thicknesses (p = 0.032) correlated with MoCA scores. GCIPL thickness (p = 0.037), total WMH (p = 0.003), PWMH (p = 0.041), and DWMH (p = 0.001) correlated with hippocampal volume in our older adults after adjusting for covariates. With hippocampal volume as the outcome, a significant interaction (p < 0.05) between GCIPL and PWMH and total WMH was observed in our older adults. Conclusion Both GCIPL thinning and higher WMH burden (especially PWMH) are associated with hippocampal volume and older adults with both pathologies are more susceptible to subclinical cognitive decline.
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Affiliation(s)
- Ruilin Wang
- Ophthalmology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xinmao Wu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Zengyi Zhang
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Le Cao
- Ophthalmology Department, West China Hospital, Sichuan University, Chengdu, China
| | | | - Hang Wang
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Wendan Tao
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Neurology Department, West China Hospital, Sichuan University, Chengdu, China
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Yliranta A, Karjalainen VL, Nuorva J, Ahmasalo R, Jehkonen M. Apraxia testing to distinguish early Alzheimer's disease from psychiatric causes of cognitive impairment. Clin Neuropsychol 2023; 37:1629-1650. [PMID: 36829305 DOI: 10.1080/13854046.2023.2181223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
Objective: Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly interpreted as symptoms of dementia; thus, more reliable diagnostic approaches are needed. The present work defines the discriminant accuracy of the Dementia Apraxia Test (DATE) between psychiatric conditions and early-onset Alzheimer's disease (AD) on its own and in combination with memory tests. Method: The consecutive sample included 50-70-year-old patients referred to dementia investigations for recent cognitive and/or affective symptoms. The DATE was administered and scored as a blinded measurement, and a receiver operating curve analysis was used to define the optimal diagnostic cut-off score. Results: A total of 24 patients were diagnosed with probable AD (mean age 61 ± 4) and 23 with a psychiatric condition (mean age 57 ± 4). The AD patients showed remarkable limb apraxia, but the psychiatric patients mainly performed at a healthy level on the DATE. The test showed a total discriminant accuracy of 87% for a total sum cut-off of 47 (sensitivity 79% and specificity 96%). The limb subscale alone reached an accuracy of 91% for a cut-off of 20 (sensitivity 83% and specificity 100%). All memory tests were diagnostically less accurate, while the combination of the limb praxis subscale and a verbal episodic memory test suggested a correct diagnosis in all but one patient. Conclusions: Apraxia testing may improve the accuracy of differentiation between AD and psychiatric aetiologies. Its potential in severe and chronic psychiatric conditions should be examined in the future.
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Affiliation(s)
- Aino Yliranta
- Faculty of Social Sciences, Tampere University
- Neurology Clinic, Lapland Central Hospital
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Nociti V, Romozzi M. The Importance of Managing Modifiable Comorbidities in People with Multiple Sclerosis: A Narrative Review. J Pers Med 2023; 13:1524. [PMID: 38003839 PMCID: PMC10672087 DOI: 10.3390/jpm13111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, degenerative demyelinating disease of the central nervous system (CNS) of unknown etiology that affects individuals in their early adulthood. In the last decade, life expectancy for people with MS (PwMS) has almost equaled that of the general population. This demographic shift necessitates a heightened awareness of comorbidities, especially the ones that can be prevented and modified, that can significantly impact disease progression and management. Vascular comorbidities are of particular interest as they are mostly modifiable health states, along with voluntary behaviors, such as smoking and alcohol consumption, commonly observed among individuals with MS. Vascular risk factors have also been implicated in the etiology of cerebral small vessel disease. Furthermore, differentiating between vascular and MS lesion load poses a significant challenge due to overlapping clinical and radiological features. This review describes the current evidence regarding the range of preventable and modifiable comorbidities and risk factors and their implications for PwMS.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marina Romozzi
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
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Duchesne J, Carrière I, Artero S, Brickman AM, Maller J, Meslin C, Chen J, Vienneau D, de Hoogh K, Jacquemin B, Berr C, Mortamais M. Ambient Air Pollution Exposure and Cerebral White Matter Hyperintensities in Older Adults: A Cross-Sectional Analysis in the Three-City Montpellier Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:107013. [PMID: 37878794 PMCID: PMC10599635 DOI: 10.1289/ehp12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Growing epidemiological evidence suggests an adverse relationship between exposure to air pollutants and cognitive health, and this could be related to the effect of air pollution on vascular health. OBJECTIVE We aim to evaluate the association between air pollution exposure and a magnetic resonance imaging (MRI) marker of cerebral vascular burden, white matter hyperintensities (WMH). METHODS This cross-sectional analysis used data from the French Three-City Montpellier study. Randomly selected participants 65-80 years of age underwent an MRI examination to estimate their total and regional cerebral WMH volumes. Exposure to fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), and black carbon (BC) at the participants' residential address during the 5 years before the MRI examination was estimated with land use regression models. Multinomial and binomial logistic regression assessed the associations between exposure to each of the three pollutants and categories of total and lobar WMH volumes. RESULTS Participants' (n = 582 ) median age at MRI was 70.7 years [interquartile range (IQR): 6.1], and 52% (n = 300 ) were women. Median exposure to air pollution over the 5 years before MRI acquisition was 24.3 (IQR: 1.7) μ g / m 3 for PM 2.5 , 48.9 (14.6) μ g / m 3 for NO 2 , and 2.66 (0.60) 10 - 5 / m for BC. We found no significant association between exposure to the three air pollutants and total WMH volume. We found that PM 2.5 exposure was significantly associated with higher risk of temporal lobe WMH burden [odds ratio (OR) for an IQR increase = 1.82 (95% confidence interval: 1.41, 2.36) for the second volume tercile, 2.04 (1.59, 2.61) for the third volume tercile, reference: first volume tercile]. Associations for other regional WMH volumes were inconsistent. CONCLUSION In this population-based study in older adults, PM 2.5 exposure was associated with increased risk of high WMH volume in the temporal lobe, strengthening the evidence on PM 2.5 adverse effect on the brain. Further studies looking at different markers of cerebrovascular damage are still needed to document the potential vascular effects of air pollution. https://doi.org/10.1289/EHP12231.
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Affiliation(s)
- Jeanne Duchesne
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Isabelle Carrière
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Sylvaine Artero
- Institute of Functional Genomics (IGF), University of Montpellier, CNRS, Inserm, Montpellier, France
| | - Adam M. Brickman
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, USA
| | - Jerome Maller
- Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia
- General Electric Healthcare, Richmond, Victoria, Australia
| | - Chantal Meslin
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Jie Chen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Bénédicte Jacquemin
- Irset Institut de Recherche en Santé, Environnement et Travail, UMR-S 1085, Inserm, University of Rennes, EHESP, Rennes, France
| | - Claudine Berr
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - Marion Mortamais
- Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
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Stendel MS, Chavez RS. Beyond the brain localization of complex traits: Distributed white matter markers of personality. J Pers 2023; 91:1140-1151. [PMID: 36273276 DOI: 10.1111/jopy.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extensive work in personality neuroscience has shown mixed results in the ability to localize reliable relationships between personality traits and neuroimaging measures. However, recent work in translational neuroimaging has recognized that multifaceted psychological dispositions are not represented in discrete, highly localized brain areas. As such, standard univariate neuroimaging analyses may not be well-suited for capturing broad personality traits supported by distributed networks. METHOD The present study uses an out-of-sample predictive modeling approach to identify multivariate signatures of Big Five personality traits within the structural integrity of white matter pathways using diffusion magnetic resonance imaging. In Study 1 (N = 491), we trained a ridge regression model to predict each of the Big Five traits and tested these models in an independent hold-out subsample. RESULTS We found that models for both Neuroticism and Openness were significantly related to predictive accuracy in the hold-out sample. Study 2 (N = 108) applied Study 1's predictive models to an independent set of data collected on a different scanner and using a different Big Five scale. Here, we found that the model for Neuroticism remained a significant predictor of individual difference. CONCLUSION Our findings provide evidence that this white matter signature of Neuroticism generalizes across differences in measurement and samples.
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Affiliation(s)
- Moriah S Stendel
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
| | - Robert S Chavez
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
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He Y, Li Z, Shi X, Ding J, Wang X. Roles of NG2 Glia in Cerebral Small Vessel Disease. Neurosci Bull 2023; 39:519-530. [PMID: 36401147 PMCID: PMC10043141 DOI: 10.1007/s12264-022-00976-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is one of the most prevalent pathologic processes affecting 5% of people over 50 years of age and contributing to 45% of dementia cases. Increasing evidence has demonstrated the pathological roles of chronic hypoperfusion, impaired cerebral vascular reactivity, and leakage of the blood-brain barrier in CSVD. However, the pathogenesis of CSVD remains elusive thus far, and no radical treatment has been developed. NG2 glia, also known as oligodendrocyte precursor cells, are the fourth type of glial cell in addition to astrocytes, microglia, and oligodendrocytes in the mammalian central nervous system. Many novel functions for NG2 glia in physiological and pathological states have recently been revealed. In this review, we discuss the role of NG2 glia in CSVD and the underlying mechanisms.
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Affiliation(s)
- Yixi He
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenghao Li
- Institute of Neuroscience, MOE Key Laboratory of Molecular Neurobiology, NMU, Shanghai, 200433, China
| | - Xiaoyu Shi
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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Wangaryattawanich P, Rutman AM, Petcharunpaisan S, Mossa-Basha M. Incidental findings on brain magnetic resonance imaging (MRI) in adults: a review of imaging spectrum, clinical significance, and management. Br J Radiol 2023; 96:20220108. [PMID: 35522780 PMCID: PMC9975529 DOI: 10.1259/bjr.20220108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Utilization of brain MRI has dramatically increased in recent decades due to rapid advancement in imaging technology and improving accessibility. As a result, radiologists increasingly encounter findings incidentally discovered on brain MRIs which are performed for unrelated indications. Some of these findings are clinically significant, necessitating further investigation or treatment and resulting in increased costs to healthcare systems as well as increased patient anxiety. Moreover, management of these incidental findings poses a significant challenge for referring physicians. Therefore, it is important for interpreting radiologists to know the prevalence, clinical consequences, and appropriate management of these findings. There is a wide spectrum of incidental findings on brain MRI such as asymptomatic brain infarct, age-related white matter changes, microhemorrhages, intracranial tumors, intracranial cystic lesions, and anatomic variants. This article provides a narrative review of important incidental findings encountered on brain MRI in adults with a focus on prevalence, clinical implications, and recommendations on management of these findings based on current available data.
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Affiliation(s)
| | | | | | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina, Chapel Hill, NC, United States
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Lou J, Sun Y, Cui Z, Gong L. Structural brain alterations in young adult males with narcissistic personality disorder: a diffusion tensor imaging study. Int J Neurosci 2023; 133:133-140. [PMID: 33635732 DOI: 10.1080/00207454.2021.1896504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSES 1. To find a difference in white matter (WM) between young adult males with narcissistic personality disorder (NPD) and healthy controls (HCs). 2. To find some correlations between white matter in the abnormal regions of NPD group and the pathological narcissism inventory (PNI). MATERIALS AND METHODS Eighteen male participants with NPD (age M = 18.39, SD = 0.164; education M = 12.33, SD = 0.14) were included in our experiment. NPD participants met the DSM-IV criteria for NPD and without other personality disorders evaluated by trained clinical psychiatrists using the Structured Clinical Interview of DSM-IV for Personality Disorders (SCID-II). Moreover, healthy controls were also confirmed to be free of any axis I or II disorders and matched with education level, age and handedness (age M = 18.83 years, SD = 0.246; education M = 12.56, SD = 0.202; all participants were right handed). Those who have had major life events in the last six months, mental and physical illnesses, claustrophobia and oral implants have been excluded. We used tract-based spatial statistics (TBSS) on diffusion tensor images (DTI) and analysis of Pearson correlation between abnormal brain regions of white matter fibers and the pathological narcissism inventory. RESULTS There was no significant difference in age and education level between NPD and HCs (p > 0.05). There were significant differences in PNI score and its subscales between NPD group and HCs (p < 0.01). Fractional anisotropy (FA) values were found decreased mainly in the right superior longitudinal fasciculus and the bilateral posterior thalamic radiation (include optic radiation). Lower axial diffusivity (AD) values were identified mostly in the left retrolenticular part of internal capsule and the left posterior thalamic radiation (include optic radiation). There existed a significant correlation between DTI data and pathological narcissism inventory. CONCLUSIONS The decreased brain white matter microstructures among three clusters were found in the association, projection/thalamic and connection pathways of white matter in young adult males with NPD. The abnormal white matter brain regions may be one of the neuropathological basis of the pathogenesis of young males with NPD, and it may be related to white matter development in early adulthood.
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Affiliation(s)
- Jing Lou
- Neuropsychological Department, Dalian Medical University, Dalian, Liaoning Province, China
| | - Yueji Sun
- Neuropsychological Department, Dalian Medical University, Dalian, Liaoning Province, China
| | - Zhixia Cui
- Neuropsychological Department, Dalian Medical University, Dalian, Liaoning Province, China
| | - Lei Gong
- Neuropsychological Department, Dalian Medical University, Dalian, Liaoning Province, China
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Gao F, Sun J, Yao M, Song Y, Yi H, Yang M, Ni Q, Kong J, Yuan H, Sun B, Wang Y. SERS "hot spot" enhance-array assay for misfolded SOD1 correlated with white matter lesions and aging. Anal Chim Acta 2023; 1238:340163. [PMID: 36464456 DOI: 10.1016/j.aca.2022.340163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Misfolding of superoxide dismutase-1 (SOD1) has been correlated with many neurodegenerative diseases, such as Amyotrophic lateral sclerosis's and Alzheimer's among others. However, it is unclear whether misfolded SOD1 plays a role in another neurodegenerative disease of white matter lesions (WMLs). In this study, a sensitive and specific method based on SERS technique was proposed for quantitative detection of misfolded SOD1 content in WMLs. To fabricate the double antibodysandwich substrates for SERS detection, gold nanostars modified with capture antibody were immobilized on glass substrates to prepare active SERS substrates, and then SERS probes conjugated with a Raman reporter and a specific target antibody were coupled with active SERS substrates. This SERS substrates had been employed for quantitative detection of misfolded SOD1 levels in WMLs and exhibited excellent stability, reliability, and accuracy. Moreover, experimental results indicated that the level of misfolded SOD1 increased with the increase in age and the degree of WMLs. Hence, misfolded SOD1 may be a potential blood marker for WMLs and aging. Meanwhile, SERS-based gold nanostars have great clinical application potential in the screening, diagnosis and treatment of WMLs.
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Affiliation(s)
- Feng Gao
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Jingyi Sun
- Shandong Provincial Hospital Affiliated to Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250021, China
| | - Minmin Yao
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Yanan Song
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China; Medical College of Qingdao University, Qingdao, 266021, China
| | - Hui Yi
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Mingfeng Yang
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China
| | - Qingbin Ni
- Postdoctoral Workstation, Taian Central Hospital, Taian, 271000, Shandong, China
| | - Jiming Kong
- Department of Human Anatomy and Cell Science, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, MB, Canada
| | - Hui Yuan
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China.
| | - Baoliang Sun
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China.
| | - Ying Wang
- Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, 271000, China.
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Dobrynina LA, Kremneva EI, Shamtieva KV, Geints AA, Filatov AS, Trubitsyna VV, Bitsieva ET, Byrochkina AA, Akhmetshina YI, Maksimov II, Krotenkova MV. [Disruption of corpus callosum microstructural integrity by diffusion MRI as a predictor of progression of cerebral microangiopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:95-104. [PMID: 37994894 DOI: 10.17116/jnevro202312311195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To assess the microstructural integrity of the corpus callosum in patients with cerebral small vessel disease (cSVD) using signal and biophysical diffusion MRI models and to identify the most sensitive markers of disease progression. MATERIAL AND METHODS Diffusion MRI (3 Tesla) was performed in 166 patients (51.8% women; mean age 60.4±7.6) with cSVD and cognitive impairment of varying severity and in 44 healthy volunteers (65.9% women; mean age 59.6±6.8), followed by calculation of signal (diffusion tensor and diffusion kurtosis) and biophysical (WMTI, NODDI, MC-SMT) models, from which profiles of three corpus callosum segments were constructed. RESULTS The best results were obtained for metrics in the forceps minor and body of the corpus callosum. Among the metrics of the signal models in the forceps minor, fraction anisotropy (FA) and mean diffusion (MD), which characterize the overall loss of microstructural integrity and increase in extra-axonal water, as well as indirect markers of demyelination when considering transverse diffusion parameters (radial diffusion and radial kurtosis), had the larger area under the curve according to the ROC analysis. Among the metrics of the biophysical models in the forceps minor, a larger area under the curve was found in the MC-SMT model for extra-axonal transverse diffusion (ETR), mean diffusion (EMD), and intra-axonal water fraction (INTRA), and in the WMTI model for intra-axonal water fraction (AWF). ETR had high inverse correlations with INTRA and AWF, while INTRA and AWF had high direct intercorrelations. CONCLUSION Metrics of signaling (FA, MD, RD, RK) and biophysical patterns (ETR, EMD, INTRA, AWF) in the forceps minor and the corpus callosum body can be considered as indicators of cSVD progression. They indicate disease progression, mainly by an increase in extra-axonal water with the development of demyelination and tissue degeneration in the corpus callosum.
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Affiliation(s)
| | | | | | - A A Geints
- Lomonosov Moscow State University, Moscow, Russia
| | - A S Filatov
- Research Center of Neurology, Moscow, Russia
| | | | | | | | | | - I I Maksimov
- West Norwegian University of Applied Sciences (HVL), Bergen, Norway
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Woldstad C, Rusinek H, Sweeney E, Butler T, Li Y, Tanzi E, Mardy C, Harvey P, de Leon MJ, Glodzik L. Quadratic relationship between systolic blood pressure and white matter lesions in individuals with hypertension. J Hypertens 2023; 41:35-43. [PMID: 36204999 PMCID: PMC9794123 DOI: 10.1097/hjh.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a well documented relationship between cardiovascular risk factors and the development of brain injury, which can lead to cognitive dysfunction. Hypertension (HTN) is a condition increasing the risk of silent and symptomatic ischemic brain lesions. Although benefits of hypertension treatment are indisputable, the target blood pressure value where the possibility of tissue damage is most reduced remains under debate. METHOD Our group performed a cross-sectional ( n = 376) and longitudinal ( n = 188) study of individuals without dementia or stroke (60% women n = 228, age 68.5 ± 7.4 years; men n = 148, age 70.7 ± 6.9 years). Participants were split into hypertensive ( n = 169) and normotensive ( n = 207) groups. MR images were obtained on a 3T system. Linear modeling was performed in hypertensive and normotensive cohorts to investigate the relationship between systolic (SBP) and diastolic (DBP) blood pressure, white matter lesion (WML), and brain volumes. RESULTS Participants in the hypertensive cohort showed a quadratic relationship between SBP and WML, with the lowest amounts of WML being measured in participants with readings at approximately 124 mmHg. Additionally, the hypertensive cohort also exhibited a quadratic relationship between DBP and mean hippocampal volume; participants with readings at approximately 77 mmHg showing the largest volumes. Longitudinally, all groups experienced WML growth, despite different BP trajectories, further suggesting that WML expansion may occur despite or because of BP reduction in individuals with compromised vascular system. CONCLUSION Overall, our study suggests that in the hypertensive group there is a valley of mid-range blood pressures displaying less pathology in the brain.
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Affiliation(s)
| | | | - Elizabeth Sweeney
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine
| | - Tracy Butler
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Yi Li
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Emily Tanzi
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Christopher Mardy
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Patrick Harvey
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Mony J. de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Lidia Glodzik
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Hormonal factors moderate the associations between vascular risk factors and white matter hyperintensities. Brain Imaging Behav 2022; 17:172-184. [PMID: 36542288 DOI: 10.1007/s11682-022-00751-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
To examine the moderation effects of hormonal factors on the associations between vascular risk factors and white matter hyperintensities in men and women, separately. White matter hyperintensities were automatically segmented and quantified in the UK Biobank dataset (N = 18,294). Generalised linear models were applied to examine (1) the main effects of vascular and hormonal factors on white matter hyperintensities, and (2) the moderation effects of hormonal factors on the relationship between vascular risk factors and white matter hyperintensities volumes. In men with testosterone levels one standard deviation higher than the mean value, smoking was associated with 27.8% higher white matter hyperintensities volumes in the whole brain. In women with a shorter post-menopause duration (one standard deviation below the mean), diabetes and higher pulse wave velocity were associated with 28.8% and 2.0% more deep white matter hyperintensities, respectively. These findings highlighted the importance of considering hormonal risk factors in the prevention and management of white matter hyperintensities.
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Phuah CL, Chen Y, Strain JF, Yechoor N, Laurido-Soto OJ, Ances BM, Lee JM. Association of Data-Driven White Matter Hyperintensity Spatial Signatures With Distinct Cerebral Small Vessel Disease Etiologies. Neurology 2022; 99:e2535-e2547. [PMID: 36123127 PMCID: PMC9754646 DOI: 10.1212/wnl.0000000000201186] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Topographical distribution of white matter hyperintensities (WMH) are hypothesized to vary by cerebrovascular risk factors. We used an unbiased pattern discovery approach to identify distinct WMH spatial patterns and investigate their association with different WMH etiologies. METHODS We performed a cross-sectional study on participants of the Alzheimer's Disease Neuroimaging Initiative (ADNI) to identify spatially distinct WMH distribution patterns using voxel-based spectral clustering analysis of aligned WMH probability maps. We included all participants from the ADNI Grand Opportunity/ADNI 2 study with available baseline 2D-FLAIR MRI scans, without history of stroke or presence of infarction on imaging. We evaluated the associations of these WMH spatial patterns with vascular risk factors, amyloid-β PET, and imaging biomarkers of cerebral amyloid angiopathy (CAA), characterizing different forms of cerebral small vessel disease (CSVD) using multivariable regression. We also used linear regression models to investigate whether WMH spatial distribution influenced cognitive impairment. RESULTS We analyzed MRI scans of 1,046 ADNI participants with mixed vascular and amyloid-related risk factors (mean age 72.9, 47.7% female, 31.4% hypertensive, 48.3% with abnormal amyloid PET). We observed unbiased partitioning of WMH into 5 unique spatial patterns: deep frontal, periventricular, juxtacortical, parietal, and posterior. Juxtacortical WMH were independently associated with probable CAA, deep frontal WMH were associated with risk factors for arteriolosclerosis (hypertension and diabetes), and parietal WMH were associated with brain amyloid accumulation, consistent with an Alzheimer disease (AD) phenotype. Juxtacortical, deep frontal, and parietal WMH spatial patterns were associated with cognitive impairment. Periventricular and posterior WMH spatial patterns were unrelated to any disease phenotype or cognitive decline. DISCUSSION Data-driven WMH spatial patterns reflect discrete underlying etiologies including arteriolosclerosis, CAA, AD, and normal aging. Global measures of WMH volume may miss important spatial distinctions. WMH spatial signatures may serve as etiology-specific imaging markers, helping to resolve WMH heterogeneity, identify the dominant underlying pathologic process, and improve prediction of clinical-relevant trajectories that influence cognitive decline.
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Affiliation(s)
- Chia-Ling Phuah
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Yasheng Chen
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Jeremy F Strain
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Nirupama Yechoor
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Osvaldo J Laurido-Soto
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Beau M Ances
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO
| | - Jin-Moo Lee
- From the Department of Neurology (C.-L.P., Y.C., J.F.S., N.Y., O.J.L.-S., B.M.A., J.-M.L.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; NeuroGenomics and Informatics Center (C.-L.P.), Washington University School of Medicine, St. Louis, MO; Mallinckrodt Institute of Radiology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; and Department of Biomedical Engineering (J.-M.L.), Washington University School of Medicine, St. Louis, MO.
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Wang Y, Bai X, Ye C, Yu Y, Wu B. The association between the severity and distribution of white matter lesions and hemorrhagic transformation after ischemic stroke: A systematic review and meta-analysis. Front Aging Neurosci 2022; 14:1053149. [PMID: 36506465 PMCID: PMC9732368 DOI: 10.3389/fnagi.2022.1053149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose As a part of the natural course of ischemic stroke, hemorrhagic transformation (HT) is a serious complication after reperfusion treatment, which may affect the prognosis of patients with ischemic stroke. White matter lesions (WMLs) refer to focal lesions on neuroimaging and have been suggested to indicate a high risk of HT. This systematic review and meta-analysis aimed to summarize current evidence on the relation between WML and HT. Methods This systematic review was prepared with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for publications on WML and HT in patients with ischemic stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) from eligible studies were combined to quantify the association between the severity of WML and the risk of HT. In addition, the descriptive analysis was adopted to evaluate the influence of different WML distributions on predicting HT. Results A total of 2,303 articles were identified after removing duplicates through database searching, and 41 studies were included in our final analysis. The meta-analysis showed that the presence of WML was associated with HT (OR = 1.62, 95%CI 1.08-2.43, p = 0.019) and symptomatic intracerebral hemorrhage (sICH) (OR = 1.64, 95%CI 1.17-2.30, p = 0.004), and moderate-to-severe WML indicated a high risk of HT (OR = 2.03, 95%CI 1.33-3.12, p = 0.001) and sICH (OR = 1.92, 95%CI 1.31-2.81, p < 0.001). The dose-response meta-analysis revealed risk effects of increasing the severity of WML on both HT and ICH. In addition, both periventricular WML (PWML) (five of seven articles) and deep WML (DWML) (five of six articles) were shown to be associated with HT. Conclusions White matter lesions are associated with overall HT and sICH in patients with ischemic stroke, and more severe WMLs indicate a high risk of HT and sICH. In addition, both PWML and DWMLs could be risk factors for HT. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42022313467.
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Affiliation(s)
- Youjie Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xueling Bai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Yu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Bo Wu
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Gwo CY, Zhu DC, Zhang R. Brain white matter hyperintensity lesion characterization in 3D T 2 fluid-attenuated inversion recovery magnetic resonance images: Shape, texture, and their correlations with potential growth. Front Neurosci 2022; 16:1028929. [PMID: 36507337 PMCID: PMC9731131 DOI: 10.3389/fnins.2022.1028929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Analyses of age-related white matter hyperintensity (WMH) lesions manifested in T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance images (MRI) have been mostly on understanding the size and location of the WMH lesions and rarely on the morphological characterization of the lesions. This work extends our prior analyses of the morphological characteristics and texture of WMH from 2D to 3D based on 3D T2 FLAIR images. 3D Zernike transformation was used to characterize WMH shape; a fuzzy logic method was used to characterize the lesion texture. We then clustered 3D WMH lesions into groups based on their 3D shape and texture features. A potential growth index (PGI) to assess dynamic changes in WMH lesions was developed based on the image texture features of the WMH lesion penumbra. WMH lesions with various sizes were segmented from brain images of 32 cognitively normal older adults. The WMH lesions were divided into two groups based on their size. Analyses of Variance (ANOVAs) showed significant differences in PGI among WMH shape clusters (P = 1.57 × 10-3 for small lesions; P = 3.14 × 10-2 for large lesions). Significant differences in PGI were also found among WMH texture group clusters (P = 1.79 × 10-6). In conclusion, we presented a novel approach to characterize the morphology of 3D WMH lesions and explored the potential to assess the dynamic morphological changes of WMH lesions using PGI.
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Affiliation(s)
- Chih-Ying Gwo
- Department of Information Management, Chien Hsin University of Science and Technology, Taoyuan City, Taiwan
| | - David C. Zhu
- Department of Radiology, Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States
- Department of Psychology, Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States
| | - Rong Zhang
- Department of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States
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Association between Serum Amyloid A Level and White Matter Hyperintensity Burden: a Cross-Sectional Analysis in Patients with Acute Ischemic Stroke. Neurol Ther 2022; 12:161-175. [PMID: 36374429 PMCID: PMC9837367 DOI: 10.1007/s40120-022-00415-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION This work aimed to determine the potential link between white matter hyperintensity (WMH) burden and serum amyloid A (SAA) level in patients with acute ischemic stroke. METHODS Consecutive patients with acute large artery atherosclerosis (LAA) stroke between April 2021 and May 2022 were included. WMH volumes (periventricular, deep, and total) were measured using the Fazekas score and a semiautomated volumetric analysis on fluid-attenuated inversion recovery-magnetic resonance imaging. The burdens of WMH were scored to assess the dose-dependent association between SAA and WMH volume. Multivariate regression and a two-piecewise linear regression model were used to evaluate whether SAA levels are an independent predictor of WMH, and to discover the threshold effect or saturation effect of SAA levels with respect to WMH volume. RESULTS The mean age of patients was 63.2 ± 11.5 years, with 65.9% men. The median SAA level was 3.93 mg/L and the total WMH volume of 6.86 cm3. In the multivariable analysis, SAA remained an independent predictor of total WMH volume [β = 0.82, 95% confidence interval (CI) = 0.49-1.07, p < 0.001], periventricular WMH volume (adjusted β = 0.76, 95% CI = 0.46-1.07, p < 0.001), and deep WMH volume (adjusted β = 0.26, 95% CI = 0.06-0.45, p = 0.011) after controlling for confounders. Furthermore, SAA levels were associated with periventricular Fazekas score, deep Fazekas score, and Fazekas grades. Threshold effect and saturation effect analyses demonstrated a nonlinear relationship between SAA levels and periventricular white matter hyperintensity (PVWMH) volumes, with SAA levels (2.12-19.89 mg/L) having significant dose-dependent relationships with periventricular WMH volumes (adjusted β = 1.98, 95% CI = 1.12-2.84, p < 0.001). CONCLUSION SAA level ranging from 2.12 to 19.89 mg/L is dose-dependently associated with periventricular WMH development. These findings point the way forward for future research into the pathophysiology of WMH.
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Röhrig L, Sperber C, Bonilha L, Rorden C, Karnath HO. Right hemispheric white matter hyperintensities improve the prediction of spatial neglect severity in acute stroke. Neuroimage Clin 2022; 36:103265. [PMID: 36451368 PMCID: PMC9723300 DOI: 10.1016/j.nicl.2022.103265] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/12/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
White matter hyperintensities (WMH) are frequently observed in brain scans of elderly people. They are associated with an increased risk of stroke, cognitive decline, and dementia. However, it is unknown yet if measures of WMH provide information that improve the understanding of poststroke outcome compared to only state-of-the-art stereotaxic structural lesion data. We implemented high-dimensional machine learning models, based on support vector regression, to predict the severity of spatial neglect in 103 acute right hemispheric stroke patients. We found that (1) the additional information of right hemispheric or bilateral voxel-based topographic WMH extent indeed yielded a significant improvement in predicting acute neglect severity (compared to the voxel-based stroke lesion map alone). (2) Periventricular WMH appeared more relevant for prediction than deep subcortical WMH. (3) Among different measures of WMH, voxel-based maps as measures of topographic extent allowed more accurate predictions compared to the use of traditional ordinally assessed visual rating scales (Fazekas-scale, Cardiovascular Health Study-scale). In summary, topographic WMH appear to be a valuable clinical imaging biomarker for predicting the severity of cognitive deficits and bears great potential for rehabilitation guidance of acute stroke patients.
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Affiliation(s)
- Lisa Röhrig
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
| | - Christoph Sperber
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany
| | - Leonardo Bonilha
- Department of Neurology, Emory University, Atlanta, GA 30322, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Hans-Otto Karnath
- Division of Neuropsychology, Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen 72076, Germany; Department of Psychology, University of South Carolina, Columbia, SC 29208, USA.
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Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnosis of vascular cognitive impairment: recommendations of the scientific department of cognitive neurology and aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s104en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.
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Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnóstico do comprometimento cognitivo vascular: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:53-72. [DOI: 10.1590/1980-5764-dn-2022-s104pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 12/14/2022] Open
Abstract
RESUMO Desde a publicação das últimas recomendações para o diagnóstico e tratamento da Demência Vascular pela Academia Brasileira de Neurologia em 2011, avanços significativos ocorreram na terminologia e critérios diagnósticos. O presente manuscrito é resultado do consenso entre especialistas indicados pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia (2020-2022). O objetivo foi atualizar as recomendações práticas para a identificação, classificação e diagnóstico do Comprometimento Cognitivo Vascular (CCV). As buscas foram realizadas nas plataformas MEDLINE, Scopus, Scielo e LILACS. As recomendações buscam fornecer uma ampla revisão sobre o tema, então sintetizar as evidências para o diagnóstico do CCV não apenas para neurologistas, mas também para outros profissionais de saúde envolvidos na avaliação e nos cuidados ao paciente com CCV, considerando as diferentes realidades dos níveis de atenção à saúde (primário, secundário e terciário) no Brasil.
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Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Miwa K, Toyoda K. Covert vascular brain injury in chronic kidney disease. Front Neurol 2022; 13:824503. [PMID: 35959397 PMCID: PMC9358355 DOI: 10.3389/fneur.2022.824503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic kidney disease (CKD) contributes to the increased risk of stroke and dementia. Accumulating evidence indicates that structural brain abnormalities, such as cerebral small vessel disease, including white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds, as well as brain atrophy, are common in patients with CKD. All of these imaging findings have been implicated in the development of stroke and dementia. The brain and kidney exhibit similar impairments and promote structural brain abnormalities due to shared vascular risk factors and similar anatomical and physiological susceptibility to vascular injury in patients with CKD. This indicates that kidney function has a significant effect on brain aging. However, as most results are derived from cross-sectional observational studies, the exact pathophysiology of structural brain abnormalities in CKD remains unclear. The early detection of structural brain abnormalities in CKD in the asymptomatic or subclinical phase (covert) should enable stroke risk prediction and guide clinicians on more targeted interventions to prevent stroke in patients with CKD. This article summarizes the currently available clinical evidence linking covert vascular brain injuries with CKD.
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Polyakova M, Mueller K, Arelin K, Lampe L, Rodriguez FS, Luck T, Kratzsch J, Hoffmann KT, Riedel-Heller S, Villringer A, Schoenknecht P, Schroeter ML. Increased Serum NSE and S100B Indicate Neuronal and Glial Alterations in Subjects Under 71 Years With Mild Neurocognitive Disorder/Mild Cognitive Impairment. Front Cell Neurosci 2022; 16:788150. [PMID: 35910248 PMCID: PMC9329528 DOI: 10.3389/fncel.2022.788150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mild cognitive impairment (MCI) is considered a pre-stage of different dementia syndromes. Despite diagnostic criteria refined by DSM-5 and a new term for MCI – “mild neurocognitive disorder” (mild NCD) – this diagnosis is still based on clinical criteria. Methods To link mild NCD to the underlying pathophysiology we assessed the degree of white matter hyperintensities (WMH) in the brain and peripheral biomarkers for neuronal integrity (neuron-specific enolase, NSE), plasticity (brain-derived neurotrophic factor, BDNF), and glial function (S100B) in 158 community-dwelling subjects with mild NCD and 82 healthy controls. All participants (63–79 years old) were selected from the Leipzig-population-based study of adults (LIFE). Results Serum S100B levels were increased in mild NCD in comparison to controls (p = 0.007). Serum NSE levels were also increased but remained non-significant after Bonferroni-Holm correction (p = 0.04). Furthermore, age by group interaction was significant for S100B. In an age-stratified sub-analysis, NSE and S100B were higher in younger subjects with mild NCD below 71 years of age. Some effects were inconsistent after controlling for potentially confounding factors. The discriminatory power of the two biomarkers NSE and S100B was insufficient to establish a pathologic threshold for mild NCD. In subjects with mild NCD, WMH load correlated with serum NSE levels (r = 0.20, p = 0.01), independently of age. Conclusion Our findings might indicate the presence of neuronal (NSE) and glial (S100B) injury in mild NCD. Future studies need to investigate whether younger subjects with mild NCD with increased biomarker levels are at risk of developing major NCD.
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Affiliation(s)
- Maryna Polyakova
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University of Leipzig, Leipzig, Germany
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- University Clinic for Psychiatry and Psychotherapy, Leipzig University, Leipzig, Germany
- *Correspondence: Maryna Polyakova
| | - Karsten Mueller
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Katrin Arelin
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Leonie Lampe
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| | - Francisca S. Rodriguez
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Research Group Psychosocial Epidemiology and Public Health, German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Tobias Luck
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Faculty of Applied Social Sciences, University of Applied Sciences Erfurt, Erfurt, Germany
| | - Jürgen Kratzsch
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University, Leipzig, Germany
| | | | - Steffi Riedel-Heller
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig University, Leipzig, Germany
| | - Arno Villringer
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- Institute of Neuroradiology, University Clinic, Leipzig, Germany
| | - Peter Schoenknecht
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
- University Clinic for Psychiatry and Psychotherapy, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, University Affiliated Hospital Arnsdorf, Technical University of Dresden, Dresden, Germany
| | - Matthias L. Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Clinic for Cognitive Neurology, University of Leipzig, Leipzig, Germany
- LIFE–Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
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Zdanovskis N, Platkājis A, Kostiks A, Šneidere K, Stepens A, Naglis R, Karelis G. Combined Score of Perivascular Space Dilatation and White Matter Hyperintensities in Patients with Normal Cognition, Mild Cognitive Impairment, and Dementia. Medicina (B Aires) 2022; 58:medicina58070887. [PMID: 35888606 PMCID: PMC9318632 DOI: 10.3390/medicina58070887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Cerebral perivascular spaces (PVS) are part of the cerebral microvascular structure and play a role in lymphatic drainage and the removal of waste products from the brain. White matter hyperintensities (WMH) are hyperintense lesions on magnetic resonance imaging that are associated with cognitive impairment, dementia, and cerebral vascular disease. WMH and PVS are direct and indirect imaging biomarkers of cerebral microvascular integrity and health. In our research, we evaluated WMH and PVS enlargement in patients with normal cognition (NC), mild cognitive impairment (MCI), and dementia (D). Materials and Methods: In total, 57 participants were included in the study and divided into groups based on neurological evaluation and Montreal Cognitive Assessment results (NC group 16 participants, MCI group 29 participants, D group 12 participants). All participants underwent 3T magnetic resonance imaging. PVS were evaluated in the basal ganglia, centrum semiovale, and midbrain. WMHs were evaluated based on the Fazekas scale and the division between deep white matter (DWM) and periventricular white matter (PVWM). The combined score based on PVS and WMH was evaluated and correlated with the results of the MoCA. Results: We found statistically significant differences between groups on several measures. Centrum semiovale PVS dilatation was more severe in MCI and dementia group and statistically significant differences were found between D-MCI and D-NC pairs. PVWM was more severe in patients with MCI and dementia group, and statistically significant differences were found between D-MCI and D-NC pairs. Furthermore, we found statistically significant differences between the groups by analyzing the combined score of PVS dilatation and WMH. We did not find statistically significant differences between the groups in PVS dilation of the basal ganglia and midbrain and DWM hyperintensities. Conclusions: PVS assessment could become one of neuroimaging biomarkers for patients with cognitive decline. Furthermore, the combined score of WMH and PVS dilatation could facilitate diagnostics of cognitive impairment, but more research is needed with a larger cohort to determine the use of PVS dilatation and the combined score.
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Affiliation(s)
- Nauris Zdanovskis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia;
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia;
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
- Correspondence:
| | - Ardis Platkājis
- Department of Radiology, Riga Stradins University, LV-1007 Riga, Latvia;
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia;
| | - Andrejs Kostiks
- Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia; (A.K.); (G.K.)
| | - Kristīne Šneidere
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
- Department of Health Psychology and Paedagogy, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ainārs Stepens
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
| | - Roberts Naglis
- Department of Radiology, Riga East University Hospital, LV-1038 Riga, Latvia;
- Military Medicine Research and Study Centre, Riga Stradins University, LV-1007 Riga, Latvia; (K.Š.); (A.S.)
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, LV-1038 Riga, Latvia; (A.K.); (G.K.)
- Department of Infectology, Riga Stradins University, LV-1007 Riga, Latvia
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Lee J, Kim HJ. Normal Aging Induces Changes in the Brain and Neurodegeneration Progress: Review of the Structural, Biochemical, Metabolic, Cellular, and Molecular Changes. Front Aging Neurosci 2022; 14:931536. [PMID: 35847660 PMCID: PMC9281621 DOI: 10.3389/fnagi.2022.931536] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Aging is accompanied by many changes in brain and contributes to progressive cognitive decline. In contrast to pathological changes in brain, normal aging brain changes have relatively mild but important changes in structural, biochemical and molecular level. Representatively, aging associated brain changes include atrophy of tissues, alteration in neurotransmitters and damage accumulation in cellular environment. These effects have causative link with age associated changes which ultimately results in cognitive decline. Although several evidences were found in normal aging changes of brain, it is not clearly integrated. Figuring out aging related changes in brain is important as aging is the process that everyone goes through, and comprehensive understanding may help to progress further studies. This review clarifies normal aging brain changes in an asymptotic and comprehensive manner, from a gross level to a microscopic and molecular level, and discusses potential approaches to seek the changes with cognitive decline.
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Affiliation(s)
- Jiseon Lee
- Department of Neurology, Hanyang University Hospital, Seoul, South Korea
| | - Hee-Jin Kim
- Department of Neurology, Hanyang University Hospital, Seoul, South Korea
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Wang B, Li X, Li H, Xiao L, Zhou Z, Chen K, Gui L, Hou X, Fan R, Chen K, Wu W, Li H, Hu X. Clinical, Radiological and Pathological Characteristics Between Cerebral Small Vessel Disease and Multiple Sclerosis: A Review. Front Neurol 2022; 13:841521. [PMID: 35812110 PMCID: PMC9263123 DOI: 10.3389/fneur.2022.841521] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebral small vessel disease (CSVD) and multiple sclerosis (MS) are a group of diseases associated with small vessel lesions, the former often resulting from the vascular lesion itself, while the latter originating from demyelinating which can damage the cerebral small veins. Clinically, CSVD and MS do not have specific signs and symptoms, and it is often difficult to distinguish between the two from the aspects of the pathology and imaging. Therefore, failure to correctly identify and diagnose the two diseases will delay early intervention, which in turn will affect the long-term functional activity for patients and even increase their burden of life. This review has summarized recent studies regarding their similarities and difference of the clinical manifestations, pathological features and imaging changes in CSVD and MS, which could provide a reliable basis for the diagnosis and differentiation of the two diseases in the future.
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Affiliation(s)
- Bijia Wang
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haoyi Li
- Department of Neurosurgery, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Li Xiao
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenhua Zhou
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kangning Chen
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Li Gui
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xianhua Hou
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Rong Fan
- Department of Neurology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Kang Chen
- Department of Radiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjing Wu
- Department of Radiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haitao Li
- Department of Radiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- *Correspondence: Haitao Li
| | - Xiaofei Hu
- Department of Radiology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- Xiaofei Hu
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Xu W, Bai Q, Dong Q, Guo M, Cui M. Blood–Brain Barrier Dysfunction and the Potential Mechanisms in Chronic Cerebral Hypoperfusion Induced Cognitive Impairment. Front Cell Neurosci 2022; 16:870674. [PMID: 35783093 PMCID: PMC9243657 DOI: 10.3389/fncel.2022.870674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic cerebral hypoperfusion (CCH) is a major cause of vascular cognitive impairment and dementia (VCID). Although the underlying mechanisms have not been fully elucidated, the emerging data suggest that blood–brain barrier (BBB) dysfunction is one of the pivotal pathological changes in CCH. BBB dysfunction appears early in CCH, contributing to the deterioration of white matter and the development of cognitive impairment. In this review, we summarize the latest experimental and clinical evidence implicating BBB disruption as a major cause of VCID. We discuss the mechanisms of BBB dysfunction in CCH, focusing on the cell interactions within the BBB, as well as the potential role of APOE genotype. In summary, we provide novel insights into the pathophysiological mechanisms underlying BBB dysfunction and the potential clinical benefits of therapeutic interventions targeting BBB in CCH.
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Affiliation(s)
- WenQing Xu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingke Bai
- Department of Neurology, Pudong People’s Hospital, Shanghai, China
| | - Qiang Dong
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Guo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- Min Guo,
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Mei Cui,
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Cao Z, Mai Y, Fang W, Lei M, Luo Y, Zhao L, Liao W, Yu Q, Xu J, Ruan Y, Xiao S, Mok VCT, Shi L, Liu J. The Correlation Between White Matter Hyperintensity Burden and Regional Brain Volumetry in Patients With Alzheimer's Disease. Front Hum Neurosci 2022; 16:760360. [PMID: 35774484 PMCID: PMC9237397 DOI: 10.3389/fnhum.2022.760360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background White matter hyperintensities (WMHs) and regional brain lobe atrophy coexist in the brain of patients with Alzheimer's disease (AD), but the association between them in patients with AD still lacks comprehensive investigation and solid imaging data support. Objective We explored whether WMHs can promote the pathological process of AD by aggravating atrophy in specific brain regions and tried to explain the regional specificity of these relationships. Methods A sample of 240 adults including 180 normal controls (NCs) and 80 cases with AD were drawn from the ADNI database. T1-weighted magnetic resonance imaging (MRI) and T2-weighted fluid-attenuated MRI of the participants were downloaded and were analyzed using AccuBrain® to generate the quantitative ratio of WMHs (WMHr, WMH volumes corrected by intracranial volume) and regional brain atrophy. We also divided WMHr into periventricular WMHr (PVWMHr) and deep WMHr (DWMHr) for the purpose of this study. The Cholinergic Pathways Hyperintensities Scale (CHIPS) scores were conducted by two evaluators. Independent t-test, Mann–Whitney U test, or χ2 test were used to compare the demographic characteristics, and Spearman correlation coefficient values were used to determine the association between WMHs and different regions of brain atrophy. Results Positive association between WMHr and quantitative medial temporal lobe atrophy (QMTA) (rs = 0.281, p = 0.011), temporal lobe atrophy (rs = 0.285, p = 0.011), and insular atrophy (rs = 0.406, p < 0.001) was found in the AD group before Bonferroni correction. PVWMHr contributed to these correlations. By separately analyzing the relationship between PVWMHr and brain atrophy, we found that there were still positive correlations after correction in QMTA (rs = 0.325, p = 0.003), temporal lobe atrophy (rs = 0.298, p = 0.007), and insular atrophy (rs = 0.429, p < 0.001) in AD group. Conclusion WMH severity tends to be associated with regional brain atrophy in patients with AD, especially with medial temporal lobe, temporal lobe, and insular lobe atrophy. PVWMHs were devoted to these correlations.
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Affiliation(s)
- Zhiyu Cao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingren Mai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenli Fang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Lei
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yishan Luo
- BrainNow Research Institute, Shenzhen, China
| | - Lei Zhao
- BrainNow Research Institute, Shenzhen, China
| | - Wang Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qun Yu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiaxin Xu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuting Ruan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Vincent C. T. Mok
- BrainNow Research Institute, Shenzhen, China
- Division of Neurology, Department of Medicine and Therapeutics, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lin Shi
- BrainNow Research Institute, Shenzhen, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- *Correspondence: Lin Shi
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Jun Liu
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Cho BJ, Lee M, Han J, Kwon S, Oh MS, Yu KH, Lee BC, Kim JH, Kim C. Prediction of White Matter Hyperintensity in Brain MRI Using Fundus Photographs via Deep Learning. J Clin Med 2022; 11:jcm11123309. [PMID: 35743380 PMCID: PMC9224833 DOI: 10.3390/jcm11123309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose: We investigated whether a deep learning algorithm applied to retinal fundoscopic images could predict cerebral white matter hyperintensity (WMH), as represented by a modified Fazekas scale (FS), on brain magnetic resonance imaging (MRI). Methods: Participants who had undergone brain MRI and health-screening fundus photography at Hallym University Sacred Heart Hospital between 2010 and 2020 were consecutively included. The subjects were divided based on the presence of WMH, then classified into three groups according to the FS grade (0 vs. 1 vs. 2+) using age matching. Two pre-trained convolutional neural networks were fine-tuned and evaluated for prediction performance using 10-fold cross-validation. Results: A total of 3726 fundus photographs from 1892 subjects were included, of which 905 fundus photographs from 462 subjects were included in the age-matched balanced dataset. In predicting the presence of WMH, the mean area under the receiver operating characteristic curve was 0.736 ± 0.030 for DenseNet-201 and 0.724 ± 0.026 for EfficientNet-B7. For the prediction of FS grade, the mean accuracies reached 41.4 ± 5.7% with DenseNet-201 and 39.6 ± 5.6% with EfficientNet-B7. The deep learning models focused on the macula and retinal vasculature to detect an FS of 2+. Conclusions: Cerebral WMH might be partially predicted by non-invasive fundus photography via deep learning, which may suggest an eye–brain association.
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Affiliation(s)
- Bum-Joo Cho
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (B.-J.C.); (S.K.)
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea
| | - Minwoo Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Jiyong Han
- Medical Artificial Intelligence Center, Hallym University Medical Center, Anyang 14068, Korea;
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (B.-J.C.); (S.K.)
| | - Mi Sun Oh
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang 14068, Korea; (M.L.); (M.S.O.); (K.-H.Y.); (B.-C.L.)
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University Biomedical Informatics (SNUBI), Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: (J.H.K.); (C.K.); Tel.: +82-2-740-8320 (J.H.K.); +82-33-240-5255 (C.K.); Fax: +82-2-3673-2167 (J.H.K.); +82-33-255-6244 (C.K.)
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea
- Correspondence: (J.H.K.); (C.K.); Tel.: +82-2-740-8320 (J.H.K.); +82-33-240-5255 (C.K.); Fax: +82-2-3673-2167 (J.H.K.); +82-33-255-6244 (C.K.)
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A Novel Rodent Model of Hypertensive Cerebral Small Vessel Disease with White Matter Hyperintensities and Peripheral Oxidative Stress. Int J Mol Sci 2022; 23:ijms23115915. [PMID: 35682594 PMCID: PMC9180536 DOI: 10.3390/ijms23115915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is the second most common cause of stroke and a major contributor to dementia. Manifestations of CSVD include cerebral microbleeds, intracerebral hemorrhages (ICH), lacunar infarcts, white matter hyperintensities (WMH) and enlarged perivascular spaces. Chronic hypertensive models have been found to reproduce most key features of the disease. Nevertheless, no animal models have been identified to reflect all different aspects of the human disease. Here, we described a novel model for CSVD using salt-sensitive ‘Sabra’ hypertension-prone rats (SBH/y), which display chronic hypertension and enhanced peripheral oxidative stress. SBH/y rats were either administered deoxycorticosteroid acetate (DOCA) (referred to as SBH/y-DOCA rats) or sham-operated and provided with 1% NaCl in drinking water. Rats underwent neurological assessment and behavioral testing, followed by ex vivo MRI and biochemical and histological analyses. SBH/y-DOCA rats show a neurological decline and cognitive impairment and present multiple cerebrovascular pathologies associated with CSVD, such as ICH, lacunes, enlarged perivascular spaces, blood vessel stenosis, BBB permeability and inflammation. Remarkably, SBH/y-DOCA rats show severe white matter pathology as well as WMH, which are rarely reported in commonly used models. Our model may serve as a novel platform for further understanding the mechanisms underlying CSVD and for testing novel therapeutics.
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Michels L, Moisa M, Stämpfli P, Hirsiger S, Baumgartner MR, Surbeck W, Seifritz E, Quednow BB. The impact of levamisole and alcohol on white matter microstructure in adult chronic cocaine users. Addict Biol 2022; 27:e13149. [PMID: 35394690 PMCID: PMC9287079 DOI: 10.1111/adb.13149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
Previous brain imaging studies with chronic cocaine users (CU) using diffusion tensor imaging (DTI) mostly focused on fractional anisotropy to investigate white matter (WM) integrity. However, a quantitative interpretation of fractional anisotropy (FA) alterations is often impeded by the inherent limitations of the underlying tensor model. A more fine-grained measure of WM alterations could be achieved by measuring fibre density (FD). This study investigates this novel DTI metric comparing 23 chronic CU and 32 healthy subjects. Quantitative hair analysis was used to determine intensity of cocaine and levamisole exposure-a cocaine adulterant with putative WM neurotoxicity. We first assessed the impact of cocaine use, levamisole exposure and alcohol use on group differences in WM integrity. Compared with healthy controls, all models revealed cortical reductions of FA and FD in CU. At the within-patient group level, we found that alcohol use and levamisole exposure exhibited regionally different FA and FD alterations than cocaine use. We found mostly negative correlations of tract-based WM associated with levamisole and weekly alcohol use. Specifically, levamisole exposure was linked with stronger WM reductions in the corpus callosum than alcohol use. Cocaine use duration correlated negatively with FA and FD in some regions. Yet, most of these correlations did not survive a correction for multiple testing. Our results suggest that chronic cocaine use, levamisole exposure and alcohol use were all linked to significant WM impairments in CU. We conclude that FD could be a sensitive marker to detect the impact of the use of multiple substances on WM integrity in cocaine but also other substance use disorders.
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Affiliation(s)
- Lars Michels
- Department of NeuroradiologyUniversity Hospital ZurichZurichSwitzerland
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
| | - Marius Moisa
- Zurich Center for Neuroeconomics, Department of NeuroeconomicsUniversity of ZurichZurichSwitzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Sarah Hirsiger
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Markus R. Baumgartner
- Center of Forensic Hair Analytics, Institute of Forensic MedicineUniversity of ZurichZurichSwitzerland
| | - Werner Surbeck
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Erich Seifritz
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
| | - Boris B. Quednow
- Neuroscience Center ZurichUniversity of Zurich and Swiss Federal Institute of Technology ZurichZurichSwitzerland
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and PsychosomaticsPsychiatric Hospital of the University of ZurichZurichSwitzerland
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Mossa-Basha M, Zhu C. White Matter Hyperintensities and Their Relationship to Outcomes after Stroke Intervention. Radiology 2022; 304:153-154. [PMID: 35348386 DOI: 10.1148/radiol.220207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mahmud Mossa-Basha
- From the Department of Radiology, University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27514 (M.M.B.); and Department of Radiology, University of Washington School of Medicine, Seattle, Wash (M.M.B., C.Z.)
| | - Chengcheng Zhu
- From the Department of Radiology, University of North Carolina School of Medicine, 101 Manning Dr, Chapel Hill, NC 27514 (M.M.B.); and Department of Radiology, University of Washington School of Medicine, Seattle, Wash (M.M.B., C.Z.)
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Saridin FN, Chew KA, Reilhac A, Giyanwali B, Villaraza SG, Tanaka T, Scheltens P, van der Flier WM, Chen CLH, Hilal S. Cerebrovascular disease in Suspected Non-Alzheimer's Pathophysiology and cognitive decline over time. Eur J Neurol 2022; 29:1922-1929. [PMID: 35340085 DOI: 10.1111/ene.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The underlying cause of cognitive decline in individuals who are positive for biomarkers of neurodegeneration (N) but negative for biomarkers of amyloid-beta (A), designated as Suspected Non-Alzheimer's Pathophysiology (SNAP), remains unclear. We evaluate whether cerebrovascular disease (CeVD) is more prevalent in those with SNAP compared to A-N- and A+N+ individuals and whether CeVD is associated with cognitive decline over time in SNAP patients. METHODS A total of 216 individuals from a prospective memory clinic cohort [mean (SD) age, 72.7(7.3) years, 100 women (56.5%)] were included and were diagnosed as no cognitive impairment (NCI), cognitive impairment no dementia (CIND), Alzheimer's dementia (AD) or Vascular dementia (VaD). All individuals underwent clinical evaluation and neuropsychological assessment annually for up to 5 years. [11 C]-PiB or [18 F]-Flutafuranol-PET imaging was performed to ascertain amyloid-beta status. MRI was performed to assess neurodegeneration as measured by medial temporal atrophy≥2, as well as significant CeVD (sCeVD) burden, defined by cortical infarct count≥1, Fazekas-score≥2, lacune count≥2 or cerebral microbleed count≥2. RESULTS Of the 216 individuals, 50(23.1%) A-N+ were (SNAP), 93(43.1%) A-N-, 36(16.7%) A+N- and 37(17.1%) A+N+. A+N+ individuals were significantly older, while A+N+ and SNAP individuals were more likely to have dementia. The SNAP group had a higher prevalence of sCeVD (90.0%) compared to A-N-. Moreover, SNAP individuals with sCeVD had significantly steeper decline in global cognition compared to A-N- over 5 years (P=0.042). CONCLUSIONS These findings suggest that CeVD is a contributing factor to cognitive decline in SNAP. Therefore, SNAP-individuals should be carefully assessed and treated for CeVD.
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Affiliation(s)
- Francis Nicole Saridin
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Kimberly Ann Chew
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Anthonin Reilhac
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Bibek Giyanwali
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Tomotaka Tanaka
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phillip Scheltens
- Department of Neurology & Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Christopher Li Hsian Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Montaser-Kouhsari L, Young CB, Poston KL. Neuroimaging approaches to cognition in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:257-286. [PMID: 35248197 DOI: 10.1016/bs.pbr.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While direct visualization of Lewy body accumulation within the brain is not yet possible in living Parkinson's disease patients, brain imaging studies offer insights into how the buildup of Lewy body pathology impacts different regions of the brain. Unlike biological biomarkers and purely behavioral research, these brain imaging studies therefore offer a unique opportunity to relate brain localization to cognitive function and dysfunction in living patients. Magnetic resonance imaging studies can reveal physical changes in brain structure as they relate to different cognitive domains and task specific impairments. Functional imaging studies use a combination of task and resting state magnetic resonance imaging, as well as positron emission tomography and single photon emission computed tomography, and can be used to determine changes in blood flow, neuronal activation and neurochemical changes in the brain associated with PD cognition and cognitive impairments. Other unique advantages to brain imaging studies are the ability to monitor changes in brain structure and function longitudinally as patients progress and the ability to study changes in brain function when patients are exposed to different pharmacological manipulations. This is particularly true when assessing the effects of dopaminergic replacement therapy on cognitive function in Parkinson's disease patients. Together, this chapter will describe imaging studies that have helped identify structural and functional brain changes associated with cognition, cognitive impairment, and dementia in Parkinson's disease.
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Affiliation(s)
- Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States; Department of Neurosurgery, Stanford University, Stanford, CA, United States.
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