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Anita NZ, Herrmann N, Ryoo SW, Major-Orfao C, Lin WZ, Kwan F, Noor S, Rabin JS, Marzolini S, Nestor S, Ruthirakuhan MT, MacIntosh BJ, Goubran M, Yang P, Cogo-Moreira H, Rapoport M, Gallagher D, Black SE, Goldstein BI, Lanctôt KL, Oh PI, Taha AY, Swardfager W. Cytochrome P450-soluble epoxide hydrolase oxylipins, depression and cognition in type 2 diabetes. J Diabetes Complications 2024; 38:108826. [PMID: 39059187 DOI: 10.1016/j.jdiacomp.2024.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/11/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024]
Abstract
AIMS This study examined serum cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) oxylipins and depressive symptoms together in relation to cognitive performance in individuals with type 2 diabetes mellitus (T2DM). METHODS Clinically cognitively normal T2DM individuals were recruited (NCT04455867). Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II; total scores ≤13 indicated minimal depressive symptoms and ≥ 14 indicated significant depressive symptoms). Executive function and verbal memory were assessed. Fasting serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass-spectrometry. RESULTS The study included 85 participants with minimal depressive symptoms and 27 with significant symptoms (mean age: 63.3 ± 9.8 years, 49 % women). In all participants, higher concentrations of linoleic acid derived sEH (12,13-dihydroxyoctadecamonoenoic acid; DiHOME) and CYP450 (12(13)-epoxyoctadecamonoenoic acid; EpOME) metabolites were associated with poorer executive function (F1,101 = 6.094, p = 0.015 and F1,101 = 5.598, p = 0.020, respectively). Concentrations of multiple sEH substrates interacted with depressive symptoms to predict 1) poorer executive function, including 9(10)-EpOME (F1,100 = 12.137, p < 0.001), 5(6)-epoxyeicosatrienoic acid (5(6)-EpETrE; F1,100 = 6.481, p = 0.012) and 11(12)-EpETrE (F1,100 = 4.409, p = 0.038), and 2) verbal memory, including 9(10)-EpOME (F1,100 = 4.286, p = 0.041), 5(6)-EpETrE (F1,100 = 6.845, p = 0.010), 11(12)-EpETrE (F1,100 = 3.981, p = 0.049) and 14(15)-EpETrE (F1,100 = 5.019, p = 0.027). CONCLUSIONS Associations of CYP450-sEH metabolites and depressive symptoms with cognition highlight the biomarker and therapeutic potential of the CYP450-sEH pathway in T2DM.
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Affiliation(s)
- Natasha Z Anita
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Si Won Ryoo
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Chelsi Major-Orfao
- Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - William Z Lin
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Felicia Kwan
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Shiropa Noor
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Sean Nestor
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Myuri T Ruthirakuhan
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics - University of Toronto, Canada
| | - Maged Goubran
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics - University of Toronto, Canada
| | - Pearl Yang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Department of Education, Østfold University College, 1757 B R A Veien 4, Halden 1757, Norway
| | - Mark Rapoport
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Damien Gallagher
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Sandra E Black
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Benjamin I Goldstein
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Department of Psychiatry - University of Toronto, Canada; Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Paul I Oh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Ameer Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA; West Coast Metabolomics Center, Genome Center, University of California, Davis, CA, USA; Center for Neuroscience, One Shields Avenue, University of California, Davis, CA, USA
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada.
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Godefroy O, Aarabi A, Béjot Y, Biessels GJ, Glize B, Mok VC, Schotten MTD, Sibon I, Chabriat H, Roussel M. Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily. Eur Stroke J 2024:23969873241271651. [PMID: 39129252 DOI: 10.1177/23969873241271651] [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: 08/13/2024] Open
Abstract
PURPOSE Post-stroke (PS) cognitive impairment (CI) is frequent and its devastating functional and vital consequences are well known. Despite recent guidelines, they are still largely neglected. A large number of recent studies have re-examined the epidemiology, diagnosis, imaging determinants and management of PSCI. The aim of this update is to determine whether these new data answer the questions that are essential to reducing PSCI, the unmet needs, and steps still to be taken. METHODS Literature review of stroke unit-era studies examining key steps in the management of PSCI: epidemiology and risk factors, diagnosis (cognitive profile and assessments), imaging determinants (quantitative measures, voxelwise localization, the disconnectome and associated Alzheimer's disease [AD]) and treatment (secondary prevention, symptomatic drugs, rehabilitation and noninvasive brain stimulation) of PSCI. FINDINGS (1) the prevalence of PSCI of approximately 50% is probably underestimated; (2) the sensitivity of screening tests should be improved to detect mild PSCI; (3) comprehensive assessment is now well-defined and should include apathy; (4) easily available factors can identify patients at high risk of PSCI; (5) key imaging determinants are the location and volume of the lesion and the resulting disconnection, associated AD and brain atrophy; WMH, ePVS, microhemorrhages, hemosiderosis, and cortical microinfarcts may contribute to cognitive impairment but are more likely to be markers of brain vulnerability or associated AD that reduce PS recovery; (6) remote and online assessment is a promising approach for selected patients; (7) secondary stroke prevention has not been proven to prevent PSCI; (8) symptomatic drugs are ineffective in treating PSCI and apathy; (9) in addition to cognitive rehabilitation, the benefits of training platforms and computerized training are yet to be documented; (10) the results and the magnitude of improvement of noninvasive brain stimulation, while very promising, need to be substantiated by large, high-quality, sham-controlled RCTs. DISCUSSION AND CONCLUSION These major advances pave the way for the reduction of PSCI. They include (1) the development of more sensitive screening tests applicable to all patients and (2) online remote assessment; crossvalidation of (3) clinical and (4) imaging factors to (5) identify patients at risk, as well as (6) factors that prompt a search for associated AD; (7) the inclusion of cognitive outcome as a secondary endpoint in acute and secondary stroke prevention trials; and (8) the validation of the benefit of noninvasive brain stimulation through high-quality, randomized, sham-controlled trials. Many of these objectives can be rapidly and easily attained.
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Affiliation(s)
- Olivier Godefroy
- Departments of Neurology, Amiens University Hospital, France
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Yannick Béjot
- Department of Neurology, Dijon University Hospital, France
- Dijon Stroke Registry, EA7460, University of Burgundy, France
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Bertrand Glize
- Department of Rehabilitation, University Hospital, Bordeaux, France
| | - Vincent Ct Mok
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Michel Thiebaut de Schotten
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodegeneratives-UMR 5293 CNRS CEA University of Bordeaux, Bordeaux, France
- Brain Connectivity and Behaviour Laboratory Sorbonne Universities Paris, France
| | - Igor Sibon
- Department of Neurology, University Hospital, Bordeaux, France
| | - Hugues Chabriat
- Department of Neurology, Lariboisière Hospital, and INSERM NeuroDiderot UMR 1141, Paris, France
| | - Martine Roussel
- Departments of Neurology, Amiens University Hospital, France
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
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Yan Q, Liu M, Xie Y, Lin Y, Fu P, Pu Y, Wang B. Kidney-brain axis in the pathogenesis of cognitive impairment. Neurobiol Dis 2024; 200:106626. [PMID: 39122123 DOI: 10.1016/j.nbd.2024.106626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
The kidney-brain axis is a bidirectional communication network connecting the kidneys and the brain, potentially affected by inflammation, uremic toxin, vascular injury, neuronal degeneration, and so on, leading to a range of diseases. Numerous studies emphasize the disruptions of the kidney-brain axis may contribute to the high morbidity of neurological disorders, such as cognitive impairment (CI) in the natural course of chronic kidney disease (CKD). Although the pathophysiology of the kidney-brain axis has not been fully elucidated, epidemiological data indicate that patients at all stages of CKD have a higher risk of developing CI compared with the general population. In contrast to other reviews, we mentioned some commonly used medicines in CKD that may play a pivotal role in the pathogenesis of CI. Revealing the pathophysiology interactions between kidney damage and brain function can reduce the potential risk of future CI. This review will deeply explore the characteristics, indicators, and potential pathophysiological mechanisms of CKD-related CI. It will provide a theoretical basis for identifying CI that progresses during CKD and ultimately prevents and treats CKD-related CI.
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Affiliation(s)
- Qianqian Yan
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Mengyuan Liu
- Department of Anesthesiology, Air Force Hospital of Western Theater Command, PLA, Chengdu 610011, China
| | - Yiling Xie
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yimi Lin
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ping Fu
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yaoyu Pu
- Department of Rheumatology and Immunology, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Bo Wang
- Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University, Chengdu 610041, China.
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Aytenew TM, Kefale D, Birhane BM, Kebede SD, Asferie WN, Kassaw A, Tiruneh YM, Legas G, Getie A, Bantie B, Asnakew S. Poststroke cognitive impairment among stroke survivors in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:2143. [PMID: 39112982 PMCID: PMC11308218 DOI: 10.1186/s12889-024-19684-3] [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: 02/15/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability among adults and elderly individuals worldwide. Although several primary studies have been conducted to determine the prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa, these studies have presented inconsistent findings. Therefore, this study aimed to determine the pooled prevalence of poststroke cognitive impairment and identify its associated factors among stroke survivors in sub-Saharan Africa. METHODS The studies were retrieved from the Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of the included studies was performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa. RESULTS A total of 10 primary studies with a sample size of 1,709 stroke survivors were included in the final meta-analysis. The pooled prevalence of PSCI was obtained from the 9 included studies with a sample size of 1,566. In contrast, the data regarding the associated factors were obtained from all the 10 included studies with a sample size of 1,709. The pooled prevalence of poststroke cognitive impairment among stroke survivors was 59.61% (95% CI: 46.87, 72.35); I2 = 96.47%; P < 0.001). Increased age (≥ 45 years) [AOR = 1.23, 95% CI: 1.09, 1.40], lower educational level [AOR = 4.35, 95% CI: 2.87, 6.61], poor functional recovery [AOR = 1.75, 95% CI: 1.42, 2.15], and left hemisphere stroke [AOR = 4.88, 95% CI: 2.98, 7.99] were significantly associated with poststroke cognitive impairment. CONCLUSIONS The pooled prevalence of poststroke cognitive impairment was considerably high among stroke survivors in sub-Saharan Africa. Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive impairment in sub-Saharan Africa. Stakeholders should focus on empowering education and lifestyle modifications, keeping their minds engaged, staying connected with social activities and introducing rehabilitative services for stroke survivors with these identified factors to reduce the risk of developing poststroke cognitive impairment.
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Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis Kebede
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Getasew Legas
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Blake JA, Long DL, Knight AJ, Goodin BR, Crowe M, Judd SE, Rhodes JD, Roth DL, Clay OJ. Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study. J Am Heart Assoc 2024; 13:e033375. [PMID: 39056351 DOI: 10.1161/jaha.123.033375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke severity ratings and a caregiver-report of poststroke functioning with longitudinal cognitive outcomes. METHODS AND RESULTS One hundred fifty-seven caregivers and stroke survivor dyads participated in the CARES (Caring for Adults Recovering From the Effects of Stroke) project, an ancillary study of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) national cohort study. The Glasgow Outcome Scale and modified Rankin Scale scores collected at hospitalization discharge were included as 2 primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at 9 months following stroke were included as a third predictor. Cognition was measured using a biennial telephone battery and included the domains of learning, memory, and executive functioning. Multiple cognitive assessments were analyzed up to 5 years poststroke, controlling for prestroke cognition and demographic variables of the stroke survivor. Separate mixed models showed significant main effects of the Glasgow Outcome Scale (b=0.3380 [95% CI, 0.14-0.5]; P=0.0009), modified Rankin Scale (b=-0.2119 [95% CI, -0.32 to -0.10]; P=0.0002), and caregiver-reported problems (b=-0.0671 [95% CI, -0.09 to -0.04]; P<0.0001) on longitudinal cognitive scores. In a combined model including all 3 predictors, only caregiver-reported problems significantly predicted cognition (b=-0.0480 [95% CI, -0.08 to -0.03]; P<0.0001). CONCLUSIONS These findings emphasize the importance of caregiver feedback in predicting cognitive consequences of stroke.
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Affiliation(s)
- Jason A Blake
- Department of Psychology University of Alabama at Birmingham Birmingham AL
| | - D Leann Long
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - Amy J Knight
- Department of Neurology University of Alabama at Birmingham Birmingham AL
| | - Burel R Goodin
- Department of Anesthesiology Washington University in St. Louis St. Louis MO
| | - Michael Crowe
- Department of Psychology University of Alabama at Birmingham Birmingham AL
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - J David Rhodes
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - David L Roth
- Center on Aging and Health Johns Hopkins School of Medicine Baltimore MD
| | - Olivio J Clay
- Department of Psychology University of Alabama at Birmingham Birmingham AL
- Alzheimer's Disease Research Center University of Alabama at Birmingham Birmingham AL
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Sarfo FS, Adu-Gyamfi R, Opare-Addo PA, Agyei B, Ampofo M, Nguah SB, Ovbiagele B. Effect of a Cardiovascular Polypill on Poststroke Cognition Among Ghanaians: Secondary Analysis of a Randomized Clinical Trial. J Am Heart Assoc 2024; 13:e034346. [PMID: 39082406 DOI: 10.1161/jaha.124.034346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Poststroke cognitive impairment is prevalent worldwide, with no satisfactory preventative therapeutic strategies. We report on the effect of a cardiovascular polypill on cognitive performance among recent stroke survivors. METHODS AND RESULTS The SMAART (Stroke Minimization through Additive Anti-atherosclerotic Agents in Routine Treatment) trial was a phase II randomized trial primarily assessing the polypill versus usual care for secondary prevention after a recent ischemic stroke. Participants allocated to the experimental arm were provided 2 Polycaps taken orally once a day for 12 months. A capsule of Polycap contained aspirin 100 mg, simvastatin 20 mg, hydrochlorothiazide 12.5 mg, ramipril 5 mg, and atenolol 50 mg. Participants in the usual care arm received standard secondary prevention therapy. We compared slopes of the trajectory of raw scores in the executive, language, memory, and visuospatial cognitive domains and aggregated cognitive scores over 12 months via a linear mixed-effects model. We enrolled 148 eligible participants (n=74 in each arm) and 59 versus 64 participants in the polypill and usual care arms, respectively, at month 12. Compared with the usual care arm, the slopes of cognitive performance over 12 months in the polypill arm were steeper by 2.02 units (95% CI, 0.52-3.53), P=0.009 in executive domain, 1.88 units (95% CI, 0.42-3.34), P=0.012 in language domain, 2.60 (0.03-5.17), P=0.049 in memory domain, 0.55 (-0.80 to 1.91), P=0.42 in the visuospatial domain, and global cognitive performance 6.87 units (95% CI, 1.44-12.30), P=0.013. CONCLUSIONS The cardiovascular polypill is associated with a signal of better cognitive performance over 12 months among stroke survivors. Further definitive trials are warranted. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03329599.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
- Komfo Anokye Teaching Hospital Kumasi Ghana
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Da Silveira RV, Magalhães TNC, Balthazar MLF, Castellano G. Differences between Alzheimer's disease and mild cognitive impairment using brain networks from magnetic resonance texture analysis. Exp Brain Res 2024; 242:1947-1955. [PMID: 38910159 DOI: 10.1007/s00221-024-06871-2] [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: 12/15/2023] [Accepted: 06/07/2024] [Indexed: 06/25/2024]
Abstract
Several studies have aimed at identifying biomarkers in the initial phases of Alzheimer's disease (AD). Conversely, texture features, such as those from gray-level co-occurrence matrices (GLCMs), have highlighted important information from several types of medical images. More recently, texture-based brain networks have been shown to provide useful information in characterizing healthy individuals. However, no studies have yet explored the use of this type of network in the context of AD. This work aimed to employ texture brain networks to investigate the distinction between groups of patients with amnestic mild cognitive impairment (aMCI) and mild dementia due to AD, and a group of healthy subjects. Magnetic resonance (MR) images from the three groups acquired at two instances were used. Images were segmented and GLCM texture parameters were calculated for each region. Structural brain networks were generated using regions as nodes and the similarity among texture parameters as links, and graph theory was used to compute five network measures. An ANCOVA was performed for each network measure to assess statistical differences between groups. The thalamus showed significant differences between aMCI and AD patients for four network measures for the right hemisphere and one network measure for the left hemisphere. There were also significant differences between controls and AD patients for the left hippocampus, right superior parietal lobule, and right thalamus-one network measure each. These findings represent changes in the texture of these regions which can be associated with the cortical volume and thickness atrophies reported in the literature for AD. The texture networks showed potential to differentiate between aMCI and AD patients, as well as between controls and AD patients, offering a new tool to help understand these conditions and eventually aid early intervention and personalized treatment, thereby improving patient outcomes and advancing AD research.
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Affiliation(s)
- Rafael Vinícius Da Silveira
- Department of Cosmic Rays and Chronology, Gleb Wataghin Physics Institute, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil.
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil.
| | - Thamires Naela Cardoso Magalhães
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcio Luiz Figueredo Balthazar
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Gabriela Castellano
- Department of Cosmic Rays and Chronology, Gleb Wataghin Physics Institute, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, Brazil
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Pathan N, Kharod MK, Nawab S, Di Scipio M, Paré G, Chong M. Genetic Determinants of Vascular Dementia. Can J Cardiol 2024; 40:1412-1423. [PMID: 38579965 DOI: 10.1016/j.cjca.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Vascular dementia (VaD) is a prevalent form of cognitive impairment with underlying vascular etiology. In this review, we examine recent genetic advancements in our understanding of VaD, encompassing a range of methodologies including genome-wide association studies, polygenic risk scores, heritability estimates, and family studies for monogenic disorders revealing the complex and heterogeneous nature of the disease. We report well known genetic associations and highlight potential pathways and mechanisms implicated in VaD and its pathological risk factors, including stroke, cerebral small vessel disease, and cerebral amyloid angiopathy. Moreover, we discuss important modifiable risk factors such as hypertension, diabetes, and dyslipidemia, emphasizing the importance of a multifactorial approach in prevention, treatment, and understanding the genetic basis of VaD. Last, we outline several areas of scientific advancements to improve clinical care, highlighting that large-scale collaborative efforts, together with an integromics approach can enhance the robustness of genetic discoveries. Indeed, understanding the genetics of VaD and its pathophysiological risk factors hold the potential to redefine VaD on the basis of molecular mechanisms and to generate novel diagnostic, prognostic, and therapeutic tools.
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Affiliation(s)
- Nazia Pathan
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Muskaan Kaur Kharod
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sajjha Nawab
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.
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9
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Muir RT, Smith EE. The Spectrum of Cerebral Small Vessel Disease: Emerging Pathophysiologic Constructs and Management Strategies. Neurol Clin 2024; 42:663-688. [PMID: 38937035 DOI: 10.1016/j.ncl.2024.03.003] [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: 06/29/2024]
Abstract
Cerebral small vessel disease (CSVD) is a spectrum of disorders that affect small arterioles, venules, cortical and leptomeningeal vessels, perivascular spaces, and the integrity of neurovascular unit, blood brain barrier, and surrounding glia and neurons. CSVD is an important cause of lacunar ischemic stroke and sporadic hemorrhagic stroke, as well as dementia-which will constitute some of the most substantive population and public health challenges over the next century. This article provides an overview of updated pathophysiologic frameworks of CSVD; discusses common and underappreciated clinical and neuroimaging manifestations of CSVD; and reviews emerging genetic risk factors linked to sporadic CSVD.
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Affiliation(s)
- Ryan T Muir
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
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10
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Godefroy O, Weaver NA, Roussel M, Dorchies F, Kassir R, Biesbroek JM, Lee KJ, Kim BJ, Bae HJ, Lim JS, Lee M, Yu KH, Aben HP, de Kort PLM, Bordet R, Lopes R, Dondaine T, Biessels GJ, Aarabi A. Architecture and anatomy of executive processes: evidence from verbal fluency and Trail Making Test in 2009 stroke patients. J Neurol 2024:10.1007/s00415-024-12541-8. [PMID: 39060618 DOI: 10.1007/s00415-024-12541-8] [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: 04/21/2024] [Revised: 06/21/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES The few voxel-wise lesion-symptom mapping (VLSM) studies aimed at identifying the anatomy of executive function are limited by the absence of a model and by small populations. Using Trail Making Test (TMT) and verbal fluency and a model of their architectures, our objective was to identify the key structures underlying two major executive processes, set-shifting and strategic word search. METHODS We applied a validated VLSM analysis to harmonized cognitive and imaging data from 2009 ischemic stroke patients as a part of the Meta VCI Map consortium. All contrast analyses used an adjusted threshold with 2000 Freedman-Lane permutations (p ≤ 0.05). RESULTS The TMT parts A and B were associated with structures involved in visual-spatial processing, the motor system, the frontal lobes, and their subcortical connections. Set-shifting depended on the left dorsomedial frontal region. Both semantic and phonemic fluency tests depended on verbal output abilities and processing speed with similar slopes in different languages. The strategic search process depended on Broca's area, F2 and related tracts, temporal and deep regions. Lastly, the lesion map of set-shifting did not overlap with those of strategic word search processes. INTERPRETATION Our results identify the anatomical substrates of two main executive processes, revealing that they represent only a specific subpart of previously reported structures. Finally, our results indicate that executive functions depend on several specific, anatomically separable executive processes mainly operating in various parts of the frontal lobes.
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Affiliation(s)
- Olivier Godefroy
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France.
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Martine Roussel
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Flore Dorchies
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Rania Kassir
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hayllm University College of Medicine, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hayllm University College of Medicine, Anyang, Republic of Korea
| | - Hugo P Aben
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Paul L M de Kort
- Department of Neurology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Régis Bordet
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Renaud Lopes
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Thibaut Dondaine
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Ardalan Aarabi
- Department of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
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11
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Dammavalam V, Rupert D, Lanio M, Jin Z, Nadkarni N, Tsirka SE, Bergese SD. Dementia after Ischemic Stroke, from Molecular Biomarkers to Therapeutic Options. Int J Mol Sci 2024; 25:7772. [PMID: 39063013 PMCID: PMC11276729 DOI: 10.3390/ijms25147772] [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: 05/01/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic stroke is a leading cause of disability worldwide. While much of post-stroke recovery is focused on physical rehabilitation, post-stroke dementia (PSD) is also a significant contributor to poor functional outcomes. Predictive tools to identify stroke survivors at risk for the development of PSD are limited to brief screening cognitive tests. Emerging biochemical, genetic, and neuroimaging biomarkers are being investigated in an effort to unveil better indicators of PSD. Additionally, acetylcholinesterase inhibitors, NMDA receptor antagonists, dopamine receptor agonists, antidepressants, and cognitive rehabilitation are current therapeutic options for PSD. Focusing on the chronic sequelae of stroke that impair neuroplasticity highlights the need for continued investigative trials to better assess functional outcomes in treatments targeted for PSD.
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Affiliation(s)
- Vikalpa Dammavalam
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (M.L.); (N.N.)
| | - Deborah Rupert
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Marcos Lanio
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (M.L.); (N.N.)
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA;
| | - Neil Nadkarni
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (M.L.); (N.N.)
| | - Stella E. Tsirka
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sergio D. Bergese
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (M.L.); (N.N.)
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12
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Zhang W, Fu W, Zhang Y. Association of Cerebral Hypoperfusion and Poor Collaterals with Cognitive Impairment in Patients with Severe Vertebrobasilar Artery Stenosis. J Alzheimers Dis Rep 2024; 8:999-1007. [PMID: 39114550 PMCID: PMC11305839 DOI: 10.3233/adr-240007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/28/2024] [Indexed: 08/10/2024] Open
Abstract
Background Effect of stenosis of vertebrobasilar artery (VBA) on cognitive function is elusive. Objective To investigate association of cerebral hypoperfusion and poor collaterals with vascular cognitive impairment (VCI) in severe VBA stenosis patients. Methods We consecutively enrolled patients with severe VBA stenosis confirmed by digital subtraction angiography who underwent computed tomographic perfusion (CTP) and cognitive assessments. Patients were divided into poor or good collaterals groups according to the collateral circulation status, and were grouped into different perfusion groups according to CTP. Cognitive function was measured by Montreal Cognitive Assessment (MoCA), Clock Drawing Test, Stroop Color Word Test, Trail Making Test, Digital Span Test, Auditory Verbal Learning Test, and Boston Naming Test scales. The association of cerebral perfusion and collaterals with VCI were explored. Results Among 88 eligible patients, VCI occurred in 51 (57.9%) patients experienced. Poor collateral was present in 73 (83.0%) patients, and hypoperfusion in 64 (72.7%). Compared with normal perfusion patients, the odds ratio with 95% confidence interval for VCI was 12.5 (3.7-42.4) for overall hypoperfusion, 31.0 (7.1-135.5) for multiple site hypoperfusion, 3.3 (1.0-10.5) for poor collaterals, and 0.1 (0-0.6) for presence of posterior communicating artery (PcoA) compensated for posterior cerebral artery (PCA) and basilar artery (BA). Additionally, decreased scores of cognitive function tests occurred in patients with decompensated perfusion or poor collaterals. Conclusions Hypoperfusion and poor collaterals were positively associated with cognitive impairment in patients with severe VBA. However, PcoA compensated for the PCA and BA had a protective role in cognitive impairment development.
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Affiliation(s)
- Weiyi Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Weilun Fu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yumei Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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13
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Deng M, Hou Y, Liu J, He J, Lan Z, Xiao H. Mesenchymal stem cell-derived exosomes overexpressing SRC-3 protect mice from cerebral ischemia by inhibiting ferroptosis. Brain Res Bull 2024; 211:110948. [PMID: 38614406 DOI: 10.1016/j.brainresbull.2024.110948] [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: 10/22/2023] [Revised: 02/26/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The treatment for cerebral ischemia remains limited, and new therapeutic strategies are urgently needed. Exosome has shown great promise for the treatment of cerebral ischemia. Steroid receptor coactivator-3 (SRC-3) was reported to be involved in neurological performances. In this study, we aimed to investigate the protective effects of mesenchymal stem cell (MSC)-derived exosomes overexpressing SRC-3 on cerebral ischemia in mice. METHODS The mice were treated with an intracerebroventricular injection of GFP-overexpressed exosomes (GFP-exo) and SRC-3-overexpressed exosomes (SRC3-exo) in a middle cerebral artery occlusion (MCAO) model of cerebral ischemia. RESULTS The results showed that SRC3-exo treatment significantly inhibited lipid peroxidation and ferroptosis of the neurons subjected to oxygen-glucose deprivation. It further suppressed the activation of microglia and astrocytes, and decreased the production of pro-inflammatory cytokines in the brains of MCAO mice. Furthermore, SRC3-exo treatment reduced the water content of brain tissue and infarct size, which alleviated the neurological damage and improved neurological performances in the MCAO mice. CONCLUSIONS Our results suggest that MSC-derived exosomes expressing SRC3 can be a therapeutic strategy for cerebral ischemia by inhibiting ferroptosis.
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Affiliation(s)
- Mingyang Deng
- Department of Hematology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ying Hou
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jianyang Liu
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jialin He
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ziwei Lan
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Han Xiao
- Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Clinical Medical Research Center for Stroke Prevention and Treatment of Hunan Province, Department of Neurology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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14
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Wang MD, Fu QH, Ni A, Yuan YP, Li CH, Wang ZX, Wang H. The role of early cerebral edema and hematoma assessment in aneurysmal subarachnoid hemorrhage (a-SAH) in predicting early brain injury (EBI) and cognitive impairment: a case controlled study. Int J Surg 2024; 110:3166-3177. [PMID: 38445521 PMCID: PMC11175797 DOI: 10.1097/js9.0000000000001244] [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: 12/18/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Early assessment and management of cerebral edema and hematoma following aneurysmal subarachnoid hemorrhage (a-SAH) can significantly impact clinical cognitive outcomes. However, current clinical practices lack predictive models to identify early structural brain abnormalities affecting cognition. To address this gap, the authors propose the development of a predictive model termed the a-SAH Early Brain Edema/Hematoma Compression Neural (Structural Brain) Networks Score System (SEBE-HCNNSS). METHODS In this study, 202 consecutive patients with spontaneous a-SAH underwent initial computed tomography (CT) or MRI scans within 24 h of ictus with follow-up 2 months after discharge. Using logistic regression analysis (univariate and multivariate), the authors evaluated the association of clinically relevant factors and various traditional scale ratings with cognitive impairment (CI). Risk factors with the highest area under the curve (AUC) values were included in the multivariate analysis and least absolute shrinkage and selection operator (LASSO) analysis or Cox regression analysis. RESULTS A total of 177 patients were enrolled in the study, and 43 patients were classified with a high SEBE-HCNNSS grade (3-5). After a mean follow-up of 2 months, 121 individuals (68.36%) with a-SAH and three control subjects developed incident CI. The CT interobserver reliability of the SEBE-HCNNSS scale was high, with a Kappa value of 1. Furthermore, ROC analysis identified the SEBE-HCNNSS scale (OR 3.322, 95% CI: 2.312-7.237, P =0.00025) as an independent predictor of edema, CI, and unfavorable prognosis. These results were also replicated in a validation cohort. CONCLUSION Overall, the SEBE-HCNNSS scale represents a simple assessment tool with promising predictive value for CI and clinical outcomes post-a-SAH. Our findings indicate its practical utility as a prognostic instrument for risk evaluation after a-SAH, potentially facilitating early intervention and treatment.
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Affiliation(s)
- Ming-Dong Wang
- Department of Neurosurgery, The First Hospital of Hebei Medical University
- Department of Neurosurgery, Hebei Hospital of Xuanwu Hospital Capital Medical University
| | - Qian-Hui Fu
- College of Pharmacy, MINZU University of China, Key Laboratory of Ministry of Education, Ministry of Education (MINZU University of China), Beijing
| | - Andrew Ni
- Warren Alpert Medical School, Brown University, Providence, USA
| | - Yun-Peng Yuan
- Department of Neurosurgery, Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai
| | - Chun-Hui Li
- Department of Neurosurgery, The First Hospital of Hebei Medical University
- Department of Neurosurgery, Hebei Hospital of Xuanwu Hospital Capital Medical University
| | - Zhan-Xiang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, People’s Republic of China
| | - Hong Wang
- Department of Neurosurgery, The Affiliated Hospital of Hebei University, Baoding, Hebei
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15
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Khalilian M, Roussel M, Godefroy O, Aarabi A. Predicting functional impairments with lesion-derived disconnectome mapping: Validation in stroke patients with motor deficits. Eur J Neurosci 2024; 59:3074-3092. [PMID: 38578844 DOI: 10.1111/ejn.16334] [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: 08/10/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
Focal structural damage to white matter tracts can result in functional deficits in stroke patients. Traditional voxel-based lesion-symptom mapping is commonly used to localize brain structures linked to neurological deficits. Emerging evidence suggests that the impact of structural focal damage may extend beyond immediate lesion sites. In this study, we present a disconnectome mapping approach based on support vector regression (SVR) to identify brain structures and white matter pathways associated with functional deficits in stroke patients. For clinical validation, we utilized imaging data from 340 stroke patients exhibiting motor deficits. A disconnectome map was initially derived from lesions for each patient. Bootstrap sampling was then employed to balance the sample size between a minority group of patients exhibiting right or left motor deficits and those without deficits. Subsequently, SVR analysis was used to identify voxels associated with motor deficits (p < .005). Our disconnectome-based analysis significantly outperformed alternative lesion-symptom approaches in identifying major white matter pathways within the corticospinal tracts associated with upper-lower limb motor deficits. Bootstrapping significantly increased the sensitivity (80%-87%) for identifying patients with motor deficits, with a minimum lesion size of 32 and 235 mm3 for the right and left motor deficit, respectively. Overall, the lesion-based methods achieved lower sensitivities compared with those based on disconnection maps. The primary contribution of our approach lies in introducing a bootstrapped disconnectome-based mapping approach to identify lesion-derived white matter disconnections associated with functional deficits, particularly efficient in handling imbalanced data.
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Affiliation(s)
- Maedeh Khalilian
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
| | - Martine Roussel
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
| | - Olivier Godefroy
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
- Faculty of Medicine, University of Picardy Jules Verne, Amiens, France
- Neurology Department, Amiens University Hospital, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neuroscience and Pathologies (UR UPJV 4559), University Research Center (CURS), University of Picardy Jules Verne, Amiens, France
- Faculty of Medicine, University of Picardy Jules Verne, Amiens, France
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16
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Gaur A, Gallagher D, Herrmann N, Chen JJ, Marzolini S, Oh P, Amemiya Y, Seth A, Kiss A, Lanctôt KL. Neurofilament Light Chain as a Biomarker of Global Cognition in Individuals With Possible Vascular Mild Cognitive Impairment. J Geriatr Psychiatry Neurol 2024:8919887241254469. [PMID: 38757180 DOI: 10.1177/08919887241254469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Neurofilament Light Chain (NfL) is a biomarker of axonal injury elevated in mild cognitive impairment (MCI) and Alzheimer's disease dementia. Blood NfL also inversely correlates with cognitive performance in those conditions. However, few studies have assessed NfL as a biomarker of global cognition in individuals demonstrating mild cognitive deficits who are at risk for vascular-related cognitive decline. OBJECTIVE To assess the relationship between blood NfL and global cognition in individuals with possible vascular MCI (vMCI) throughout cardiac rehabilitation (CR). Additionally, NfL levels were compared to age/sex-matched cognitively unimpaired (CU) controls. METHOD Participants with coronary artery disease (vMCI or CU) were recruited at entry to a 24-week CR program. Global cognition was measured using the Montreal Cognitive Assessment (MoCA) and plasma NfL level (pg/ml) was quantified using a highly sensitive enzyme-linked immunosorbent assay. RESULTS Higher plasma NfL was correlated with worse MoCA scores at baseline (β = -.352, P = .029) in 43 individuals with vMCI after adjusting for age, sex, and education. An increase in NfL was associated with worse global cognition (b[SE] = -4.81[2.06], P = .023) over time, however baseline NfL did not predict a decline in global cognition. NfL levels did not differ between the vMCI (n = 39) and CU (n = 39) groups (F(1, 76) = 1.37, P = .245). CONCLUSION Plasma NfL correlates with global cognition at baseline in individuals with vMCI, and is associated with decline in global cognition during CR. Our findings increase understanding of NfL and neurobiological mechanisms associated with cognitive decline in vMCI.
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Affiliation(s)
- Amish Gaur
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Damien Gallagher
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jinghan Jenny Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Yutaka Amemiya
- Genomics Core Facility, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Arun Seth
- Genomics Core Facility, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alex Kiss
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, Toronto, ON, Canada
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17
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Folloso MC, Villaraza SG, Yi-Wen L, Pek-Lan K, Tanaka T, Hilal S, Venketasubramanian N, Li-Hsian Chen C. The AHA/ASA and DSM-V diagnostic criteria for vascular cognitive impairment identify cases with predominant vascular pathology. Int J Stroke 2024:17474930241252556. [PMID: 38651759 DOI: 10.1177/17474930241252556] [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: 04/25/2024]
Abstract
BACKGROUND There are major challenges in determining the etiology of vascular cognitive impairment (VCI) clinically, especially in the presence of mixed pathologies, such as vascular and amyloid. Most recently, two criteria (American Heart Association/American Stroke Association (AHA/ASA) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)) have been proposed for the clinical diagnosis of VCI but have not as yet been validated using neuroimaging. AIMS This study aims to determine whether the AHA/ASA and DSM-V criteria for VCI can distinguish between cases with predominantly vascular pathology and cases with mixed pathology. METHODS A total of 186 subjects were recruited from a cross-sectional memory clinic-based study at the National University Hospital, Singapore. All subjects underwent clinical and neuropsychological assessment, magnetic resonance imaging (MRI) and carbon 11-labeled Pittsburgh Compound B ([11C] PiB) positron emission tomography (PET) scans. Diagnosis of the etiological subtypes of VCI (probable vascular mild cognitive impairment (VaMCI), possible VaMCI, non-VaMCI, probable vascular dementia (VaD), possible VaD, non-VaD) were performed following AHA/ASA and DSM-V criteria. Brain amyloid burden was determined for each subject with standardized uptake value ratio (SUVR) values ⩾1.5 classified as amyloid positive. RESULTS Using κ statistics, both criteria had excellent agreement for probable VaMCI, probable VaD, and possible VaD (κ = 1.00), and good for possible VaMCI (κ = 0.71). Using the AHA/ASA criteria, the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) was significantly lower compared to possible VaMCI (26.7%), non-VaMCI (33.3%), possible VaD (73.3%), and non-VaD (76.2%) (p < 0.001). Similarly, using the DSM-V criteria, the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) was significantly lower compared to possible VaMCI (26.3%), non-VaMCI (32.1%), possible VaD (73.3%), and non-VaD (76.2%) (p < 0.001). In both criteria, there was good agreement in differentiating individuals with non-VaD and possible VaD, with significantly higher (p < 0.001) global [11C]-PiB SUVR, from individuals with probable VaMCI and probable VaD, who had predominant vascular pathology. CONCLUSION The AHA/ASA and DSM-V criteria for VCI can identify VCI cases with little to no concomitant amyloid pathology, hence supporting the utility of AHA/ASA and DSM-V criteria in diagnosing patients with predominant vascular pathology. DATA ACCESS STATEMENT Data supporting this study are available from the Memory Aging and Cognition Center, National University of Singapore. Access to the data is subject to approval and a data sharing agreement due to University policy.
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Affiliation(s)
- Melmar C Folloso
- Memory, Ageing and Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore
| | - Steven G Villaraza
- Memory, Ageing and Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore
| | - Lo Yi-Wen
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Khong Pek-Lan
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Tomotaka Tanaka
- Memory, Ageing and Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Saima Hilal
- Memory, Ageing and Cognition Centre, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | - Christopher Li-Hsian Chen
- Memory, Ageing and Cognition Centre, National University Health System, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University Hospital, Singapore
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18
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Desikan SK, Brahmbhatt B, Patel J, Kankaria AA, Anagnostakos J, Dux M, Beach K, Gray VL, McDonald T, Crone C, Sikdar S, Sorkin JD, Lal BK. Cognitive impairment in asymptomatic carotid artery stenosis is associated with abnormal segments in the Circle of Willis. J Vasc Surg 2024:S0741-5214(24)01085-1. [PMID: 38710420 DOI: 10.1016/j.jvs.2024.04.059] [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: 01/09/2024] [Revised: 04/11/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Our group has previously demonstrated that patients with asymptomatic carotid artery stenosis (ACAS) demonstrate cognitive impairment. One proposed mechanism for cognitive impairment in patients with ACAS is cerebral hypoperfusion due to flow-restriction. We tested whether the combination of a high-grade carotid stenosis and inadequate cross-collateralization in the Circle of Willis (CoW) resulted in worsened cognitive impairment. METHODS Twenty-four patients with high-grade (≥70% diameter-reducing) ACAS underwent carotid duplex ultrasound, cognitive assessment, and 3D time-of-flight magnetic resonance angiography. The cognitive battery consisted of nine neuropsychological tests assessing four cognitive domains: learning and recall, attention and working memory, motor and processing speed, and executive function. Raw cognitive scores were converted into standardized T-scores. A structured interpretation of the magnetic resonance angiography images was performed with each segment of the CoW categorized as being either normal or abnormal. Abnormal segments of the CoW were defined as segments characterized as narrowed or occluded due to congenital aplasia or hypoplasia, or acquired atherosclerotic stenosis or occlusion. Linear regression was used to estimate the association between the number of abnormal segments in the CoW, and individual cognitive domain scores. Significance was set to P < .05. RESULTS The mean age of the patients was 66.1 ± 9.6 years, and 79.2% (n = 19) were male. A significant negative association was found between the number of abnormal segments in the CoW and cognitive scores in the learning and recall (β = -6.5; P = .01), and attention and working memory (β = -7.0; P = .02) domains. There was a trend suggesting a negative association in the motor and processing speed (β = -2.4; P = .35) and executive function (β = -4.5; P = .06) domains that did not reach significance. CONCLUSIONS In patients with high-grade ACAS, the concomitant presence of increasing occlusive disease in the CoW correlates with worse cognitive function. This association was significant in the learning and recall and attention and working memory domains. Although motor and processing speed and executive function also declined numerically with increasing abnormal segments in the CoW, the relationship was not significant. Since flow restriction at a carotid stenosis compounded by inadequate collateral compensation across a diseased CoW worsens cerebral perfusion, our findings support the hypothesis that cerebral hypoperfusion underlies the observed cognitive impairment in patients with ACAS.
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Affiliation(s)
- Sarasijhaa K Desikan
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD.
| | - Binal Brahmbhatt
- Department of Bioengineering, George Mason University, Fairfax, VA
| | - Jigar Patel
- Radiology Service, Veterans Affairs Medical Center, Baltimore, MD
| | - Aman A Kankaria
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD
| | - John Anagnostakos
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD
| | - Moira Dux
- Neuropsychology Section, Veterans Affairs Medical Center, Baltimore, MD
| | - Kirk Beach
- D. Eugene Strandness Vascular Laboratory, Department of Surgery, University of Washington, Seattle, WA
| | - Vicki L Gray
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD
| | - Tara McDonald
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD
| | - Caroline Crone
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD
| | | | - John D Sorkin
- Baltimore VA Geriatric Research, Education, and Clinical Center, Baltimore, MD; Department of Medicine, Division of Gerontology and Palliative Care, University of Maryland School of Medicine, Baltimore, MD
| | - Brajesh K Lal
- Division of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD.
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19
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Aghamoosa S, Lopez J, Rbeiz K, Fleischmann HH, Horn O, Madden K, Caulfield KA, Antonucci MU, Revuelta G, McTeague LM, Benitez A. A phase I trial of accelerated intermittent theta burst rTMS for amnestic MCI. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332680. [PMID: 38719432 DOI: 10.1136/jnnp-2023-332680] [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] [Received: 09/22/2023] [Accepted: 03/27/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Emerging evidence suggests that repetitive transcranial magnetic stimulation (rTMS) enhances cognition in mild cognitive impairment (MCI). Accelerated intermittent theta burst stimulation (iTBS) rTMS protocols are promising as they substantially reduce burden by shortening the treatment course, but the safety, feasibility, and acceptability of iTBS have not been established in MCI. METHODS 24 older adults with amnestic MCI (aMCI) due to possible Alzheimer's disease enrolled in a phase I trial of open-label accelerated iTBS to the left dorsolateral prefrontal cortex (8 stimulation sessions of 600 pulses of iTBS/day for 3 days). Participants rated common side effects during and after each session and retrospectively (at post-treatment and 4-week follow-up). They completed brain MRI (for safety assessments and electric field modeling), neuropsychiatric evaluations, and neuropsychological testing before and after treatment; a subset of measures was administered at follow-up. RESULTS Retention was high (95%) and there were no adverse neuroradiological, neuropsychiatric, or neurocognitive effects of treatment. Participants reported high acceptability, minimal side effects, and low desire to quit despite some rating the treatment as tiring. Electric field modeling data suggest that all participants received safe and therapeutic cortical stimulation intensities. We observed a significant, large effect size (d=0.98) improvement in fluid cognition using the NIH Toolbox Cognition Battery from pre-treatment to post-treatment. CONCLUSIONS Our findings support the safety, feasibility, and acceptability of accelerated iTBS in aMCI. In addition, we provide evidence of target engagement in the form of improved cognition following treatment. These promising results directly inform future trials aimed at optimizing treatment parameters. TRIAL REGISTRATION NUMBER NCT04503096.
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Affiliation(s)
- Stephanie Aghamoosa
- Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James Lopez
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katrina Rbeiz
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Holly H Fleischmann
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Olivia Horn
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katrina Madden
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kevin A Caulfield
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael U Antonucci
- Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Gonzalo Revuelta
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa M McTeague
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson VA Health Care System, Charleston, South Carolina, USA
| | - Andreana Benitez
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina, USA
- Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
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20
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Song J. BDNF Signaling in Vascular Dementia and Its Effects on Cerebrovascular Dysfunction, Synaptic Plasticity, and Cholinergic System Abnormality. J Lipid Atheroscler 2024; 13:122-138. [PMID: 38826183 PMCID: PMC11140249 DOI: 10.12997/jla.2024.13.2.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 06/04/2024] Open
Abstract
Vascular dementia (VaD) is the second most common type of dementia and is characterized by memory impairment, blood-brain barrier disruption, neuronal cell loss, glia activation, impaired synaptic plasticity, and cholinergic system abnormalities. To effectively prevent and treat VaD a good understanding of the mechanisms underlying its neuropathology is needed. Brain-derived neurotrophic factor (BDNF) is an important neurotrophic factor with multiple functions in the systemic circulation and the central nervous system and is known to regulate neuronal cell survival, synaptic formation, glia activation, and cognitive decline. Recent studies indicate that when compared with normal subjects, patients with VaD have low serum BDNF levels and that BDNF deficiency in the serum and cerebrospinal fluid is an important indicator of VaD. Here, we review current knowledge on the role of BDNF signaling in the pathology of VaD, such as cerebrovascular dysfunction, synaptic dysfunction, and cholinergic system impairment.
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Affiliation(s)
- Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun, Korea
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21
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Levine DA, Whitney RT, Ye W, Briceño EM, Gross AL, Giordani BJ, Sussman JB, Lazar RM, Howard VJ, Aparicio HJ, Beiser AS, Elkind MSV, Gottesman RF, Koton S, Pendlebury ST, Kollipara AS, Springer MV, Seshadri S, Romero JR, Fitzpatrick AL, Longstreth WT, Hayward RA. Associations Between Stroke Type, Ischemic Stroke Subtypes, and Post-Stroke Cognitive Trajectories. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.29.24306600. [PMID: 38903102 PMCID: PMC11188123 DOI: 10.1101/2024.04.29.24306600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Background It is unclear how post-stroke cognitive trajectories differ by stroke type and ischemic stroke subtype. We studied associations between stroke types (ischemic, hemorrhagic), ischemic stroke subtypes (cardioembolic, large artery atherosclerotic, lacunar/small vessel, cryptogenic/other determined etiology), and post-stroke cognitive decline. Methods This pooled cohort analysis from four US cohort studies (1971-2019) identified 1,143 dementia-free individuals with acute stroke during follow-up: 1,061 (92.8%) ischemic, 82 (7.2%) hemorrhagic, 49.9% female, 30.8% Black. Median age at stroke was 74.1 (IQR, 68.6, 79.3) years. Outcomes were change in global cognition (primary) and changes in executive function and memory (secondary). Outcomes were standardized as T-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1-SD difference in cognition. Median follow-up for the primary outcome was 6.0 (IQR, 3.2, 9.2) years. Linear mixed-effects models estimated changes in cognition after stroke. Results On average, the initial post-stroke global cognition score was 50.78 points (95% CI, 49.52, 52.03) in ischemic stroke survivors and did not differ in hemorrhagic stroke survivors (difference, -0.17 points [95% CI, -1.64, 1.30]; P=0.82) after adjusting for demographics and pre-stroke cognition. On average, ischemic stroke survivors showed declines in global cognition, executive function, and memory. Post-stroke declines in global cognition, executive function, and memory did not differ between hemorrhagic and ischemic stroke survivors. 955 ischemic strokes had subtypes: 200 (20.9%) cardioembolic, 77 (8.1%) large artery atherosclerotic, 207 (21.7%) lacunar/small vessel, 471 (49.3%) cryptogenic/other determined etiology. On average, small vessel stroke survivors showed declines in global cognition and memory, but not executive function. Initial post-stroke cognitive scores and cognitive declines did not differ between small vessel survivors and survivors of other ischemic stroke subtypes. Post-stroke vascular risk factor levels did not attenuate associations. Conclusion Stroke survivors had cognitive decline in multiple domains. Declines did not differ by stroke type or ischemic stroke subtype.
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Affiliation(s)
- Deborah A. Levine
- Department of Internal Medicine, University of Michigan (U-M), Ann Arbor, MI
- Department of Neurology, U-M, Ann Arbor, MI
| | - Rachael T. Whitney
- Department of Internal Medicine, University of Michigan (U-M), Ann Arbor, MI
| | - Wen Ye
- Department of Biostatistics, U-M, Ann Arbor, MI
| | - Emily M. Briceño
- Department of Physical Medicine and Rehabilitation, U-M, Ann Arbor, MI
| | - Alden L. Gross
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | | | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan (U-M), Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ronald M. Lazar
- Department of Neurology University of Alabama at Birmingham, AL
| | | | | | - Alexa S. Beiser
- Department of Neurology, Boston University, MA
- Department of Biostatistics, Boston University, MA
| | | | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Silvia Koton
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
- Department of Nursing, Tel Aviv University, Israel
| | - Sarah T. Pendlebury
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK; NIHR Biomedical Research Centre, Departments of Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, UK
| | - Adam S. Kollipara
- Department of Internal Medicine, University of Michigan (U-M), Ann Arbor, MI
| | | | - Sudha Seshadri
- Department of Neurology, University of Texas San Antonio, TX
| | | | | | | | - Rodney A. Hayward
- Department of Internal Medicine, University of Michigan (U-M), Ann Arbor, MI
- VA Ann Arbor Healthcare System, Ann Arbor, MI
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22
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He Y, He T, Li H, Chen W, Zhong B, Wu Y, Chen R, Hu Y, Ma H, Wu B, Hu W, Han Z. Deciphering mitochondrial dysfunction: Pathophysiological mechanisms in vascular cognitive impairment. Biomed Pharmacother 2024; 174:116428. [PMID: 38599056 DOI: 10.1016/j.biopha.2024.116428] [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: 12/20/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 04/12/2024] Open
Abstract
Vascular cognitive impairment (VCI) encompasses a range of cognitive deficits arising from vascular pathology. The pathophysiological mechanisms underlying VCI remain incompletely understood; however, chronic cerebral hypoperfusion (CCH) is widely acknowledged as a principal pathological contributor. Mitochondria, crucial for cellular energy production and intracellular signaling, can lead to numerous neurological impairments when dysfunctional. Recent evidence indicates that mitochondrial dysfunction-marked by oxidative stress, disturbed calcium homeostasis, compromised mitophagy, and anomalies in mitochondrial dynamics-plays a pivotal role in VCI pathogenesis. This review offers a detailed examination of the latest insights into mitochondrial dysfunction within the VCI context, focusing on both the origins and consequences of compromised mitochondrial health. It aims to lay a robust scientific groundwork for guiding the development and refinement of mitochondrial-targeted interventions for VCI.
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Affiliation(s)
- Yuyao He
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Tiantian He
- Sichuan Academy of Chinese Medicine Sciences, China
| | - Hongpei Li
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Wei Chen
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Biying Zhong
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yue Wu
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Runming Chen
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Yuli Hu
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Huaping Ma
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Bin Wu
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Wenyue Hu
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China.
| | - Zhenyun Han
- Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China.
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23
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Jaywant A, Keenan A. Pathophysiology, Assessment, and Management of Post-Stroke Cognitive Impairment, Depression, and Fatigue. Phys Med Rehabil Clin N Am 2024; 35:463-478. [PMID: 38514230 DOI: 10.1016/j.pmr.2023.06.028] [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: 03/23/2024]
Abstract
Post-stroke cognitive impairment, depression, and fatigue are common, persistent, and disabling. This review summarizes current knowledge on the pathophysiology, assessment, and management of these debilitating neuropsychiatric sequelae of stroke. We briefly review evolving knowledge on the neural mechanisms and risk factors for each condition. We describe patient-reported outcome measures and clinician rating techniques that can be used to assist in screening and comprehensive assessment. We then discuss behavioral and pharmacologic management strategies. Heterogeneity of stroke remains a challenge in management and new research is still needed to optimize and personalize treatments for stroke survivors.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA.
| | - Alexandra Keenan
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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24
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Luzum G, Thrane G, Aam S, Eldholm RS, Grambaite R, Munthe-Kaas R, Thingstad P, Saltvedt I, Askim T. A Machine Learning Approach to Predict Post-stroke Fatigue. The Nor-COAST study. Arch Phys Med Rehabil 2024; 105:921-929. [PMID: 38242298 DOI: 10.1016/j.apmr.2023.12.005] [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: 05/16/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study aimed to predict fatigue 18 months post-stroke by utilizing comprehensive data from the acute and sub-acute phases after stroke in a machine-learning set-up. DESIGN A prospective multicenter cohort-study with 18-month follow-up. SETTING Outpatient clinics at 3 university hospitals and 2 local hospitals. PARTICIPANTS 474 participants with the diagnosis of acute stroke (mean ± SD age; 70.5 (11.3), 59% male; N=474). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome, fatigue at 18 months, was assessed using the Fatigue Severity Scale (FSS-7). FSS-7≥5 was defined as fatigue. In total, 45 prediction variables were collected, at initial hospital-stay and 3-month post-stroke. RESULTS The best performing model, random forest, predicted 69% of all subjects with fatigue correctly with a sensitivity of 0.69 (95% CI: 0.50, 0.86), a specificity of 0.74 (95% CI: 0.66, 0.83), and an Area under the Receiver Operator Characteristic curve of 0.79 (95% CI: 0.69, 0.87) in new unseen data. The proportion of subjects predicted to suffer from fatigue, who truly suffered from fatigue at 18-months was estimated to 0.41 (95% CI: 0.26, 0.57). The proportion of subjects predicted to be free from fatigue who truly did not have fatigue at 18-months was estimated to 0.90 (95% CI: 0.83, 0.96). CONCLUSIONS Our findings indicate that the model has satisfactory ability to predict fatigue in the chronic phase post-stroke and may be applicable in clinical settings.
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Affiliation(s)
- Geske Luzum
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Gyrd Thrane
- Department of Health and Care Science, The Arctic University of Norway, Tromsø, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ramune Grambaite
- Department of Psychology, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Kongsberg Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
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25
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Chen NYC, Tan MYL, Xu J, Zuo L, Dong Y. VasCog Screen test: sensitive in detecting cognitive impairment in patients who had a stroke or with heart failure. Stroke Vasc Neurol 2024:svn-2023-002701. [PMID: 38649196 DOI: 10.1136/svn-2023-002701] [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: 07/03/2023] [Accepted: 02/17/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Vascular diseases, such as stroke and heart failure (HF), are associated with cognitive decline. Vascular cognitive impairment (CI) is commonly found in patients who had a stroke and with HF, ranging from mild CI to dementia. Early detection of CI is crucial for effective management and rehabilitation. This study aimed to develop the VasCog Screen test, a screening tool to detect CI in patients who had a stroke and with HF. METHOD 427 patients who had a stroke and with HF were assessed using cognitive measures including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery. The short-MoCA was derived and combined with Symbol Digit Modalities Test (SDMT) to create the VasCog Screen. The discriminatory ability of different tests for CI was compared, establishing optimal cut-off points. Variants of short-MoCA including the SDMT were also evaluated. RESULTS Similar prevalence rates of CI were found in stroke and HF cohorts. The most prevalent neuropsychological impairment was visuomotor speed, followed by visual memory and visuoconstruction. More than half of the patients were found to have CI. The VasCog Screen outperformed MMSE, MoCA and short-MoCA in detecting CI. The addition of SDMT to variants of the short-MoCA increased diagnostic accuracy. CONCLUSION The VasCog Screen test offers a cognitive screening tool, which is sensitive to cognitive deficits characteristically found in patients who had a stroke and with HF. It was found to have good sensitivity, specificity and classification accuracy. It is easy to administer in busy clinics, enabling early detection of CI and facilitating appropriate interventions.
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Affiliation(s)
| | | | - Jing Xu
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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26
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Pinheiro FI, Araújo-Filho I, do Rego ACM, de Azevedo EP, Cobucci RN, Guzen FP. Hepatopancreatic metabolic disorders and their implications in the development of Alzheimer's disease and vascular dementia. Ageing Res Rev 2024; 96:102250. [PMID: 38417711 DOI: 10.1016/j.arr.2024.102250] [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: 12/05/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
Dementia has been faced with significant public health challenges and economic burdens that urges the need to develop safe and effective interventions. In recent years, an increasing number of studies have focused on the relationship between dementia and liver and pancreatic metabolic disorders that result in diseases such as diabetes, obesity, hypertension and dyslipidemia. Previous reports have shown that there is a plausible correlation between pathologies caused by hepatopancreatic dysfunctions and dementia. Glucose, insulin and IGF-1 metabolized in the liver and pancreas probably have an important influence on the pathophysiology of the most common dementias: Alzheimer's and vascular dementia. This current review highlights recent studies aimed at identifying convergent mechanisms, such as insulin resistance and other diseases, linked to altered hepatic and pancreatic metabolism, which are capable of causing brain changes that ultimately lead to dementia.
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Affiliation(s)
- Francisco I Pinheiro
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil; Department of Surgical, Federal University of Rio Grande do Norte, Natal 59010-180, Brazil; Institute of Education, Research and Innovation of the Liga Norte Rio-Grandense Against Cancer
| | - Irami Araújo-Filho
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil; Department of Surgical, Federal University of Rio Grande do Norte, Natal 59010-180, Brazil; Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Amália C M do Rego
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil; Institute of Education, Research and Innovation of the Liga Norte Rio-Grandense Against Cancer
| | - Eduardo P de Azevedo
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil
| | - Ricardo N Cobucci
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil; Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil; Postgraduate Program in Science Applied to Women`s Health, Medical School, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Fausto P Guzen
- Postgraduate Program in Biotechnology, Health School, Potiguar University (UnP), Natal, RN, Brazil; Postgraduate Program in Health and Society, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Mossoró, Brazil; Postgraduate Program in Physiological Sciences, Department of Biomedical Sciences, Faculty of Health Sciences, State University of Rio Grande do Norte (UERN), Mossoró, Brazil.
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27
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Clancy U, Kancheva AK, Valdés Hernández MDC, Jochems ACC, Muñoz Maniega S, Quinn TJ, Wardlaw JM. Imaging Biomarkers of VCI: A Focused Update. Stroke 2024; 55:791-800. [PMID: 38445496 DOI: 10.1161/strokeaha.123.044171] [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: 03/07/2024]
Abstract
Vascular cognitive impairment is common after stroke, in memory clinics, medicine for the elderly services, and undiagnosed in the community. Vascular disease is said to be the second most common cause of dementia after Alzheimer disease, yet vascular dysfunction is now known to predate cognitive decline in Alzheimer disease, and most dementias at older ages are mixed. Neuroimaging has a major role in identifying the proportion of vascular versus other likely pathologies in patients with cognitive impairment. Here, we aim to provide a pragmatic but evidence-based summary of the current state of potential imaging biomarkers, focusing on magnetic resonance imaging and computed tomography, which are relevant to diagnosing, estimating prognosis, monitoring vascular cognitive impairment, and incorporating our own experiences. We focus on markers that are well-established, with a known profile of association with cognitive measures, but also consider more recently described, including quantitative tissue markers of vascular injury. We highlight the gaps in accessibility and translation to more routine clinical practice.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angelina K Kancheva
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Susana Muñoz Maniega
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (A.K.K., T.J.Q.)
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, The University of Edinburgh, United Kingdom (U.C., M.d.C.V.H. A.C.C.J., S.M.M., J.M.W.)
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Biessels GJ. Neuropsychological assessment in vascular cognitive impairment: A call to lay the quest for the best test to rest. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100219. [PMID: 39071739 PMCID: PMC11273092 DOI: 10.1016/j.cccb.2024.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Gallucci L, Sperber C, Guggisberg AG, Kaller CP, Heldner MR, Monsch AU, Hakim A, Silimon N, Fischer U, Arnold M, Umarova RM. Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment. Int J Stroke 2024:17474930241238637. [PMID: 38425239 DOI: 10.1177/17474930241238637] [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: 03/02/2024]
Abstract
BACKGROUND State-of-the-art stroke treatment significantly reduces lesion size and stroke severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI). AIMS In a cohort of patients receiving modern state-of-the-art stroke care including endovascular therapy, we assessed the frequency of PSCI and the pattern of domain-specific cognitive deficits, identified risk factors for PSCI, and determined the impact of acute PSCI on stroke outcome. METHODS In this prospective monocentric cohort study, we examined patients with first-ever anterior circulation ischemic stroke without pre-stroke cognitive decline, using a comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined PSCI as at least moderate (<1.5 standard deviation) deficits in ⩾2 cognitive domains. Multivariable regression analysis was applied to define risk factors for PSCI. RESULTS We analyzed 329 non-aphasic patients admitted from December 2020 to July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 ± 2.7 years of education). Although most patients had mild stroke (median National Institutes of Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% with NIHSS ⩽ 5), 69.3% of them presented with PSCI 2.7 ± 2.0 days post-stroke. The most severely and often affected cognitive domains were verbal learning, episodic memory, executive functions, selective attention, and constructive abilities (39.1%-51.2% of patients), whereas spatial neglect was less frequent (18.5%). The risk of PSCI was reduced with more years of education (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.23-0.99) and right hemisphere lesions (OR = 0.47, 95% CI = 0.26-0.84), and increased with stroke severity (NIHSS 24 h, OR = 4.19, 95% CI = 2.72-6.45), presence of hyperlipidemia (OR = 1.93, 95% CI = 1.01-3.68), but was not influenced by age. After adjusting for stroke severity and depressive symptoms, acute PSCI was associated with poor functional outcome (modified Rankin Scale > 2, F = 13.695, p < 0.001) and worse global cognition (Montreal Cognitive Assessment (MoCA) score, F = 20.069, p < 0.001) at 3 months post-stroke. CONCLUSION Despite modern stroke therapy and many strokes having mild severity, PSCI in the acute stroke phase remains frequent and associated with worse outcome. The most prevalent were learning and memory deficits. Cognitive reserve operationalized as years of education independently protects post-stroke cognition.
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Affiliation(s)
- Laura Gallucci
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christoph Sperber
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian G Guggisberg
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph P Kaller
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Mirjam R Heldner
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | - Arsany Hakim
- University Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Norbert Silimon
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Roza M Umarova
- Department of Neurology, University Hospital, Inselspital, University of Bern, Bern, Switzerland
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30
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Rashidi-Ranjbar N, Churchill NW, Black SE, Kumar S, Tartaglia MC, Freedman M, Lang A, Steeves TDL, Swartz RH, Saposnik G, Sahlas D, McLaughlin P, Symons S, Strother S, Pollock BG, Rajji TK, Ozzoude M, Tan B, Arnott SR, Bartha R, Borrie M, Masellis M, Pasternak SH, Frank A, Seitz D, Ismail Z, Tang-Wai DF, Casaubon LK, Mandzia J, Jog M, Scott CJM, Dowlatshahi D, Hassan A, Grimes D, Marras C, Zamyadi M, Munoz DG, Ramirez J, Berezuk C, Holmes M, Fischer CE, Schweizer TA. Neuropsychiatric symptoms and brain morphology in patients with mild cognitive impairment, cerebrovascular disease and Parkinson disease: A cross sectional and longitudinal study. Int J Geriatr Psychiatry 2024; 39:e6074. [PMID: 38491809 DOI: 10.1002/gps.6074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) increase risk of developing dementia and are linked to various neurodegenerative conditions, including mild cognitive impairment (MCI due to Alzheimer's disease [AD]), cerebrovascular disease (CVD), and Parkinson's disease (PD). We explored the structural neural correlates of NPS cross-sectionally and longitudinally across various neurodegenerative diagnoses. METHODS The study included individuals with MCI due to AD, (n = 74), CVD (n = 143), and PD (n = 137) at baseline, and at 2-years follow-up (MCI due to AD, n = 37, CVD n = 103, and PD n = 84). We assessed the severity of NPS using the Neuropsychiatric Inventory Questionnaire. For brain structure we included cortical thickness and subcortical volume of predefined regions of interest associated with corticolimbic and frontal-executive circuits. RESULTS Cross-sectional analysis revealed significant negative correlations between appetite with both circuits in the MCI and CVD groups, while apathy was associated with these circuits in both the MCI and PD groups. Longitudinally, changes in apathy scores in the MCI group were negatively linked to the changes of the frontal-executive circuit. In the CVD group, changes in agitation and nighttime behavior were negatively associated with the corticolimbic and frontal-executive circuits, respectively. In the PD group, changes in disinhibition and apathy were positively associated with the corticolimbic and frontal-executive circuits, respectively. CONCLUSIONS The observed correlations suggest that underlying pathological changes in the brain may contribute to alterations in neural activity associated with MBI. Notably, the difference between cross-sectional and longitudinal results indicates the necessity of conducting longitudinal studies for reproducible findings and drawing robust inferences.
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Affiliation(s)
- Neda Rashidi-Ranjbar
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nathan W Churchill
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandra E Black
- Division of Neurology, Department of Medicine, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program Sunnybrook Health Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sanjeev Kumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria C Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Morris Freedman
- Division of Neurology, Department of Medicine, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Anthony Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, Sunnybrook HSC, University of Toronto, Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program Sunnybrook Health Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gustavo Saposnik
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Clinical Outcomes and Decision Neuroscience Unit, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Dametrios Sahlas
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Paula McLaughlin
- Nova Scotia Health, Halifax, Nova Scotia, Canada
- Departments of Medicine (Geriatrics) and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Symons
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Stephen Strother
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Bruce G Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tarek K Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Miracle Ozzoude
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program Sunnybrook Health Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Brian Tan
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Stephen R Arnott
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Robert Bartha
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Michael Borrie
- Nova Scotia Health, Halifax, Nova Scotia, Canada
- Departments of Medicine (Geriatrics) and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mario Masellis
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Joseph's Healthcare Centre, London, Ontario, Canada
| | - Stephen H Pasternak
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- St. Joseph's Healthcare Centre, London, Ontario, Canada
| | - Andrew Frank
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dallas Seitz
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David F Tang-Wai
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Leanne K Casaubon
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Mandzia
- St. Joseph's Healthcare Centre, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
| | - Mandar Jog
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J M Scott
- L.C. Campbell Cognitive Neurology Research Unit, Hurvitz Brain Sciences Research Program Sunnybrook Health Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute (TBRHRI), Northern Ontario School of Medicine University (NOSMU), Thunder Bay, Ontario, Canada
| | - David Grimes
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Connie Marras
- The Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mojdeh Zamyadi
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - David G Munoz
- Division of Neurosurgery, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Ramirez
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Courtney Berezuk
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Melissa Holmes
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Corinne E Fischer
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Sanchez E, Wilkinson T, Coughlan G, Mirza S, Baril A, Ramirez J, Binns MA, Black SE, Borrie M, Dilliott AA, Dixon RA, Dowlatshahi D, Farhan S, Finger E, Fischer CE, Frank A, Freedman M, Goncalves RA, Grimes DA, Hassan A, Hegele RA, Kumar S, Lang AE, Marras C, McLaughlin PM, Orange JB, Pasternak SH, Pollock BG, Rajji TK, Roberts AC, Robinson JF, Rogaeva E, Sahlas DJ, Saposnik G, Strong MJ, Swartz RH, Tang‐Wai DF, Tartaglia MC, Troyer AK, Kvartsberg H, Zetterberg H, Munoz DP, Masellis M. Association of plasma biomarkers with cognition, cognitive decline, and daily function across and within neurodegenerative diseases: Results from the Ontario Neurodegenerative Disease Research Initiative. Alzheimers Dement 2024; 20:1753-1770. [PMID: 38105605 PMCID: PMC10984487 DOI: 10.1002/alz.13560] [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: 06/29/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION We investigated whether novel plasma biomarkers are associated with cognition, cognitive decline, and functional independence in activities of daily living across and within neurodegenerative diseases. METHODS Glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), phosphorylated tau (p-tau)181 and amyloid beta (Aβ)42/40 were measured using ultra-sensitive Simoa immunoassays in 44 healthy controls and 480 participants diagnosed with Alzheimer's disease/mild cognitive impairment (AD/MCI), Parkinson's disease (PD), frontotemporal dementia (FTD) spectrum disorders, or cerebrovascular disease (CVD). RESULTS GFAP, NfL, and/or p-tau181 were elevated among all diseases compared to controls, and were broadly associated with worse baseline cognitive performance, greater cognitive decline, and/or lower functional independence. While GFAP, NfL, and p-tau181 were highly predictive across diseases, p-tau181 was more specific to the AD/MCI cohort. Sparse associations were found in the FTD and CVD cohorts and for Aβ42/40 . DISCUSSION GFAP, NfL, and p-tau181 are valuable predictors of cognition and function across common neurodegenerative diseases, and may be useful in specialized clinics and clinical trials.
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Nakagawa K, Chen R, Ross GW, Donlon TA, Allsopp RC, Willcox DC, Morris BJ, Willcox BJ, Masaki KH. FOXO3 longevity genotype attenuates the impact of hypertension on cerebral microinfarct risk. J Hypertens 2024; 42:484-489. [PMID: 38009316 PMCID: PMC10873049 DOI: 10.1097/hjh.0000000000003620] [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] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The G -allele of FOXO3 SNP rs2802292 , which is associated with human resilience and longevity, has been shown to attenuate the impact of hypertension on the risk of intracerebral hemorrhage (ICH). We sought to determine whether the FOXO3 G -allele similarly attenuates the impact of hypertension on the risk of cerebral microinfarcts (CMI). METHODS From a prospective population-based cohort of American men of Japanese ancestry from the Kuakini Honolulu Heart Program (KHHP) and Kuakini Honolulu-Asia Aging Study (KHAAS) that had brain autopsy data, age-adjusted prevalence of any CMI on brain autopsy was assessed. Logistic regression models, adjusted for age at death, cardiovascular risk factors, FOXO3 and APOE-ε4 genotypes, were utilized to determine the predictors of any CMI. Interaction of FOXO3 genotype and hypertension was analyzed. RESULTS Among 809 men with complete data, 511 (63.2%) participants had evidence of CMI. A full multivariable model demonstrated that BMI [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.14, P = 0.015) was the only predictor of CMI, while hypertension was a borderline predictor (OR 1.44, 95% CI 1.00-2.08, P = 0.052). However, a significant interaction between FOXO3 G -allele carriage and hypertension was observed ( P = 0.020). In the stratified analyses, among the participants without the longevity-associated FOXO3 G -allele, hypertension was a strong predictor of CMI (OR 2.25, 95% CI 1.34-3.77, P = 0.002), while among those with the longevity-associated FOXO3 G -allele, hypertension was not a predictor of CMI (OR 0.88, 95% CI 0.51-1.54, P = 0.66). CONCLUSION The longevity-associated FOXO3 G -allele mitigates the impact of hypertension on the risk of CMI.
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Affiliation(s)
- Kazuma Nakagawa
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Neuroscience Institute, The Queen's Medical Center
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii
| | - Randi Chen
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
| | - G Webster Ross
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii
- Pacific Health Research and Education Institute
- Veterans Affairs Pacific Islands Healthcare Systems
- Department of Geriatric Medicine
| | - Timothy A Donlon
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Department of Geriatric Medicine
- Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii
| | - Richard C Allsopp
- Institute for Biogenesis Research, University of Hawaii, Honolulu, Hawaii, USA
| | - D Craig Willcox
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Department of Human Welfare, Okinawa International University, Ginowan, Okinawa, Japan
| | - Brian J Morris
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Department of Geriatric Medicine
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Bradley J Willcox
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Department of Geriatric Medicine
| | - Kamal H Masaki
- Center of Biomedical Research Excellence on Aging, Department of Research, Kuakini Medical Center
- Department of Geriatric Medicine
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Koob JL, Gorski M, Krick S, Mustin M, Fink GR, Grefkes C, Rehme AK. Behavioral and neuroanatomical correlates of facial emotion processing in post-stroke depression. Neuroimage Clin 2024; 41:103586. [PMID: 38428325 PMCID: PMC10944179 DOI: 10.1016/j.nicl.2024.103586] [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: 10/27/2023] [Revised: 02/24/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Emotion processing deficits are known to accompany depressive symptoms and are often seen in stroke patients. Little is known about the influence of post-stroke depressive (PSD) symptoms and specific brain lesions on altered emotion processing abilities and how these phenomena develop over time. This potential relationship may impact post-stroke rehabilitation of neurological and psychosocial function. To address this scientific gap, we investigated the relationship between PSD symptoms and emotion processing abilities in a longitudinal study design from the first days post-stroke into the early chronic phase. METHODS Twenty-six ischemic stroke patients performed an emotion processing task on videos with emotional faces ('happy,' 'sad,' 'anger,' 'fear,' and 'neutral') at different intensity levels (20%, 40%, 60%, 80%, 100%). Recognition accuracies and response times were measured, as well as scores of depressive symptoms (Montgomery-Åsberg Depression Rating Scale). Twenty-eight healthy participants matched in age and sex were included as a control group. Whole-brain support-vector regression lesion-symptom mapping (SVR-LSM) analyses were performed to investigate whether specific lesion locations were associated with the recognition accuracy of specific emotion categories. RESULTS Stroke patients performed worse in overall recognition accuracy compared to controls, specifically in the recognition of happy, sad, and fearful faces. Notably, more depressed stroke patients showed an increased processing towards specific negative emotions, as they responded significantly faster to angry faces and recognized sad faces of low intensities significantly more accurately. These effects obtained for the first days after stroke partly persisted to follow-up assessment several months later. SVR-LSM analyses revealed that inferior and middle frontal regions (IFG/MFG) and insula and putamen were associated with emotion-recognition deficits in stroke. Specifically, recognizing happy facial expressions was influenced by lesions affecting the anterior insula, putamen, IFG, MFG, orbitofrontal cortex, and rolandic operculum. Lesions in the posterior insula, rolandic operculum, and MFG were also related to reduced recognition accuracy of fearful facial expressions, whereas recognition deficits of sad faces were associated with frontal pole, IFG, and MFG damage. CONCLUSION PSD symptoms facilitate processing negative emotional stimuli, specifically angry and sad facial expressions. The recognition accuracy of different emotional categories was linked to brain lesions in emotion-related processing circuits, including insula, basal ganglia, IFG, and MFG. In summary, our study provides support for psychosocial and neural factors underlying emotional processing after stroke, contributing to the pathophysiology of PSD.
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Affiliation(s)
- Janusz L Koob
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Maximilian Gorski
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Sebastian Krick
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Maike Mustin
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
| | - Gereon R Fink
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52428, Germany
| | - Christian Grefkes
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52428, Germany; Goethe University Frankfurt and University Hospital Frankfurt, Department of Neurology, Frankfurt am Main 60596, Germany.
| | - Anne K Rehme
- University Hospital Cologne, Department of Neurology, Cologne 50937, Germany
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Hung TH, Chen VCH, Chuang YC, Hsu YH, Wu WC, Tsai YH, McIntyre RS, Weng JC. Investigating the effect of hypertension on vascular cognitive impairment by using the resting-state functional connectome. Sci Rep 2024; 14:4580. [PMID: 38403657 PMCID: PMC10894879 DOI: 10.1038/s41598-024-54996-9] [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: 02/16/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
Hypertension (HTN) affects over 1.2 billion individuals worldwide and is defined as systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. Hypertension is also considered a high risk factor for cerebrovascular diseases, which may lead to vascular cognitive impairment (VCI). VCI is associated with executive dysfunction and is also a transitional stage between hypertension and vascular dementia. Hence, it is essential to establish a reliable approach to diagnosing the severity of VCI. In 28 HTN (51-83 yrs; 18 males, 10 females) and 28 healthy controls (HC) (51-75 yrs; 7 males, 21 females), we investigated which regions demonstrate alterations in the resting-state functional connectome due to vascular cognitive impairment in HTN by using the amplitude of the low-frequency fluctuations (ALFF), regional homogeneity (ReHo), graph theoretical analysis (GTA), and network-based statistic (NBS) methods. In the group comparison between ALFF/ReHo, HTN showed reduced spontaneous activity in the regions corresponding to vascular or metabolic dysfunction and enhanced brain activity, mainly in the primary somatosensory cortex and prefrontal areas. We also observed cognitive dysfunction in HTN, such as executive function, processing speed, and memory. Both the GTA and NBS analyses indicated that the HTN demonstrated complex local segregation, worse global integration, and weak functional connectivity. Our findings show that resting-state functional connectivity was altered, particularly in the frontal and parietal regions, by hypertensive individuals with potential vascular cognitive impairment.
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Affiliation(s)
- Tai-Hsin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Chen Chuang
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Wen-Chau Wu
- Institute of Medical Device and Imaging, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan-Hsiung Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, Department of Psychiatry, University Health Network, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan, 33302, Taiwan.
- Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.
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Blake JA, Long DL, Knight AJ, Goodin BR, Crowe M, Judd SE, Rhodes JD, Roth DL, Clay OJ. Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.26.23297649. [PMID: 37961600 PMCID: PMC10635206 DOI: 10.1101/2023.10.26.23297649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective Cognitive impairment after stroke is common, present up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of two stroke severity ratings and a caregiver-report of post-stroke functioning with longitudinal cognitive outcomes. Methods The analysis was conducted on 157 caregivers and stroke survivor dyads who participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) collected at hospitalization discharge were included as two primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at nine months following stroke were included as a third predictor. Cognition was assessed using a biennial telephone battery, incorporating multiple cognitive assessments to assess learning, memory, and executive functioning. Longitudinal cognitive scores were analyzed up to five years post-stroke, controlling for baseline (pre-stroke) cognitive scores and demographic variables of each stroke survivor collected at CARES baseline. Results Separate mixed models showed significant main effects of GOS (b=0.3280, p=0.0009), mRS (b=-0.2119, p=0.0002), and caregiver-reported impairments (b=-0.0671, p<0.0001) on longitudinal cognitive scores. In a combined model including all three predictors, only caregiver-reported problems significantly predicted cognitive outcomes (b=-0.0480, p<0.0001). Impact These findings underscore the importance of incorporating caregivers feedback in understanding cognitive consequences of stroke.
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Shore S, Li H, Zhang M, Whitney R, Gross AL, Bhatt AS, Nallamothu BK, Giordani B, Briceño EM, Sussman JB, Gutierrez J, Yaffe K, Griswold M, Johansen MC, Lopez OL, Gottesman RF, Sidney S, Heckbert SR, Rundek T, Hughes TM, Longstreth WT, Levine DA. Trajectory of Cognitive Function After Incident Heart Failure. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.09.24302608. [PMID: 38370803 PMCID: PMC10871464 DOI: 10.1101/2024.02.09.24302608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background The size/magnitude of cognitive changes after incident heart failure (HF) are unclear. We assessed whether incident HF is associated with changes in cognitive function after accounting for pre-HF cognitive trajectories and known determinants of cognition. Methods This pooled cohort study included adults without HF, stroke, or dementia from six US population-based cohort studies from 1971-2019: Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Offspring Study, Multi-Ethnic Study of Atherosclerosis, and Northern Manhattan Study. Linear mixed-effects models estimated changes in cognition at the time of HF (change in the intercept) and the rate of cognitive change over the years after HF (change in the slope), controlling for pre-HF cognitive trajectories and participant factors. Change in global cognition was the primary outcome. Change in executive function and memory were secondary outcomes. Cognitive outcomes were standardized to a t-score metric (mean [SD], 50 [10]); a 1-point difference represented a 0.1-SD difference in cognition. Results The study included 29,614 adults (mean [SD] age was 61.1 [10.5] years, 55% female, 70.3% White, 22.2% Black 7.5% Hispanic). During a median follow-up of 6.6 (Q1-Q3: 5-19.8) years, 1,407 (4.7%) adults developed incident HF. Incident HF was associated with an acute decrease in global cognition (-1.08 points; 95% CI -1.36, -0.80) and executive function (-0.65 points; 95% CI -0.96, -0.34) but not memory (-0.51 points; 95% CI -1.37, 0.35) at the time of the event. Greater acute decreases in global cognition after HF were seen in those with older age, female sex and White race. Individuals with incident HF, compared to HF-free individuals, demonstrated faster declines in global cognition (-0.15 points per year; 95% CI, -0.21, -0.09) and executive function (-0.16 points per year; 95% CI -0.23, -0.09) but not memory ( -0.11 points per year; 95% CI -0.26, 0.04) compared with pre-HF slopes. Conclusions In this pooled cohort study, incident HF was associated with an acute decrease in global cognition and executive function at the time of the event and faster declines in global cognition and executive function over the following years.
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Affiliation(s)
| | - Hanyu Li
- University of Michigan, Ann Arbor, MI, USA
| | - Min Zhang
- University of Michigan, Ann Arbor, MI, USA
| | | | - Alden L. Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ankeet S. Bhatt
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | | | | | | | | | | | - Michael Griswold
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD, USA
| | - Stephen Sidney
- Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, CA, USA
| | | | - Tatjana Rundek
- University of Miami – Miller School of Medicine, Evelyn F. McKnight Brain Institute, FL, USA
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Cova I, Mele F, Nicotra A, Maestri G, Cucumo V, Pomati S, Salvadori E, Pantoni L. The Luigi Sacco Hospital VAS-COG stroke care pathway: A five-year experience. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100210. [PMID: 38357360 PMCID: PMC10865214 DOI: 10.1016/j.cccb.2024.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
Background Psycho-cognitive consequences are a frequent cause of disability in stroke survivors but are often underdiagnosed also because of lack of services dedicated to these aspects. We started assessing systematically cognitive and behavioral functions in acute stroke patients and to follow them up. Here, we report a retrospective analysis of the organization of the Sacco VAS-COG stroke care pathway and the refinements implemented during 5 years of activity. Methods The protocol includes baseline collection of clinical history, general and neurologic examinations, functional, neuropsychological, and neuroimaging assessment. At follow-up, a diagnosis of cognitive decline was made based on best clinical judgment in the first period (January 2018 to May 2019, namely VAS-COG protocol 1.0) and then based on an extensive neuropsychological battery (May 2019 to January 2023, namely VASCOG protocol 2.0); psychiatric and behavioral disturbances are investigated through suitable scales. Results From January 2018 to December 2022, 834 patients (mean age 76±13.6 years; 46.6 % females) with acute cerebrovascular events were admitted to the stroke unit, mostly (80 %) for ischemic strokes. Pre-event cognitive impairment was not assessable in 78 patients (9.3 %) because no reliable informant was present and was reported in 327/756 (43 %) patients. During follow-up, post-stroke cognitive impairment was detected in 124/217 (57.1 %) patients in VAS-COG protocol 1.0 and in 137/201(68.2 %) patients in VAS-COG protocol 2.0, while 95/218 (43.2 %) patients were found to be depressed and patients presented on average 2.5 neuropsychiatric symptoms on Neuropsychiatric Inventory-questionnaire. Conclusions The VAS-COG stroke care pathway represents a model for patients and for their families.
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Affiliation(s)
- I. Cova
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - F. Mele
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - A. Nicotra
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - G. Maestri
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - V. Cucumo
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - S. Pomati
- Neurology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - E. Salvadori
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 7, Milano 20157, Italy
| | - L. Pantoni
- Neuroscience Research Center, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 7, Milano 20157, Italy
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Lamar M, Arfanakis K, Evia A, Makkinejad N, Capuano AW, Kim N, Leurgans SE, Fleischman DA, Duke Han S, Poole V, Barnes LL. Changes in an in-vivo classifier of ARTerioloSclerosis (ARTS) with simultaneous change in cognition for older African Americans. Neurobiol Aging 2024; 134:21-27. [PMID: 37979249 PMCID: PMC10845033 DOI: 10.1016/j.neurobiolaging.2023.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
At autopsy, African American decedents often have mixed Alzheimer's and cerebrovascular brain pathologies including arteriolosclerosis. We applied a novel in-vivo classifier of ARTerioloSclerosis (ARTS) in 167 older African Americans (∼75y of age) with > 2 biennial 3 T MRI scans and > 3 years of associated cognitive follow-up to determine if ARTS scores (higher score=higher likelihood of arteriolosclerosis) changed over time and if this change associated with changes in cognition in the same individuals. Mixed effects regression models tested whether ARTS scores increased over time, while simultaneous mixed effects regression models estimated the simultaneous rates of change in both ARTS and cognition and the correlation of these changes. ARTS scores increased over time (estimate=0.030, SE=0.002, p < 0.0001). Faster increases in ARTS were associated with faster rates of global cognitive decline (r = -0.447, p = 0.006) and domain-specific cognitive functions. Applying an in-vivo marker of arteriolosclerosis in an African American cohort revealed that the likelihood of arteriolosclerosis increases over time, and participants whose ARTS scores increased more rapidly tended to have faster than average rates of cognitive decline.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, USA; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | | | - Nazanin Makkinejad
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Ana W Capuano
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Namhee Kim
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Debra A Fleischman
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - S Duke Han
- Rush Alzheimer's Disease Center, USA; Department of Family Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Victoria Poole
- Rush Alzheimer's Disease Center, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Medina-Rioja R, Patwardhan A, Mercado-Pompa A, Masellis M, Black SE. Ten Things to Remember (and Not Forget) About Vascular Cognitive Impairment. Stroke 2024; 55:e29-e32. [PMID: 38214157 DOI: 10.1161/strokeaha.123.042756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Raul Medina-Rioja
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.M.-R., A.P., M.M., S.E.B.)
| | - Ameya Patwardhan
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.M.-R., A.P., M.M., S.E.B.)
| | - Andres Mercado-Pompa
- Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia "Manuel Velasco Suarez," Ciudad de Mexico (A.M.-P.)
| | - Mario Masellis
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.M.-R., A.P., M.M., S.E.B.)
| | - Sandra E Black
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.M.-R., A.P., M.M., S.E.B.)
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Messé SR, Overbey JR, Thourani VH, Moskowitz AJ, Gelijns AC, Groh MA, Mack MJ, Ailawadi G, Furie KL, Southerland AM, James ML, Moy CS, Gupta L, Voisine P, Perrault LP, Bowdish ME, Gillinov AM, O'Gara PT, Ouzounian M, Whitson BA, Mullen JC, Miller MA, Gammie JS, Pan S, Erus G, Browndyke JN. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement. J Thorac Cardiovasc Surg 2024; 167:624-633.e4. [PMID: 35483981 PMCID: PMC9996687 DOI: 10.1016/j.jtcvs.2022.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/14/2021] [Accepted: 01/23/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The effects of stroke and delirium on postdischarge cognition and patient-centered health outcomes after surgical aortic valve replacement (SAVR) are not well characterized. Here, we assess the impact of postoperative stroke and delirium on these health outcomes in SAVR patients at 90 days. METHODS Patients (N = 383) undergoing SAVR (41% received concomitant coronary artery bypass graft) enrolled in a randomized trial of embolic protection devices underwent serial neurologic and delirium evaluations at postoperative days 1, 3, and 7 and magnetic resonance imaging at day 7. Outcomes included 90-day functional status, neurocognitive decline from presurgical baseline, and quality of life. RESULTS By postoperative day 7, 25 (6.6%) patients experienced clinical stroke and 103 (28.5%) manifested delirium. During index hospitalization, time to discharge was longer in patients experiencing stroke (hazard ratio, 0.62; 95% confidence interval [CI], 0.42-0.94; P = .02) and patients experiencing delirium (hazard ratio, 0.68; 95% CI, 0.54-0.86; P = .001). At day 90, patients experiencing stroke were more likely to have a modified Rankin score >2 (odds ratio [OR], 5.9; 95% CI, 1.7-20.1; P = .01), depression (OR, 5.3; 95% CI, 1.6-17.3; P = .006), a lower 12-Item Short Form Survey physical health score (adjusted mean difference -3.3 ± 1.9; P = .08), and neurocognitive decline (OR, 7.8; 95% CI, 2.3-26.4; P = .001). Delirium was associated with depression (OR, 2.2; 95% CI, 0.9-5.3; P = .08), lower 12-Item Short Form Survey physical health (adjusted mean difference -2.3 ± 1.1; P = .03), and neurocognitive decline (OR, 2.2; 95% CI, 1.2-4.0; P = .01). CONCLUSIONS Stroke and delirium occur more frequently after SAVR than is commonly recognized, and these events are associated with disability, depression, cognitive decline, and poorer quality of life at 90 days postoperatively. These findings support the need for new interventions to reduce these events and improve patient-centered outcomes.
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Affiliation(s)
- Steven R Messé
- Department of Stroke and Neurocritical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pa
| | - Jessica R Overbey
- International Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vinod H Thourani
- Marcus Valve Center, Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Ga
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Mark A Groh
- Asheville Heart, Mission Health and Hospitals, Asheville, NC
| | - Michael J Mack
- Cardiovascular Surgery, Baylor Scott & White Health, Plano, Tex
| | - Gorav Ailawadi
- Departments of Cardiac Surgery and Surgery, University of Michigan Health System, Ann Arbor, Mich
| | - Karen L Furie
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI
| | - Andrew M Southerland
- Division of Vascular Neurology, University of Virginia Health System, Charlottesville, Va
| | - Michael L James
- Department of Anesthesiology, Duke University Medical Center, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC
| | - Claudia Scala Moy
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
| | - Lopa Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Pierre Voisine
- Department of Surgery, Institut de Cardiologie et Pneumologie de Québec, Québec, Canada
| | | | - Michael E Bowdish
- Surgery and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Patrick T O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Mass
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, UHN-Toronto General Hospital, Toronto, Ontario, Canada
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - John C Mullen
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Marissa A Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
| | - James S Gammie
- Department of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, Md
| | - Stephanie Pan
- International Center for Health Outcomes and Innovation Research (InCHOIR), The Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Guray Erus
- Department of Radiology, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pa
| | - Jeffrey N Browndyke
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
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Gyabaah S, Adu-Boakye Y, Sarfo-Kantanka O, Gyan KF, Kokuro C, Agyei M, Akassi J, Tawiah P, Norman B, Ovbiagele B, Sarfo FS. Frequency & factors associated with elevated lipoprotein-a among Ghanaian stroke survivors. J Neurol Sci 2024; 456:122839. [PMID: 38103418 DOI: 10.1016/j.jns.2023.122839] [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: 09/23/2023] [Revised: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Indigenous Africans are genetically predisposed to elevated lipoprotein-a (Lp(a)), a veritable risk factor for ischemic stroke. Recent studies have demonstrated the promising efficacy of therapeutic interventions for addressing elevated Lp(a) among patients at high risk of atherosclerotic cardiovascular events. It is important to assess the burden of elevated Lp(a) among stroke survivors of African ancestry aimed at addressing potential unmet therapeutic gaps for optimal secondary prevention. PURPOSE To assess the frequency of elevated lipoprotein-a among Ghanaian stroke survivors and factors associated with it. METHODS A prospective study conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital among ischemic stroke survivors aged ≥18 years. Serum lipoprotein-a concentrations were measured using ELISA kits. A multivariate regression analysis was fitted to identify factors independently associated with elevated lipoprotein-a concentration > 30 mg/dl. RESULTS Among 116 stroke survivors, 35 (30.2%) had elevated Lp(a). The adjusted odds ratio (95% CI) of factors associated with elevated Lp(a) were female sex 3.09 (1.05-9.12), p = 0.04, diabetes mellitus 3.52 (1.32-9.40), p = 0.01, urban dwelling 4.64 (1.61-13.39), p = 0.005 and total cholesterol 1.85 (1.28-2.67), p = 0.001. Whereas the LDL cholesterol significantly decreased from baseline to month 12 among a subset of participants, the Lp(a) levels significantly increased from a baseline value of 29.38 ± 15.32 mg/dl to 40.97 ± 29.72 mg/dl, p = 0.032. CONCLUSION Approximately 1 in 3 Ghanaian ischemic stroke survivors harbor an elevated Lp(a) associated with female sex, urban residence, diabetes mellitus and raised cholesterol. This burden highlights an unmet therapeutic gap in secondary risk reduction in this resource-limited setting.
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Affiliation(s)
| | - Yaw Adu-Boakye
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Osei Sarfo-Kantanka
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Collins Kokuro
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Martin Agyei
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - John Akassi
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Phyllis Tawiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Betty Norman
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Fred Stephen Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
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Navickaite E, Saltvedt I, Lydersen S, Munthe-Kaas R, Ihle-Hansen H, Grambaite R, Aam S. Diagnostic accuracy of the Clock Drawing Test in screening for early post-stroke neurocognitive disorder: the Nor-COAST study. BMC Neurol 2024; 24:22. [PMID: 38195396 PMCID: PMC10775614 DOI: 10.1186/s12883-023-03523-w] [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: 04/22/2023] [Accepted: 12/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Post-stroke neurocognitive disorder, though common, is often overlooked by clinicians. Moreover, although the Montreal Cognitive Assessment (MoCA) has proven to be a valid screening test for neurocognitive disorder, even more time saving tests would be preferred. In our study, we aimed to determine the diagnostic accuracy of the Clock Drawing Test (CDT) for post-stroke neurocognitive disorder and the association between the CDT and MoCA. METHODS This study is part of the Norwegian Cognitive Impairment After Stroke study, a multicentre prospective cohort study following patients admitted with acute stroke. At the three-month follow-up, patients were classified with normal cognition, mild neurocognitive disorder, or major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Any neurocognitive disorder compromised both mild- and major neurocognitive disorder. The CDT at the three-month assessment was given scores ranging from 0 to 5. Patients able to complete the CDT and whose cognitive status could be classified were included in analyses. The CDT diagnostic accuracy for post-stroke neurocognitive disorder was identified using receiver operating characteristic curves, sensitivity, specificity, positive predictive value, and negative predictive value. The association between the MoCA and CDT was analysed with Spearman's rho. RESULTS Of 554 participants, 238 (43.0%) were women. Mean (SD) age was 71.5 (11.8) years, while mean (SD) National Institutes of Health Stroke Scale score was 2.6 (3.7). The area under the receiver operating characteristic curve of the CDT for major neurocognitive disorder and any neurocognitive disorder was 0.73 (95% CI, 0.68-0.79) and 0.68 (95% CI, 0.63-0.72), respectively. A CDT cutoff of < 5 yielded 68% sensitivity and 60% specificity for any neurocognitive disorder and 78% sensitivity and 53% specificity for major neurocognitive disorder. Spearman's correlation coefficient between scores on the MoCA and CDT was 0.50 (95% CI, 0.44-0.57, p < .001). CONCLUSIONS The CDT is not accurate enough to diagnose post-stroke neurocognitive disorder but shows acceptable accuracy in identifying major neurocognitive disorder. Performance on the CDT was associated with performance on MoCA; however, the CDT is inferior to MoCA in identifying post-stroke neurocognitive disorder. TRIAL REGISTRATION ClinicalTrials.gov (NCT02650531). Retrospectively registered January 8, 2016.
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Affiliation(s)
- Egle Navickaite
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway.
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Kongsberg Hospital, Vestre Viken Hospital Trust, Kongsberg, Norway
- Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Ihle-Hansen
- Stroke Unit, Department of Neurology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Faculty of Medicine and Health Science, Trondheim, Norway
- Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Kalaria RN, Akinyemi RO, Paddick SM, Ihara M. Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health. Expert Rev Neurother 2024; 24:25-44. [PMID: 37916306 PMCID: PMC10872925 DOI: 10.1080/14737175.2023.2273393] [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: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI. AREAS COVERED The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They emphasize modifiable risk factors identified by the 2020 Lancet Dementia Commission. The most profound risks for VCI also include lower education, cardiometabolic factors, and compromised cognitive reserve. Finally, they discuss pharmacological and non-pharmacological interventions. EXPERT OPINION By virtue of the high frequencies of stroke and cardiovascular disease the global prevalence of VCI is expectedly higher than prevalent neurodegenerative disorders causing dementia. Since ~ 90% of the global burden of stroke can be attributed to modifiable risk factors, a formidable opportunity arises to reduce the burden of not only stroke but VCI outcomes including progression from mild to the major in form of vascular dementia. Strict control of vascular risk factors and secondary prevention of cerebrovascular disease via pharmacological interventions will impact on burden of VCI. Non-pharmacological measures by adopting healthy diets and encouraging physical and cognitive activities and urging multidomain approaches are important for prevention of VCI and preservation of vascular brain health.
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Affiliation(s)
- Raj N Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Centre, Osaka, Japan
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Bhat MA, Dhaneshwar S. Neurodegenerative Diseases: New Hopes and Perspectives. Curr Mol Med 2024; 24:1004-1032. [PMID: 37691199 DOI: 10.2174/1566524023666230907093451] [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: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023]
Abstract
Alzheimer's disease, Parkinson's disease, Amyotrophic lateral sclerosis, Huntington's disease, and Friedrich ataxia are all incurable neurodegenerative diseases defined by the continuous progressive loss of distinct neuronal subtypes. Despite their rising prevalence among the world's ageing population, fewer advances have been made in the concurrent massive efforts to develop newer drugs. Recently, there has been a shift in research focus towards the discovery of new therapeutic agents for neurodegenerative diseases. In this review, we have summarized the recently developed therapies and their status in the management of neurodegenerative diseases.
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Affiliation(s)
- Mohammad Aadil Bhat
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Noida, UP, India
| | - Suneela Dhaneshwar
- Amity Institute of Pharmacy, Amity University Maharashtra, Mumbai, Maharashtra, India
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45
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Hsu YH, Lee M, Pan KL, Chen CY, Hung TH, Chen VCH. Neuropsychiatric and cognitive symptoms in people with hypertension: An examination with the NINDS-CSN consensus protocol. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:39-47. [PMID: 34658278 DOI: 10.1080/23279095.2021.1986826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypertension has been associated with risk of cognitive impairments. The American Heart Association recommended the use of the harmonized neuropsychological protocol suggested by the National Institute of Neurologic Disorders and Stroke and the Canadian Stroke Network (NINDS-CSN) for studying related cognitive impairments. Initially designed for vascular cognitive impairment, empirical data of results from NINDS-CSN protocol has not been well-established in hypertension. The present study recruited 58 adults diagnosed with hypertension and 44 normotensive controls. Tests from the NINDS-CSN protocol were given in three lengths, including neuropsychological tests and neuropsychiatric inventories. The results showed higher proportions of hypertensive adults with impairments on tests of memory and executive functions and that they performed worse as a group on several tests from the 30-minute protocol, but not on the other additional tests in the full-length version, nor on cognitive screening test in the 5-minute protocol such as the Mini-Mental State Examination or the Montreal Cognitive Assessment. There was no significant group difference on neuropsychiatric symptoms. These findings suggested that the 30-minute version of the NINDS-CSN protocol with the two supplemental tests was able to reveal selective cognitive deficits in hypertensive adults and provide a practical solution for related studies, balancing between the requirement of sensitivity, domain variety, and brevity.
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Affiliation(s)
- Yen-Hsuan Hsu
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
| | - Meng Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Heart Failure Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chen-Yu Chen
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Tai-Hsin Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chang Gung Institute of Technology, Taoyuan, Taiwan
| | - Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
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Andriuta D, Wiener E, Perron A, Ouin E, Masmoudi I, Thibaut W, Martin J, Roussel M, Constans JM, Aarabi A, Godefroy O. Neuroimaging determinants of cognitive impairment in the memory clinic: how important is the vascular burden? J Neurol 2024; 271:504-518. [PMID: 37777991 DOI: 10.1007/s00415-023-12009-1] [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: 05/10/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
While neurodegenerative and vascular neurocognitive disorder (NCD) often co-occur, the contribution of vascular lesions, especially stroke lesions identified on MRI, to global cognition in a real-life memory clinic population remains unclear. The main objective of this retrospective study was to determine NCD neuroimaging correlates: the GM atrophy pattern and vascular lesions (especially stroke lesion localization by voxel-based lesion-symptom mapping, VLSM) in a memory clinic. We included 336 patients with mild or major NCD who underwent cerebral MRI and a neuropsychological assessment. The GM atrophy pattern (obtained by voxel-based morphometry, VBM) and the stroke lesion localization (obtained by VLSM) associated with G5 z-score (a global cognitive score), were included as independent variables with other neuroimaging and clinical indices in a stepwise linear regression model. The mean age was 70.3 years and the mean MMSE score 21.3. On MRI, 75 patients had at least one stroke lesion. The G 5 z-score was associated with GM density in the pattern selected by the VBM analysis (R2 variation = 0.166, p < 0.001) and the presence of a stroke lesion in the region selected by the VSLM analysis (mainly in the right frontal region; R2 variation = 0.018, p = 0.008). The interaction between the two factors was insignificant (p = 0.374). In conclusion, in this first study combining VBM and VLSM analysis in a memory clinic, global cognition was associated with a specific GM atrophy pattern and the presence of a stroke lesion mainly in the right frontal region.
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Affiliation(s)
- Daniela Andriuta
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France.
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France.
| | - Emmanuel Wiener
- Department of Neurology, Versailles - Le Chesnay Medical Center, Le Chesnay-Rocquencourt, France
| | - Alexandre Perron
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Elisa Ouin
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Ines Masmoudi
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - William Thibaut
- Department of Neurology, La Reunion University Medical Center, Site South Saint-Pierre, Saint-Pierre, La Reunion, France
| | - Jeanne Martin
- Department of Neurology, Bretagne Atlantique Medical Center, Vannes, France
| | - Martine Roussel
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - Ardalan Aarabi
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Medical Center, Amiens University Hospital, 80054, Amiens, France
- Laboratoire de Neurosciences Fonctionnelles Et Pathologies (UR UPJV 4559), Jules Verne University of Picardy, Amiens, France
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47
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Saks DG, Smith EE, Sachdev PS. National and international collaborations to advance research into vascular contributions to cognitive decline. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100195. [PMID: 38226362 PMCID: PMC10788430 DOI: 10.1016/j.cccb.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Cerebrovascular disease is the second most common cause of cognitive disorders, usually referred to as vascular contributions to cognitive impairment and dementia (VCID) and makes some contribution to about 70 % of all dementias. Despite its importance, research into VCID has lagged as compared to cognitive impairment due to Alzheimer's disease. There is an increasing appreciation that closing this gap requires large national and international collaborations. This paper highlights 24 notable large-scale national and international efforts to advance research into VCID (MarkVCID, DiverseVCID, DISCOVERY, COMPASS-ND, HBC, RHU SHIVA, UK DRI Vascular Theme, STROKOG, Meta VCI Map, ISGC, ENIGMA-Stroke Recovery, CHARGE, SVDs@target, BRIDGET, CADASIL Consortium, CADREA, AusCADASIL, DPUK, DPAU, STRIVE, HARNESS, FINESSE, VICCCS, VCD-CRE Delphi). These collaborations aim to investigate the effects on cognition from cerebrovascular disease or impaired cerebral blood flow, the mechanisms of action, means of prevention and avenues for treatment. Consensus groups have been developed to harmonise global approaches to VCID, standardise terminology and inform management and treatment, and data sharing is becoming the norm. VCID research is increasingly a global collaborative enterprise which bodes well for rapid advances in this field.
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Affiliation(s)
- Danit G Saks
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
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48
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Campbell A, Gustafsson L, Grimley R, Gullo H, Rosbergen I, Summers M. Mapping the trajectory of acute mild-stroke cognitive recovery using serial computerised cognitive assessment. BRAIN IMPAIR 2023; 24:629-648. [PMID: 38167363 DOI: 10.1017/brimp.2022.24] [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: 11/07/2022]
Abstract
INTRODUCTION Cognitive impairment is common post-stroke. There is a need to understand patterns of early cognitive recovery post-stroke to guide both clinical and research practice. The aim of the study was to map the trajectory of cognitive recovery during the first week to 90-days post-stroke using serial computerised assessment. METHOD An observational cohort study recruited consecutive stroke patients admitted to a stroke unit within 48 hours of onset. Cognitive function was assessed using the computerised Cambridge Neuropsychological Test Automated Battery (CANTAB) daily for seven days, then 14, 30 and 90 days post-stroke. The CANTAB measured visual episodic memory and learning, information processing speed, visuo-spatial working memory, complex sustained attention and mental flexibility. Repeated measures MANOVA/ANOVA with Least Squares Difference post-hoc analyses were performed to ascertain significant change over time. RESULT Forty-eight participants, mean age 73, primarily mild, ischaemic stroke, completed all assessment timepoints. There was a trajectory of early, global cognitive improvement, indicative of a post-stroke delirium, that largely stabilised between 6 and 14-days post-stroke. Change over time was examined within each cognitive test, with one measure stabilising by day 6 (Reaction Time) and others detecting improving performances up to 14 days post-stroke. CONCLUSIONS Serial, computerised cognitive assessment can effectively map post-stroke cognitive recovery and revealed an early phase of global improvement over 14 days that is evidence for an acute post-stroke delirium. Resolution of post-stroke delirium in the second week following mild stroke indicates more extensive neuropsychological testing may be undertaken earlier than previously thought.
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Affiliation(s)
- Alana Campbell
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, Queensland, Australia
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
| | - Louise Gustafsson
- Griffith University (School of Health Sciences and Social Work), Brisbane, Queensland, Australia
| | - Rohan Grimley
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
- Griffith University (School of Medicine), Sunshine Coast, Queensland, Australia
| | - Hannah Gullo
- The University of Queensland (School of Health and Rehabilitation Sciences), Brisbane, Queensland, Australia
| | - Ingrid Rosbergen
- Queensland Health (Sunshine Coast Hospital and Health Service), Sunshine Coast, Queensland, Australia
- University of Applied Sciences, UAS, Leiden, The Netherlands
| | - Mathew Summers
- University of the Sunshine Coast (School of Health and Behavioural Sciences), Sunshine Coast, Queensland, Australia
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49
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Hosoki S, Hansra GK, Jayasena T, Poljak A, Mather KA, Catts VS, Rust R, Sagare A, Kovacic JC, Brodtmann A, Wallin A, Zlokovic BV, Ihara M, Sachdev PS. Molecular biomarkers for vascular cognitive impairment and dementia. Nat Rev Neurol 2023; 19:737-753. [PMID: 37957261 DOI: 10.1038/s41582-023-00884-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/15/2023]
Abstract
As disease-specific interventions for dementia are being developed, the ability to identify the underlying pathology and dementia subtypes is increasingly important. Vascular cognitive impairment and dementia (VCID) is the second most common cause of dementia after Alzheimer disease, but progress in identifying molecular biomarkers for accurate diagnosis of VCID has been relatively limited. In this Review, we examine the roles of large and small vessel disease in VCID, considering the underlying pathophysiological processes that lead to vascular brain injury, including atherosclerosis, arteriolosclerosis, ischaemic injury, haemorrhage, hypoperfusion, endothelial dysfunction, blood-brain barrier breakdown, inflammation, oxidative stress, hypoxia, and neuronal and glial degeneration. We consider the key molecules in these processes, including proteins and peptides, metabolites, lipids and circulating RNA, and consider their potential as molecular biomarkers alone and in combination. We also discuss the challenges in translating the promise of these biomarkers into clinical application.
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Affiliation(s)
- Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Gurpreet K Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, Australia
| | - Karen A Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Vibeke S Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Ruslan Rust
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Abhay Sagare
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jason C Kovacic
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, NY, USA
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Berislav V Zlokovic
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
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50
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Elendu C, Amaechi DC, Elendu TC, Ibhiedu JO, Egbunu EO, Ndam AR, Ogala F, Ologunde T, Peterson JC, Boluwatife AI, Okongko AO, Fatoye JO, Akpovona OL, Onyekweli SO, Temitope AY, Achimugu AO, Temilade AV. Stroke and cognitive impairment: understanding the connection and managing symptoms. Ann Med Surg (Lond) 2023; 85:6057-6066. [PMID: 38098605 PMCID: PMC10718363 DOI: 10.1097/ms9.0000000000001441] [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: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
Stroke is a leading cause of long-term disability worldwide, and cognitive impairment is a common consequence of stroke. Understanding the connection between stroke and cognitive impairment is crucial for effectively managing symptoms and improving patients' quality of life. This abstract provides an overview of the relationship between stroke and cognitive impairment and explores strategies for managing cognitive symptoms in stroke survivors. A comprehensive review of relevant literature was conducted to examine the association between stroke and cognitive impairment. Various factors contributing to cognitive impairment after stroke were explored, including the location and severity of the stroke, vascular risk factors, and underlying mechanisms. Evidence-based strategies for managing cognitive symptoms in stroke survivors were also analyzed, such as cognitive rehabilitation, pharmacological interventions, and lifestyle modifications. The review revealed a strong link between stroke and cognitive impairment. The location and severity of the stroke play a significant role in determining the specific cognitive deficits experienced by individuals. Vascular risk factors, including hypertension, diabetes, and atrial fibrillation, contribute to cognitive decline after stroke. Mechanisms such as cerebral hypoperfusion, white matter damage, and neuroinflammation also play a role. Cognitive rehabilitation programs have shown promising results in improving cognitive function, while certain medications may help manage specific cognitive symptoms. Lifestyle modifications like physical exercise and a healthy diet have been associated with better cognitive outcomes in stroke survivors.
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Affiliation(s)
| | | | | | | | | | | | - Faith Ogala
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Tunde Ologunde
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | | | | | | | | | - Otite L. Akpovona
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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