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White matter disease as a biomarker for long-term cerebrovascular disease and dementia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:292. [PMID: 24496967 DOI: 10.1007/s11936-013-0292-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OPINION STATEMENT White matter disease is commonly detected on brain MRI of aging individuals as white matter hyperintensities (WMH), or 'leukoaraiosis." Over the years, it has become increasingly clear that the presence and extent of WMH is a radiographic marker of small cerebral vessel disease and an important predictor of the lifelong risk of stroke, cognitive impairment, and functional disability. A number of large population-based studies have outlined the significance of WMH as a biomarker for long-term cerebrovascular disease and dementia. In this review, we describe the conceptual framework and methodology that support this association and link the existing knowledge to future lines of investigation in the field.
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Salat DH. Imaging small vessel-associated white matter changes in aging. Neuroscience 2013; 276:174-86. [PMID: 24316059 DOI: 10.1016/j.neuroscience.2013.11.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 01/18/2023]
Abstract
Alterations in cerebrovascular structure and function may underlie the most common age-associated cognitive, psychiatric, and neurological conditions presented by older adults. Although much remains to understand, existing research suggests several age-associated detrimental conditions may be mediated through sometimes subtle small vessel-induced damage to the cerebral white matter. Here we review a selected portion of the vast work that demonstrates links between changes in vascular and neural health as a function of advancing age, and how even changes in low-to-moderate risk individuals, potentially beginning early in the adult age-span, may have an important impact on functional status in late life.
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Affiliation(s)
- D H Salat
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Department of Radiology, Charlestown, MA, USA; Neuroimaging Research for Veterans Center, Boston VA Healthcare System, Boston, MA, USA.
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Zhang A, Ajilore O, Zhan L, GadElkarim J, Korthauer L, Yang S, Leow A, Kumar A. White matter tract integrity of anterior limb of internal capsule in major depression and type 2 diabetes. Neuropsychopharmacology 2013; 38:1451-9. [PMID: 23389692 PMCID: PMC3682138 DOI: 10.1038/npp.2013.41] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A number of studies have shown an association between diabetes and depression. However, the underlying mechanisms are still unclear. Previous findings indicate a role for the prefrontal cortex and subcortical gray matter regions in type 2 diabetes and major depressive disorder (MDD). The purpose of this study was to examine the white matter integrity in the fibers that are part of the anterior limb of internal capsule (ALIC) in MDD and diabetic subjects using diffusion tensor imaging tractography. We studied 4 groups of subjects including 1) 42 healthy controls (HC), 2) 28 MDD subjects (MD), 3) 24 patients diagnosed with type 2 diabetes without depression (DC), and 4) 22 patients diagnosed with diabetes and depression (DD). Results revealed significantly decreased fractional anisotropy (FA; P=.021) and a trend towards significant increase in radial diffusivity (RD; P=.078) of the right ALIC in depressed subjects (MD+DD) compared to non-depressed subjects (HC+DC). While there were no significant diabetes effects or interactions between depression and diabetes, subjects with high depression ratings and high hemoglobin A1c levels had the lowest mean FA values in the right ALIC. In addition, we found a significant negative correlation between FA of the left ALIC with hemoglobin A1c in diabetic subjects (DC+DD; P=.016). Our study demonstrated novel findings of white matter abnormalities of the ALIC in depression and diabetes. These findings have implications for clinical manifestations of depression and diabetes as well as their pathophysiology.
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Affiliation(s)
- Aifeng Zhang
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL,Department of Psychiatry, University of Illinois at Chicago, 1601 W Taylor St, MC 912, Chicago, IL 60612 USA, Tel: + 312 413 4562, Fax: +312 996 7658, E-mail:
| | - Liang Zhan
- LONI, Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Johnson GadElkarim
- Department of Bioengineering, University of Illinois-Chicago, Chicago, IL
| | - Laura Korthauer
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL
| | - Shaolin Yang
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL,Department of Bioengineering, University of Illinois-Chicago, Chicago, IL,Department of Radiology, University of Illinois-Chicago, Chicago, IL
| | - Alex Leow
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL,Department of Bioengineering, University of Illinois-Chicago, Chicago, IL,Community Psychiatry Associates, Sacramento, CA
| | - Anand Kumar
- Department of Psychiatry, University of Illinois-Chicago, Chicago, IL
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Krishnadas R, McLean J, Batty DG, Burns H, Deans KA, Ford I, McConnachie A, McGinty A, McLean JS, Millar K, Sattar N, Shiels PG, Velupillai YN, Packard CJ, Cavanagh J. Cardio-metabolic risk factors and cortical thickness in a neurologically healthy male population: Results from the psychological, social and biological determinants of ill health (pSoBid) study. Neuroimage Clin 2013; 2:646-57. [PMID: 24179815 PMCID: PMC3777783 DOI: 10.1016/j.nicl.2013.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/03/2013] [Accepted: 04/16/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cardio-metabolic risk factors have been associated with poor physical and mental health. Epidemiological studies have shown peripheral risk markers to be associated with poor cognitive functioning in normal healthy population and in disease. The aim of the study was to explore the relationship between cardio-metabolic risk factors and cortical thickness in a neurologically healthy middle aged population-based sample. METHODS T1-weighted MRI was used to create models of the cortex for calculation of regional cortical thickness in 40 adult males (average age = 50.96 years), selected from the pSoBid study. The relationship between cardio-vascular risk markers and cortical thickness across the whole brain, was examined using the general linear model. The relationship with various covariates of interest was explored. RESULTS Lipid fractions with greater triglyceride content (TAG, VLDL and LDL) were associated with greater cortical thickness pertaining to a number of regions in the brain. Greater C reactive protein (CRP) and intercellular adhesion molecule (ICAM-1) levels were associated with cortical thinning pertaining to perisylvian regions in the left hemisphere. Smoking status and education status were significant covariates in the model. CONCLUSIONS This exploratory study adds to a small body of existing literature increasingly showing a relationship between cardio-metabolic risk markers and regional cortical thickness involving a number of regions in the brain in a neurologically normal middle aged sample. A focused investigation of factors determining the inter-individual variations in regional cortical thickness in the adult brain could provide further clarity in our understanding of the relationship between cardio-metabolic factors and cortical structures.
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Key Words
- Apo, apolipoprotien
- BMI, body mass index
- CIMT, carotid intima-media thickness
- CRP, high sensitivity C-reactive protein
- Cardiovascular risk
- Cholesterol
- Cortical thickness
- ELISA, enzyme linked immunosorbent assay
- HDL, high-density lipoprotein
- ICAM, intercellular adhesion molecule-1
- IL-6, interleukin-6
- Inflammation
- LDL, low-density lipoprotein
- Metabolic risk
- PCA, principal component analysis
- SIMD, Scottish Index of Multiple Deprivation
- TAG, triglycerides
- pSoBid, psychological, social and biological determinants of ill health
- tPA, tissue plasminogen activator
- vWF, von Willebrand factor
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Affiliation(s)
- Rajeev Krishnadas
- Sackler Institute of Psychobiological Research, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - John McLean
- Sackler Institute of Psychobiological Research, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - David G. Batty
- Medical Research Council Social and Public Health Sciences Unit, Glasgow, Scotland, UK
- Clinical Epidemiology Group, Department of Epidemiology and Public Health, University College London, London, England, UK
| | - Harry Burns
- Scottish Government, Edinburgh, Scotland, UK
| | - Kevin A. Deans
- Department of Clinical Biochemistry, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland, UK
- Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Agnes McGinty
- Glasgow Clinical Research Facility, Glasgow, Scotland, UK
| | | | - Keith Millar
- Sackler Institute of Psychobiological Research, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Paul G. Shiels
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | | | | | - Jonathan Cavanagh
- Sackler Institute of Psychobiological Research, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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Kardys A, Weinstock-Guttman B, Dillon M, Masud MW, Weinstock N, Mahfooz N, Lang JK, Weinstock A, Lincoff N, Zivadinov R, Ramanathan M. Cholesterol affects retinal nerve fiber layer thickness in patients with multiple sclerosis with optic neuritis. Eur J Neurol 2013; 20:1264-71. [DOI: 10.1111/ene.12162] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- A. Kardys
- Department of Pharmaceutical Sciences; State University of New York; Buffalo NY USA
| | | | - M. Dillon
- Department of Neurology; State University of New York; Buffalo NY USA
| | - M. W. Masud
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Weinstock
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Mahfooz
- Department of Neurology; State University of New York; Buffalo NY USA
| | - J. K. Lang
- Department of Neurology; State University of New York; Buffalo NY USA
| | - A. Weinstock
- Department of Neurology; State University of New York; Buffalo NY USA
| | - N. Lincoff
- Department of Neurology; State University of New York; Buffalo NY USA
| | - R. Zivadinov
- Department of Neurology; State University of New York; Buffalo NY USA
- Department of Neurology; Buffalo Neuroimaging Analysis Center; State University of New York; Buffalo NY USA
| | - M. Ramanathan
- Department of Pharmaceutical Sciences; State University of New York; Buffalo NY USA
- Department of Neurology; State University of New York; Buffalo NY USA
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Leritz EC, Shepel J, Williams VJ, Lipsitz LA, McGlinchey RE, Milberg WP, Salat DH. Associations between T1 white matter lesion volume and regional white matter microstructure in aging. Hum Brain Mapp 2013; 35:1085-100. [PMID: 23362153 DOI: 10.1002/hbm.22236] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 10/16/2012] [Accepted: 11/11/2012] [Indexed: 01/18/2023] Open
Abstract
White matter lesions, typically manifesting as regions of signal intensity abnormality (WMSA) on MRI, increase in frequency with age. However, the role of this damage in cognitive decline and disease is still not clear, as lesion volume has only loosely been associated with clinical status. Diffusion tensor imaging (DTI) has been used to examine the quantitative microstructural integrity of white matter, and has applications in the examination of subtle changes to tissue that appear visually normal on conventional imaging. The primary goal of this study was to determine whether major macrostructural white matter damage, (total WMSA volume), is associated with microstructural integrity of normal appearing white matter, and if these macrostructural changes fully account for microstructural changes. Imaging was performed in 126 nondemented individuals, ages 43-85 years, with no history of cerebrovascular disease. Controlling for age, greater WMSA volume was associated with decreased fractional anisotropy (FA) in widespread brain regions. Patterns were similar for FA and radial diffusivity but in contrast, WMSA was associated with axial diffusivity in fewer areas. Age was associated with FA in several regions, and many of these effects remained even when controlling for WMSA volume, suggesting the etiology of WMSAs does not fully account for all age-associated white matter deterioration. These results provide evidence that WMSA volume is associated with the integrity of normal-appearing white matter. In addition, our results suggest that overt lesions may not account for the association of increasing age with decreased white matter tissue integrity.
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Affiliation(s)
- Elizabeth C Leritz
- Geriatric Research, Education and Clinical Center (GRECC) and Neuroimaging Research for Veterans Center (NeRVe), VA Boston Healthcare System, Boston, Massachusetts; Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts
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