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Saridin FN, Chew KA, Reilhac A, Giyanwali B, Villaraza SG, Tanaka T, Scheltens P, van der Flier WM, Chen CLH, Hilal S. Cerebrovascular disease in Suspected Non-Alzheimer's Pathophysiology and cognitive decline over time. Eur J Neurol 2022; 29:1922-1929. [PMID: 35340085 DOI: 10.1111/ene.15337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The underlying cause of cognitive decline in individuals who are positive for biomarkers of neurodegeneration (N) but negative for biomarkers of amyloid-beta (A), designated as Suspected Non-Alzheimer's Pathophysiology (SNAP), remains unclear. We evaluate whether cerebrovascular disease (CeVD) is more prevalent in those with SNAP compared to A-N- and A+N+ individuals and whether CeVD is associated with cognitive decline over time in SNAP patients. METHODS A total of 216 individuals from a prospective memory clinic cohort [mean (SD) age, 72.7(7.3) years, 100 women (56.5%)] were included and were diagnosed as no cognitive impairment (NCI), cognitive impairment no dementia (CIND), Alzheimer's dementia (AD) or Vascular dementia (VaD). All individuals underwent clinical evaluation and neuropsychological assessment annually for up to 5 years. [11 C]-PiB or [18 F]-Flutafuranol-PET imaging was performed to ascertain amyloid-beta status. MRI was performed to assess neurodegeneration as measured by medial temporal atrophy≥2, as well as significant CeVD (sCeVD) burden, defined by cortical infarct count≥1, Fazekas-score≥2, lacune count≥2 or cerebral microbleed count≥2. RESULTS Of the 216 individuals, 50(23.1%) A-N+ were (SNAP), 93(43.1%) A-N-, 36(16.7%) A+N- and 37(17.1%) A+N+. A+N+ individuals were significantly older, while A+N+ and SNAP individuals were more likely to have dementia. The SNAP group had a higher prevalence of sCeVD (90.0%) compared to A-N-. Moreover, SNAP individuals with sCeVD had significantly steeper decline in global cognition compared to A-N- over 5 years (P=0.042). CONCLUSIONS These findings suggest that CeVD is a contributing factor to cognitive decline in SNAP. Therefore, SNAP-individuals should be carefully assessed and treated for CeVD.
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Affiliation(s)
- Francis Nicole Saridin
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Kimberly Ann Chew
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Anthonin Reilhac
- Clinical Imaging Research Centre, National University of Singapore, Singapore
| | - Bibek Giyanwali
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Tomotaka Tanaka
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phillip Scheltens
- Department of Neurology & Alzheimer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Christopher Li Hsian Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
| | - Saima Hilal
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Memory Aging & Cognition Centre, National University Health System, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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52
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Montaser-Kouhsari L, Young CB, Poston KL. Neuroimaging approaches to cognition in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:257-286. [PMID: 35248197 DOI: 10.1016/bs.pbr.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
While direct visualization of Lewy body accumulation within the brain is not yet possible in living Parkinson's disease patients, brain imaging studies offer insights into how the buildup of Lewy body pathology impacts different regions of the brain. Unlike biological biomarkers and purely behavioral research, these brain imaging studies therefore offer a unique opportunity to relate brain localization to cognitive function and dysfunction in living patients. Magnetic resonance imaging studies can reveal physical changes in brain structure as they relate to different cognitive domains and task specific impairments. Functional imaging studies use a combination of task and resting state magnetic resonance imaging, as well as positron emission tomography and single photon emission computed tomography, and can be used to determine changes in blood flow, neuronal activation and neurochemical changes in the brain associated with PD cognition and cognitive impairments. Other unique advantages to brain imaging studies are the ability to monitor changes in brain structure and function longitudinally as patients progress and the ability to study changes in brain function when patients are exposed to different pharmacological manipulations. This is particularly true when assessing the effects of dopaminergic replacement therapy on cognitive function in Parkinson's disease patients. Together, this chapter will describe imaging studies that have helped identify structural and functional brain changes associated with cognition, cognitive impairment, and dementia in Parkinson's disease.
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Affiliation(s)
- Leila Montaser-Kouhsari
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States; Department of Neurosurgery, Stanford University, Stanford, CA, United States.
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53
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Rath J, Foesleitner O, Haider L, Bickel H, Leutmezer F, Polanec S, Arnoldner MA, Sunder-Plassmann G, Prayer D, Berger T, Rommer P, Kasprian G. Neuroradiological differentiation of white matter lesions in patients with multiple sclerosis and Fabry disease. Orphanet J Rare Dis 2022; 17:37. [PMID: 35123534 PMCID: PMC8817613 DOI: 10.1186/s13023-022-02187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
Objective White matter lesions (WML) in multiple sclerosis (MS) differ from vascular WML caused by Fabry disease (FD). However, in atypical cases the discrimination can be difficult and may vary between individual raters. The aim of this study was to evaluate interrater reliability of WML differentiation between MS and FD patients. Materials and methods Brain MRI scans of 21 patients with genetically confirmed FD were compared to 21 matched patients with MS. Pseudonymized axial FLAIR sequences were assessed by 6 blinded raters and attributed to either the MS or the FD group to investigate interrater reliability. Additionally, localization of WML was compared between the two groups. Results The median age of patients was 46 years (IQR 35–58). Interrater reliability was moderate with a Fleiss' Kappa of 0.45 (95%CI 0.3–0.59). Overall, 85% of all ratings in the MS group and 75% in the FD group were correct. However, only 38% of patients with MS and 33% of patients with FD were correctly identified by all 6 raters. WML involving the corpus callosum (p < 0.001) as well as juxtacortical (p < 0.001) and infratentorial lesions (p = 0.03) were more frequently observed in MS patients. Conclusion Interrater reliability regarding visual differentiation of WML in MS from vascular WML in FD on standard axial FLAIR images alone is only moderate, despite the distinctive features of lesions in each group.
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54
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Wu X, Ya J, Zhou D, Ding Y, Ji X, Meng R. Pathogeneses and Imaging Features of Cerebral White Matter Lesions of Vascular Origins. Aging Dis 2021; 12:2031-2051. [PMID: 34881084 PMCID: PMC8612616 DOI: 10.14336/ad.2021.0414] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
White matter lesion (WML), also known as white matter hyperintensities or leukoaraiosis, was first termed in 1986 to describe the hyperintense signals on T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) maps. Over the past decades, a growing body of pathophysiological findings regarding WMLs have been discovered and discussed. Currently, the generally accepted WML pathogeneses mainly include hypoxia-ischemia, endothelial dysfunction, blood-brain barrier disruption, and infiltration of inflammatory mediators or cytokines. However, none of them can explain the whole dynamics of WML formation. Herein, we primarily focus on the pathogeneses and neuroimaging features of vascular WMLs. To achieve this goal, we searched papers with any type published in PubMed from 1950 to 2020 and cross-referenced the keywords including “leukoencephalopathy”, “leukoaraiosis”, “white matter hyperintensity”, “white matter lesion”, “pathogenesis”, “pathology”, “pathophysiology”, and “neuroimaging”. Moreover, references of the selected articles were browsed and searched for additional pertinent articles. We believe this work will supply the robust references for clinicians to further understand the different WML patterns of varying vascular etiologies and thus make customized treatment.
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Affiliation(s)
- Xiaoqin Wu
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Ya
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Division of Clinical Neuroscience, Queen's Medical Center School of Medicine, the University of Nottingham, Nottingham NG7 2UH, UK
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Xunming Ji
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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55
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Ekusheva EV. [Efficacy of Sermion in the treatment of tinnitus noise in patients with chronic cerebrovascular pathology]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:60-66. [PMID: 34874656 DOI: 10.17116/jnevro202112110160] [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: 11/17/2022]
Abstract
Noise in the ears or tinnitus is one of the earliest and most frequent non-cognitive manifestations of chronic cerebral ischemia (CCI) and is the most difficult clinical phenomenon for therapeutic intervention. OBJECTIVE Of an open observational noncomparative clinical study was to study in patients with CCI and tinnitus and/or head the efficacy and tolerability of Sermion in a daily dose of 30 mg for 6 months. MATERIAL AND METHODS 56 patients (51.1±8.7 years) were clinically and neurologically examined using standard questionnaires to analyze the severity of tinnitus and its impact on daily life and the level of patient distress associated with noise, and to study the quality of life using the SF-36 questionnaire. All patients independently assessed the therapy satisfaction index. RESULTS AND CONCLUSION The safety, good tolerance and obvious clinical effect were shown when using the drug Sermion. The best results were obtained with the use of Sermion for 6 months in relation to the severity of tinnitus, the degree of its influence on daily activity, the level of distress and an increase in the quality of life of patients, as well as a significant improvement in well-being and cognitive functions in almost all subjects. It has been shown that after an adequate course of therapy and after 3 months, the therapeutic efficacy of Sermion is preserved, and the patients themselves were more satisfied with this remedy after 6 months of treatment. The data obtained suggest a wider use of Sermion in patients with cerebrovascular diseases and tinnitus and/or head, the use of which allows a safe, effective and pathogenetically reasonable effect on the existing disorders in these patients.
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Affiliation(s)
- E V Ekusheva
- Academy of Postgraduate Education of the Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia.,Belgorod State National Research University, Belgorod, Russia
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56
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Hotz I, Deschwanden PF, Mérillat S, Liem F, Kollias S, Jäncke L. Associations of subclinical cerebral small vessel disease and processing speed in non-demented subjects: A 7-year study. Neuroimage Clin 2021; 32:102884. [PMID: 34911190 PMCID: PMC8633374 DOI: 10.1016/j.nicl.2021.102884] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 12/22/2022]
Abstract
Markers of cerebral small vessel disease (CSVD) have previously been associated with age-related cognitive decline. Using longitudinal data of cognitively healthy, older adults (N = 216, mean age at baseline = 70.9 years), we investigated baseline status and change in white matter hyperintensities (WMH) (total, periventricular, deep), normal appearing white matter (NAWM), brain parenchyma volume (BPV) and processing speed over seven years as well as the impact of different covariates by applying latent growth curve (LGC) models. Generally, we revealed a complex pattern of associations between the different CSVD markers. More specifically, we observed that changes of deep WMH (dWMH), as compared to periventricular WMH (pWMH), were more strongly related to the changes of other CSVD markers and also to baseline processing speed performance. Further, the number of lacunes rather than their volume reflected the severity of CSVD. With respect to the studied covariates, we revealed that higher education had a protective effect on subsequent total WMH, pWMH, lacunar number, NAWM volume, and processing speed performance. The indication of antihypertensive drugs was associated with lower lacunar number and volume at baseline and the indication of antihypercholesterolemic drugs came along with higher processing speed performance at baseline. In summary, our results confirm previous findings, and extend them by providing information on true within-person changes, relationships between the different CSVD markers and brain-behavior associations. The moderate to strong associations between changes of the different CSVD markers indicate a common pathological relationship and, thus, support multidimensional treatment strategies.
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Affiliation(s)
- Isabel Hotz
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
| | - Pascal Frédéric Deschwanden
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Susan Mérillat
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Franziskus Liem
- University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Spyridon Kollias
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland; University Research Priority Program (URPP), Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
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57
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Narasimhan M, Schwartz R, Halliday G. Parkinsonism and cerebrovascular disease. J Neurol Sci 2021; 433:120011. [PMID: 34686356 DOI: 10.1016/j.jns.2021.120011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
The relationship between cerebrovascular disease and parkinsonism is commonly seen in everyday clinical practice but remains ill-defined and under-recognised with little guidance for the practising neurologist. We attempt to define this association and to illustrate key clinical, radiological and pathological features of the syndrome of Vascular Parkinsonism (VaP). VaP is a major cause of morbidity in the elderly associated with falls, hip fractures and cognitive impairment. Although acute parkinsonism is reported in the context of an acute cerebrovascular event, the vast majority of VaP presents as an insidious syndrome usually in the context of vascular risk factors and radiological evidence of small vessel disease. There may be an anatomic impact on basal ganglia neuronal networks, however the effect of small vessel disease (SVD) on these pathways is not clear. There are now established reporting standards for radiological features of SVD on MRI. White matter hyperintensities and lacunes have been thought to be the representative radiological features of SVD but other features such as the perivascular space are gaining more importance, especially in context of the glymphatic system. It is important to consider VaP in the differential diagnosis of Parkinson disease (PD) and in these situations, neuroimaging may offer diagnostic benefit especially in those patients with atypical presentations or refractoriness to levodopa. Proactive management of vascular risk factors, monitoring of bone density and an exercise program may offer easily attainable therapeutic targets in PD and VaP. Levodopa therapy should be considered in patients with VaP, however the dose and effect may be different from use in PD. This article is part of the Special Issue "Parkinsonism across the spectrum of movement disorders and beyond" edited by Joseph Jankovic, Daniel D. Truong and Matteo Bologna.
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Affiliation(s)
- Manisha Narasimhan
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | - Raymond Schwartz
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Glenda Halliday
- Brain and Mind Centre and Faculty of Health and Medical Sciences, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
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Rau A, Reisert M, Kellner E, Hosp JA, Urbach H, Demerath T. Increased interstitial fluid in periventricular and deep white matter hyperintensities in patients with suspected idiopathic normal pressure hydrocephalus. Sci Rep 2021; 11:19552. [PMID: 34599204 PMCID: PMC8486779 DOI: 10.1038/s41598-021-98054-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/26/2021] [Indexed: 01/18/2023] Open
Abstract
Periventricular white matter changes are common in patients with idiopathic normal pressure hydrocephalus (iNPH) and considered to represent focally elevated interstitial fluid. We compared diffusion measures in periventricular hyperintensities in patients with imaging features of iNPH to patients without. The hypothesis is that periventricular hyperintensities in patients with presumed iNPH show higher water content than in patients without imaging features of iNPH. 21 patients with iNPH Radscale 7-12 ("high probability of iNPH") and 10 patients with iNPH Radscale 2-4 ("low probability of iNPH") were examined with a neurodegeneration imaging protocol including a diffusion microstructure imaging sequence. Periventricular hyperintensities and deep white matter hyperintensities were segmented and diffusion measures were compared. In patients with imaging features of iNPH, the free water content in periventricular hyperintensities was significantly higher compared to the control group (p = 0.005). This effect was also detectable in deep white matter hyperintensities (p = 0.024). Total brain volumes and total gray or white matter volumes did not differ between the groups. Periventricular cap free water fraction was highly discriminative regarding patients with presumed iNPH and controls with an ROC AUC of 0.933. Quantitative diffusion microstructure imaging shows elevated water content in periventricular hyperintensities in patients with imaging features of iNPH, which could be the imaging correlate for pathologic fluid accumulation and may be used as an imaging biomarker in the future.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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59
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Roseborough AD, Rasheed B, Jung Y, Nishimura K, Pinsky W, Langdon KD, Hammond R, Pasternak SH, Khan AR, Whitehead SN. Microvessel stenosis, enlarged perivascular spaces, and fibrinogen deposition are associated with ischemic periventricular white matter hyperintensities. Brain Pathol 2021; 32:e13017. [PMID: 34538024 PMCID: PMC8713528 DOI: 10.1111/bpa.13017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/24/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022] Open
Abstract
Periventricular white matter hyperintensities (pvWMH) are neuroimaging abnormalities surrounding the lateral ventricles that are apparent on magnetic resonance imaging (MRI). They are associated with age, neurodegenerative disease, and cerebrovascular risk factors. While pvWMH ultimately represent a loss of white matter structural integrity, the pathological causes are heterogeneous in nature, and currently, cannot be distinguished using neuroimaging alone. pvWMH could occur because of a combination of small vessel disease (SVD), ependymal loss, blood–brain barrier dysfunction, and microgliosis. In this study we aimed to characterize microvascular stenosis, fibrinogen extravasation, and microgliosis within pvWMH with and without imaging evidence of periventricular infarction. Using postmortem neuroimaging of human brains (n = 20), we identified pvWMH with and without periventricular infarcts (PVI). We performed histological analysis of microvessel stenosis, perivascular spaces, microgliosis, and immunohistochemistry against fibrinogen as a measure of serum protein extravasation. Herein, we report distinctions between pvWMH with and without periventricular infarcts based on associations with microvessel stenosis, enlarged perivascular spaces, and fibrinogen IHC. Microvessel stenosis was significantly associated with PVI and with cellular deposition of fibrinogen in the white matter. The presence of fibrinogen was associated with PVI and increased number of microglia. These findings suggest that neuroimaging‐based detection of infarction within pvWMH may help distinguish more severe lesions, associated with underlying microvascular disease and BBB dysfunction, from milder pvWMH that are a highly frequent finding on MRI.
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Affiliation(s)
- Austyn D Roseborough
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Berk Rasheed
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Youngkyung Jung
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Nishimura
- Department of Physiology and Pharmacology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - William Pinsky
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kristopher D Langdon
- Department of Pathology and Laboratory Medicine, The Cumming School of Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Robert Hammond
- Department of Pathology and Laboratory Medicine, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Stephen H Pasternak
- Department of Clinical Neurological Sciences, Robarts Research Institute, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Ali R Khan
- Department of Medical Biophysics, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Shawn N Whitehead
- Vulnerable Brain Laboratory, Department of Anatomy and Cell Biology, The Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
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60
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Derraz I, Abdelrady M, Gaillard N, Ahmed R, Cagnazzo F, Dargazanli C, Lefevre PH, Corti L, Riquelme C, Mourand I, Gascou G, Bonafe A, Arquizan C, Costalat V. White Matter Hyperintensity Burden and Collateral Circulation in Large Vessel Occlusion Stroke. Stroke 2021; 52:3848-3854. [PMID: 34517773 DOI: 10.1161/strokeaha.120.031736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensity (WMH), a marker of chronic cerebral small vessel disease, might impact the recruitment of leptomeningeal collaterals. We aimed to assess whether the WMH burden is associated with collateral circulation in patients treated by endovascular thrombectomy for anterior circulation acute ischemic stroke. METHODS Consecutive acute ischemic stroke due to anterior circulation large vessel occlusion and treated with endovascular thrombectomy from January 2015 to December 2017 were included. WMH volumes (periventricular, deep, and total) were assessed by a semiautomated volumetric analysis on fluid-attenuated inversion recovery-magnetic resonance imaging. Collateral status was graded on baseline catheter angiography using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology grading system (good when ≥3). We investigated associations of WMH burden with collateral status. RESULTS A total of 302 patients were included (mean age, 69.1±19.4 years; women, 55.6%). Poor collaterals were observed in 49.3% of patients. Median total WMH volume was 3.76 cm3 (interquartile range, 1.09-11.81 cm3). The regression analyses showed no apparent relationship between WMH burden and the collateral status measured at baseline angiography (adjusted odds ratio, 0.987 [95% CI, 0.971-1.003]; P=0.12). CONCLUSIONS WMH burden exhibits no overt association with collaterals in large vessel occlusive stroke.
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Affiliation(s)
- Imad Derraz
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Mohamed Abdelrady
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Raed Ahmed
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Cyril Dargazanli
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Pierre-Henri Lefevre
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Lucas Corti
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Carlos Riquelme
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Gregory Gascou
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Alain Bonafe
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.-H.L., C.R., G.G., A.B., V.C.), Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
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Dobrynina LA, Alexandrova EV, Zabitova MR, Kalashnikova LA, Krotenkova MV, Akhmetzyanov BM. Anti-NR2 glutamate receptor antibodies as an early biomarker of cerebral small vessel disease. Clin Biochem 2021; 96:26-32. [PMID: 34245693 DOI: 10.1016/j.clinbiochem.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cerebral small vessel disease (SVD) associated with age and vascular risk factors is one of the leading causes of cognitive disorders as well as ischemic and hemorrhagic strokes. The pathogenesis of this disease has not been fully understood yet. The previously established association of the antibodies against the NR2 subunit of the NMDA receptor (NR2ab) with the mechanisms of SVD such as ischemia and blood-brain barrier (BBB) disruption, might suggest their importance in the brain damage. DESIGN & METHODS We studied the NR2ab serum level in 70 patients (45 females, 61.1 ± 6.3 y.o.) with different severity of cognitive impairment and MRI features of SVD and 20 healthy volunteers (12 females, 58.5 ± 6.4 y.o.). RESULTS The elevated level of NR2ab was associated with subjective cognitive impairment (SCI) (p = 0.028) and mild cognitive impairment (MCI) (p = 0.017), Fazekas grade (F) 2 (p = 0,002) and F3 (p = 0,009) of white matter hyperintensities (WMH) and the numbers of lacunes in the cerebral white matter (less than 5) (p = 0,039). CONCLUSION The detected increase in serum NR2ab level in patients with SCI, as well as the minimal amount of white matter lacunes, is most likely caused by hypoxia-induced endothelial damage in the early stage of SVD. Normal NR2ab values in patients with F1 WMH, the increased NR2ab level in patients with F2 and F3 WMH and those with the minimal number of lacunes can indicate that NR2bs are involved in diffuse brain damage due to hypoxia-induced loss of BBB integrity.
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Affiliation(s)
- Larisa A Dobrynina
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia.
| | - Evgenia V Alexandrova
- Federal State Autonomous Institution «N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St., Moscow, Russia
| | - Maryam R Zabitova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia
| | | | - Marina V Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia
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Lee JW, Kim D, Lee S, Choi SW, Kong SK, Hwangbo L, Lee JI, Oh SJ. The Clinical Value of Periventricular White Matter Hyperintensity on MRI in Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol 2021; 131:244-251. [PMID: 34032144 DOI: 10.1177/00034894211018925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the clinical value of periventricular white matter hyperintensity (PWMH) found on brain magnetic resonance imaging (MRI) in patients with sudden sensorineural hearing loss (SSNHL). METHODS In this prospective study, 115 patients who were diagnosed with SSNHL aged between 55 and 75 years were analyzed. All subjects underwent brain MRI and were divided into a PWMH and control groups, depending on the presence of PWMH on MRI. PWMH was subdivided into 3 groups according to severity. Pure-tone average results and hearing gain were compared between the 2 groups before treatment and 2 months after treatment. Hearing improvement was assessed using Sigel's criteria. RESULTS A total of 106 patients (43 in the PWMH group and 63 in the control group) finally completed the 2-month follow-up. Average hearing gain in the PWMH group was significantly higher than in the control group (34.8 ± 20.3 and 25.9 ± 20.3, respectively, P = .029). PWMH score 1 showed significantly better hearing levels and hearing gain compared to PWMH score 3 and the control group. Multivariate analysis revealed that younger age, better initial hearing level, and the presence of PVWM score 1 were associated with good recovery. CONCLUSIONS The presence of PWMH score 1 on brain MRI in patients with SSNHL was associated with better treatment response and was a good prognostic factor in a multivariate analysis while the hearing recovery in more severe PWMH (scores 2, 3) was not different from the control group.
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Affiliation(s)
- Jung Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Deoksu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seokhwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Sung-Won Choi
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Soo-Keun Kong
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Busan, South Korea
| | - Lee Hwangbo
- Department of Diagnostic Radiology, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae Il Lee
- Department of Neurosurgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, South Korea
| | - Se-Joon Oh
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University, Busan, South Korea
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Hakala JO, Pahkala K, Juonala M, Salo P, Kähönen M, Hutri-Kähönen N, Lehtimäki T, Laitinen TP, Jokinen E, Taittonen L, Tossavainen P, Viikari JSA, Raitakari OT, Rovio SP. Cardiovascular Risk Factor Trajectories Since Childhood and Cognitive Performance in Midlife: The Cardiovascular Risk in Young Finns Study. Circulation 2021; 143:1949-1961. [PMID: 33966448 DOI: 10.1161/circulationaha.120.052358] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular risk factors, such as high blood pressure, adverse serum lipids, and elevated body mass index in midlife, may harm cognitive performance. It is important to note that longitudinal accumulation of cardiovascular risk factors since childhood may be associated with cognitive performance already since childhood, but the previous evidence is scarce. We studied the associations of cardiovascular risk factors from childhood to midlife, their accumulation, and midlife cognitive performance. METHODS From 1980, a population-based cohort of 3596 children (3-18 years of age) have been repeatedly followed up for 31 years. Blood pressure, serum lipids, and body mass index were assessed in all follow-ups. Cardiovascular risk factor trajectories from childhood to midlife were identified using latent class growth mixture modeling. Cognitive testing was performed in 2026 participants 34 to 49 years of age using a computerized test. The associations of the cardiovascular risk factor trajectories and cognitive performance were studied for individual cardiovascular risk factors and cardiovascular risk factor accumulation. RESULTS Consistently high systolic blood pressure (β=-0.262 SD [95% CI, -0.520 to -0.005]) and serum total cholesterol (β=-0.214 SD [95% CI, -0.365 to -0.064]) were associated with worse midlife episodic memory and associative learning compared with consistently low values. Obesity since childhood was associated with worse visual processing and sustained attention (β=-0.407 SD [95% CI, -0.708 to -0.105]) compared with normal weight. An inverse association was observed for the cardiovascular risk factor accumulation with episodic memory and associative learning (P for trend=0.008; 3 cardiovascular risk factors: β=-0.390 SD [95% CI, -0.691 to -0.088]), with visual processing and sustained attention (P for trend<0.0001; 3 cardiovascular risk factors: β=-0.443 SD [95% CI, -0.730 to -0.157]), and with reaction and movement time (P for trend=0.048; 2 cardiovascular risk factors: β=-0.164 SD [95% CI, -0.318 to -0.010]). CONCLUSIONS Longitudinal elevated systolic blood pressure, high serum total cholesterol, and obesity from childhood to midlife were inversely associated with midlife cognitive performance. It is important to note that the higher the number of cardiovascular risk factors, the worse was the observed cognitive performance. Therefore, launching preventive strategies against cardiovascular risk factors beginning from childhood might benefit primordial promotion of cognitive health in adulthood.
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Affiliation(s)
- Juuso O Hakala
- Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku, Finland.,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health (J.O.H., K.P.), University of Turku, Finland.,Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku, Finland.,Paavo Nurmi Centre, Sports and Exercise Medicine Unit, Department of Physical Activity and Health (J.O.H., K.P.), University of Turku, Finland.,Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital, Turku, Finland
| | - Markus Juonala
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland
| | - Pia Salo
- Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku, Finland.,Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology (M.K.), Tampere University Hospital, Finland.,DFaculty of Medicine and Health Technology (M.K., N.H.-K., T.L.), Tampere University, Finland
| | - Nina Hutri-Kähönen
- Department of Pediatrics (N.H.-K.), Tampere University Hospital, Finland.,DFaculty of Medicine and Health Technology (M.K., N.H.-K., T.L.), Tampere University, Finland
| | - Terho Lehtimäki
- DFaculty of Medicine and Health Technology (M.K., N.H.-K., T.L.), Tampere University, Finland.,Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center, Tampere (T.L.)
| | - Tomi P Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Finland (T.P.L.)
| | - Eero Jokinen
- Department of Paediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland (E.J.)
| | - Leena Taittonen
- Vaasa Central Hospital, Finland (L.T.).,Department of Pediatrics, University of Oulu, Finland (L.T., P.T.)
| | | | - Jorma S A Viikari
- Department of Medicine (M.J., J.S.A.V.), University of Turku, Finland.,Division of Medicine (M.J., J.S.A.V.), Turku University Hospital, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku, Finland.,Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine (O.T.R.), Turku University Hospital, Finland
| | - Suvi P Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku, Finland.,Centre for Population Health Research (J.O.H., K.P., P.S., O.T.R., S.P.R.), University of Turku and Turku University Hospital, Turku, Finland
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Wu MN, Fang PT, Hung CH, Hsu CY, Chou PS, Yang YH. The association between white matter changes and development of malignant middle cerebral artery infarction: A case-control study. Medicine (Baltimore) 2021; 100:e25751. [PMID: 33907171 PMCID: PMC8084049 DOI: 10.1097/md.0000000000025751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 02/05/2023] Open
Abstract
ABSTRACT Disrupted blood-brain barrier (BBB) in patients with ischemic stroke plays a critical role in malignant middle cerebral artery infarction (MMI) development.Cerebral white matter changes (WMC), particularly in the deep subcortical area or in severe one, may be also underlain by disrupted BBB. It is unclear whether the presence of WMC with potential premorbid disruption of BBB makes patients susceptible to MMI. Therefore, this study aimed to clarify any putative relationship between the MMI and WMC in terms of their severity and locations.In this case-control study, patients with infarction in the middle cerebral artery territory were retrospectively reviewed. Brain magnetic resonance images were analyzed according to Fazekas scale, and identified WMC were divided into periventricular WMC (PV-WMC) and deep subcortical WMC (deep-WMC). Patients were scored as having WMC, PV-WMC, deep-WMC, severe PV-WMC, and severe deep-WMC according to the severity and locations. Patients were defined as having MMI if either a progressive conscious disturbance or signs of uncal herniation was recorded in combination with a midline shift >5 mm identified on the follow-up computed tomography.Among 297 patients admitted between July 2009 and February 2015, 92 patients were eligible for final analysis. Compared to patients without MMI, patients with MMI had a higher score of National Institutes of Health Stroke Scale, a larger infarct volume, and an increasingly greater proportion of severe PV-WMC, deep-WMC, and severe deep-WMC, respectively. After adjustment for sex, age, infarct volume, and history of hypertension, severe deep-WMC (odds ratio [OR] = 6.362, 95% confidence interval [CI] = 1.444-28.023, P = .0144) and severe PV-WMC (odds ratio = 5.608, 95% confidence interval = 1.107-28.399, P = .0372) were significantly associated with MMI development.MMI and WMC are significantly associated such that MMI development is more likely when PV-WMC or deep-WMC is more severe. We hypothesize that Fazekas scale-defined severe deep-WMC and PV-WMC may be considered as clinically approachable predictors of MMI development. These findings support that the WMC with potential premorbid disrupted BBB may make patients susceptible to MMI, and further prospective study should be conducted to clarify this hypothesis.
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Affiliation(s)
| | - Pen-Tzu Fang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital
| | | | | | | | - Yuan-Han Yang
- Department of Neurology
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan)
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Conrad F, Hirsiger S, Winklhofer S, Baumgartner MR, Stämpfli P, Seifritz E, Wegener S, Quednow BB. Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions. J Psychiatry Neurosci 2021; 46:E281-E291. [PMID: 33844483 PMCID: PMC8061741 DOI: 10.1503/jpn.200057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Cocaine use has been associated with vascular pathologies, including cerebral white matter hyperintensities. Street cocaine is most often adulterated with levamisole, an anthelminthic drug that may also be associated with vascular toxicity. However, whether levamisole exposure from cocaine consumption further accelerates the development of white matter lesions remains unknown. Methods We investigated the association of cocaine and levamisole exposure with white matter hyperintensities in 35 chronic cocaine users and 34 healthy controls. We measured cocaine and levamisole concentrations in hair samples, which reflected exposure up to 6 months previously. We assessed the number and total surface area of the white matter hyperintensities using structural MRI (FLAIR sequence). Using generalized linear models, we analyzed the contributions of cocaine and levamisole to the number and area of white matter hyperintensities, accounting for several confounding factors. Results Analysis using generalized linear models revealed that cocaine users had more white matter hyperintensities in terms of total surface area, but not in terms of number. Further generalized linear models that included cocaine and levamisole hair concentrations (instead of group) as predictors indicated that levamisole exposure was strongly associated with more and larger white matter hyperintensities, suggesting that the elevated white matter hyperintensities in cocaine users were driven mainly by levamisole exposure. Finally, white matter hyperintensities in levamisole-exposed cocaine users were located primarily in the periventricular and juxtacortical white matter. Limitations The sample size was moderate, and blood pressure was not systematically assessed. Conclusion As an adulterant of cocaine, levamisole appears to increase the risk of white matter injury.
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Affiliation(s)
- Florian Conrad
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sarah Hirsiger
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Sebastian Winklhofer
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Markus R Baumgartner
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Philipp Stämpfli
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Erich Seifritz
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Susanne Wegener
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
| | - Boris B Quednow
- From the Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (Conrad, Wegener); the Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland (Hirsiger, Stämpfli, Seifritz, Quednow); the Department of Neuroradiology, University Hospital Zürich, University of Zurich, Switzerland (Winklhofer); the Center of Forensic Hair Analytics, Institute of Forensic Medicine, University of Zurich, Switzerland (Baumgartner); and the Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland (Seifritz, Wegener, Quednow)
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Yamasaki T, Ikawa F, Hidaka T, Kuwabara M, Matsuda S, Ozono I, Chiku M, Kitamura N, Hamano T, Akishita M, Yamaguchi S, Tomimoto H, Suzuki M. Prevalence and risk factors for brain white matter changes in young and middle-aged participants with Brain Dock (brain screening): a registry database study and literature review. Aging (Albany NY) 2021; 13:9496-9509. [PMID: 33820872 PMCID: PMC8064194 DOI: 10.18632/aging.202933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
This study aimed to determine the prevalence and risk factors for brain white matter changes in normal young and middle-aged participants who underwent Brain Dock (brain screening). We analyzed 5,000 consecutive healthy participants from the Brain Dock registry between August to December 2018. Age, sex, body mass index (BMI), medical history, deep subcortical white matter high intensity (DSWMH), periventricular high intensity (PVH), and enlargement of perivascular space (EPVS) were investigated in relation to age. The prevalence of DSWMH, PVH, and EPVS were 35.3%, 14.0%, and 17.8%, respectively. Multivariate logistic regression analyses for brain white matter changes were conducted. The significant risk factors in participants aged < 50 years were: age (OR:1.09, 95% CI:1.07-1.12), the female sex (1.29, 1.03-1.60), BMI obesity (1.86, 1.12-3.08), and hypertension (1.67, 1.18-2.35) for DSWMH; age (1.08, 1.04-1.13) and the female sex (1.56, 1.03-2.36) for PVH; and age (1.07, 1.05-1.10) and the female sex (0.77, 0.60-1.00) for EPVS. In conclusion, age was consistently identified as a significant risk factor in young and middle-aged participants. Some risk factors for brain white matter changes were identified even in young and middle-aged participants in this study. Further longitudinal studies should be done in the future.
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Affiliation(s)
- Tomohiro Yamasaki
- Postgraduate Clinical Training Center, Shimane University Hospital, Shimane, Japan
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Shimane, Japan
| | - Masaaki Chiku
- Department of Cardiovascular Medicine, Medical Check Studio Tokyo Ginza Clinic, Tokyo, Japan
| | - Naoyuki Kitamura
- Department of Diagnostic Radiology, Kasumi Clinic, Hiroshima, Japan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Liu J, Ke X, Lai Q. Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities. Acta Radiol 2021; 62:515-523. [PMID: 32551801 DOI: 10.1177/0284185120932386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter. PURPOSE To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals. MATERIAL AND METHODS A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV). RESULTS Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities. CONCLUSION Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.
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Affiliation(s)
- Jiyang Liu
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Xiaoting Ke
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Qingquan Lai
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
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68
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Dao E, Tam R, Hsiung GYR, Ten Brinke L, Crockett R, Barha CK, Yoo Y, Al Keridy W, Doherty SH, Laule C, MacKay AL, Liu-Ambrose T. Exploring the Contribution of Myelin Content in Normal Appearing White Matter to Cognitive Outcomes in Cerebral Small Vessel Disease. J Alzheimers Dis 2021; 80:91-101. [PMID: 33523006 DOI: 10.3233/jad-201134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Myelin damage is a salient feature in cerebral small vessel disease (cSVD). Of note, myelin damage extends into the normal appearing white matter (NAWM). Currently, the specific role of myelin content in cognition is poorly understood. OBJECTIVE The objective of this exploratory study was to investigate the association between NAWM myelin and cognitive function in older adults with cSVD. METHODS This exploratory study included 55 participants with cSVD. NAWM myelin was measured using myelin water imaging and was quantified as myelin water fraction (MWF). Assessment of cognitive function included processing speed (Trail Making Test Part A), set shifting (Trail Making Test Part B minus A), working memory (Verbal Digit Span Backwards Test), and inhibition (Stroop Test). Multiple linear regression analyses assessed the contribution of NAWM MWF on cognitive outcomes controlling for age, education, and total white matter hyperintensity volume. The overall alpha was set at ≤0.05. RESULTS After accounting for age, education, and total white matter hyperintensity volume, lower NAWM MWF was significantly associated with slower processing speed (β = -0.29, p = 0.037) and poorer working memory (β= 0.30, p = 0.048). NAWM MWF was not significantly associated with set shifting or inhibitory control (p > 0.132). CONCLUSION Myelin loss in NAWM may play a role in the evolution of impaired processing speed and working memory in people with cSVD. Future studies, with a longitudinal design and larger sample sizes, are needed to fully elucidate the role of myelin as a potential biomarker for cognitive function.
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Affiliation(s)
- Elizabeth Dao
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Roger Tam
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Department of Radiology, UBC, Vancouver, Canada.,School of Biomedical Engineering, UBC, Vancouver, Canada
| | - Ging-Yuek R Hsiung
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Division of Neurology, UBC Hospital, Vancouver, Canada
| | - Lisanne Ten Brinke
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Rachel Crockett
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Cindy K Barha
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | | | - Walid Al Keridy
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Division of Neurology, UBC Hospital, Vancouver, Canada.,Department of Medicine, King Saud University, College of Medicine, Riyadh, Saudi Arabia
| | - Stephanie H Doherty
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Cornelia Laule
- Department of Radiology, UBC, Vancouver, Canada.,Department of Pathology and Laboratory Medicine, UBC, Vancouver, Canada.,Department of Physics and Astronomy, UBC, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Alex L MacKay
- Department of Radiology, UBC, Vancouver, Canada.,UBC MRI Research Centre, UBC, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
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69
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Jiang J, Gao Y, Zhang R, Wang L, Zhao X, Dai Q, Zhang W, Xu X, Chen X. Differential Effects of Serum Lipoprotein-Associated Phospholipase A2 on Periventricular and Deep Subcortical White Matter Hyperintensity in Brain. Front Neurol 2021; 12:605372. [PMID: 33763010 PMCID: PMC7982574 DOI: 10.3389/fneur.2021.605372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background and Purpose: Serum level of lipoprotein-associated phospholipase A2 (Lp-PLA2) was associated with white matter hyperintensity (WMH). There were differences in the anatomical structure and pathophysiological mechanism between periventricular WMH (PVWMH) and deep subcortical WMH (DSWMH). In this study, we aimed to investigate the effects of serum Lp-PLA2 on the PVWMH and DSWMH. Methods: In total, 711 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this cross-sectional study, who had received physical examinations in the Department of Neurology, the Affiliated Jiangning Hospital of Nanjing Medical University due to dizziness and headaches between January 2016 and July 2019. Enzyme linked immunosorbent assay (ELISA) was utilized to determine the serum Lp-PLA2. Fazekas scale was used to measure the severity of PVWMH (grade 0-3) and DSWMH (grade 0-3) on MRI scans. Ordinal regression analysis was carried out to investigate the relationship between serum Lp-PLA2 and PVWMH or DSWMH. Results: Finally, 567 cases were included in this study. The average level of serum Lp-PLA2 was 213.35±59.34 ng/ml. There were statistical differences in the age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Lp-PLA2 grade, creatinine, Hcy, and H-CRP (P < 0.05) in PVWMH groups. Ordinal regression analysis indicated that there was a lower risk of PVWMH in the patients with normal and moderately elevated serum Lp-PLA2 compared with those with significantly elevated serum Lp-PLA2 after adjusting age, hypertension, diabetes mellitus, atrial fibrillation, lacunar infarction, Cr, Hcy, and H-CRP. In addition, PVWMH was correlated to advanced age, hypertension, diabetes mellitus, and lacunar infarction. After adjusting for confounding factors, DSWMH was correlated to advanced age and lacunar infarction. There was no correlation between serum Lp-PLA2 and DSWMH. Conclusions: Serum Lp-PLA2 was closely associated with the pathogenesis of PVWMH rather than DSWMH. There might be different pathological mechanisms between PVWMH and DSWMH.
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Affiliation(s)
- Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Yuanyuan Gao
- Department of General Practice, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xiaoyuan Zhao
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Wei Zhang
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xiujian Xu
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital With Nanjing Medical University, Nanjing, China
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70
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Moretti R, Giuffré M, Caruso P, Gazzin S, Tiribelli C. Homocysteine in Neurology: A Possible Contributing Factor to Small Vessel Disease. Int J Mol Sci 2021; 22:ijms22042051. [PMID: 33669577 PMCID: PMC7922986 DOI: 10.3390/ijms22042051] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing amino acid generated during methionine metabolism, accumulation of which may be caused by genetic defects or the deficit of vitamin B12 and folate. A serum level greater than 15 micro-mols/L is defined as hyperhomocysteinemia (HHcy). Hcy has many roles, the most important being the active participation in the transmethylation reactions, fundamental for the brain. Many studies focused on the role of homocysteine accumulation in vascular or degenerative neurological diseases, but the results are still undefined. More is known in cardiovascular disease. HHcy is a determinant for the development and progression of inflammation, atherosclerotic plaque formation, endothelium, arteriolar damage, smooth muscle cell proliferation, and altered-oxidative stress response. Conversely, few studies focused on the relationship between HHcy and small vessel disease (SVD), despite the evidence that mice with HHcy showed a significant end-feet disruption of astrocytes with a diffuse SVD. A severe reduction of vascular aquaporin-4-water channels, lower levels of high-functioning potassium channels, and higher metalloproteinases are also observed. HHcy modulates the N-homocysteinylation process, promoting a pro-coagulative state and damage of the cellular protein integrity. This altered process could be directly involved in the altered endothelium activation, typical of SVD and protein quality, inhibiting the ubiquitin-proteasome system control. HHcy also promotes a constant enhancement of microglia activation, inducing the sustained pro-inflammatory status observed in SVD. This review article addresses the possible role of HHcy in small-vessel disease and understands its pathogenic impact.
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Affiliation(s)
- Rita Moretti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
- Correspondence:
| | - Mauro Giuffré
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
| | - Paola Caruso
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy; (M.G.); (P.C.)
| | - Silvia Gazzin
- Italian Liver Foundation, AREA SCIENCE PARK, 34149 Trieste, Italy; (S.G.); (C.T.)
| | - Claudio Tiribelli
- Italian Liver Foundation, AREA SCIENCE PARK, 34149 Trieste, Italy; (S.G.); (C.T.)
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71
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Rajani RM, Dupré N, Domenga-Denier V, Van Niel G, Heiligenstein X, Joutel A. Characterisation of early ultrastructural changes in the cerebral white matter of CADASIL small vessel disease using high-pressure freezing/freeze-substitution. Neuropathol Appl Neurobiol 2021; 47:694-704. [PMID: 33483954 DOI: 10.1111/nan.12697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/29/2022]
Abstract
AIMS The objective of this study was to elucidate the early white matter changes in CADASIL small vessel disease. METHODS We used high-pressure freezing and freeze substitution (HPF/FS) in combination with high-resolution electron microscopy (EM), immunohistochemistry and confocal microscopy of brain specimens from control and CADASIL (TgNotch3R169C ) mice aged 4-15 months to study white matter lesions in the corpus callosum. RESULTS We first optimised the HPF/FS protocol in which samples were chemically prefixed, frozen in a sample carrier filled with 20% polyvinylpyrrolidone and freeze-substituted in a cocktail of tannic acid, osmium tetroxide and uranyl acetate dissolved in acetone. EM analysis showed that CADASIL mice exhibit significant splitting of myelin layers and enlargement of the inner tongue of small calibre axons from the age of 6 months, then vesiculation of the inner tongue and myelin sheath thinning at 15 months of age. Immunohistochemistry revealed an increased number of oligodendrocyte precursor cells, although only in older mice, but no reduction in the number of mature oligodendrocytes at any age. The number of Iba1 positive microglial cells was increased in older but not in younger CADASIL mice, but the number of activated microglial cells (Iba1 and CD68 positive) was unchanged at any age. CONCLUSION We conclude that early WM lesions in CADASIL affect first and foremost the myelin sheath and the inner tongue, suggestive of a primary myelin injury. We propose that those defects are consistent with a hypoxic/ischaemic mechanism.
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Affiliation(s)
- Rikesh M Rajani
- Institute of Psychiatry and Neurosciences of Paris, Inserm U1266, Université de Paris, Paris, France
| | - Nicolas Dupré
- Institute of Psychiatry and Neurosciences of Paris, Inserm U1266, Université de Paris, Paris, France
| | - Valérie Domenga-Denier
- Institute of Psychiatry and Neurosciences of Paris, Inserm U1266, Université de Paris, Paris, France
| | - Guillaume Van Niel
- Institute of Psychiatry and Neurosciences of Paris, Inserm U1266, Université de Paris, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
| | | | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, Inserm U1266, Université de Paris, Paris, France.,GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France.,Department of Pharmacology, College of Medicine, University of Vermont, Burlington, VT, USA
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72
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Van Etten EJ, Bharadwaj PK, Hishaw GA, Huentelman MJ, Trouard TP, Grilli MD, Alexander GE. Influence of regional white matter hyperintensity volume and apolipoprotein E ε4 status on hippocampal volume in healthy older adults. Hippocampus 2021; 31:469-480. [PMID: 33586848 PMCID: PMC9119498 DOI: 10.1002/hipo.23308] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 12/22/2020] [Accepted: 01/23/2021] [Indexed: 11/08/2022]
Abstract
While total white matter hyperintensity (WMH) volume on magnetic resonance imaging (MRI) has been associated with hippocampal atrophy, less is known about how the regional distribution of WMH volume may differentially affect the hippocampus in healthy aging. Additionally, apolipoprotein E (APOE) ε4 carriers may be at an increased risk for greater WMH volumes and hippocampal atrophy in aging. The present study sought to investigate whether regional WMH volume mediates the relationship between age and hippocampal volume and if this association is moderated by APOE ε4 status in a group of 190 cognitively healthy adults (APOE ε4 status [carrier/non-carrier] = 59/131), ages 50-89. Analyses revealed that temporal lobe WMH volume significantly mediated the relationship between age and average bilateral hippocampal volume, and this effect was moderated by APOE ε4 status (-0.020 (SE = 0.009), 95% CI, [-0.039, -0.003]). APOE ε4 carriers, but not non-carriers, showed negative indirect effects of age on hippocampal volume through temporal lobe WMH volume (APOE ε4 carriers: -0.016 (SE = 0.007), 95% CI, [-0.030, -0.003]; APOE ε4 non-carriers: .005 (SE = 0.006), 95% CI, [-0.006, 0.017]). These findings remained significant after additionally adjusting for sex, years of education, hypertension status and duration, cholesterol status, diabetes status, Body Mass Index, history of smoking, and the Wechsler Adult Intelligence Scale-IV Full Scale IQ. There were no significant moderated mediation effects for frontal, parietal, and occipital lobe WMH volumes, with or without covariates. Our findings indicate that in cognitively healthy older adults, elevated WMH volume regionally localized to the temporal lobes in APOE ε4 carriers is associated with reduced hippocampal volume, suggesting greater vulnerability to brain aging and the risk for Alzheimer's disease.
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Affiliation(s)
- Emily J Van Etten
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA
| | - Pradyumna K Bharadwaj
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA
| | - Georg A Hishaw
- Department of Neurology, University of Arizona, Tucson, Arizona, USA
| | - Matthew J Huentelman
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA.,Neurogenomics Division, The Translational Genomics Research Institute (TGen), Phoenix, Arizona, USA.,Arizona Alzheimer's Consortium, Phoenix, Arizona, USA
| | - Theodore P Trouard
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA.,Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA.,Arizona Alzheimer's Consortium, Phoenix, Arizona, USA
| | - Matthew D Grilli
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA.,Department of Neurology, University of Arizona, Tucson, Arizona, USA
| | - Gene E Alexander
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, USA.,Department of Psychiatry, University of Arizona, Tucson, Arizona, USA.,Neuroscience Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona, USA.,Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona, USA.,Arizona Alzheimer's Consortium, Phoenix, Arizona, USA
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73
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White matter hyperintensities and patterns of atrophy in early onset Alzheimer's disease with causative gene mutations. Clin Neurol Neurosurg 2021; 203:106552. [PMID: 33601235 DOI: 10.1016/j.clineuro.2021.106552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE White matter hyperintensities could be found in many degenerative dementias including Alzheimer's disease (AD). Pathogenesis of white matter hyperintensities in AD is complicated. We aim to identify the features of white matter hyperintensities and the atrophy pattern in early onset Alzheimer's disease with causative gene mutations. METHODS 7 AD dementia patients with causative mutations were included and the clinical history, neuropsychology, neuroimaging,APOE genotype and whole-genome sequencing (WGS) were analyzed. Axial T1-weighted images and Fluid attenuated inversion recovery (FLAIR) were analyzed with visual rating scale to examine cortical atrophy and white matter hyperintensities. RESULTS 5 female and 2 male patients with 4PSEN1, 2PSEN2 and 1APP mutation were included. The average age of onset was 46.7y/o (44-52) and the duration of disease was 28.6 months (8-60). Clinical phenotype included memory loss (100 %), visual/spatial disorder (100 %), executive dysfunction (100 %), calculation disorder (85.7 %), disorientation (85.7 %), language problem (57.1 %), personality change (28.6 %) and movement disorder (14.3 %). The grading of posterior cortex atrophy was higher than medial temporal lobe atrophy. Periventricular hyperintensities surrounding occipital and frontal horn of ventricle and sub-ventricular bands were most common, while small foci of lesions were also detected in deep white matter, sub-cortical and juxta-cortical area. Mutations carriers in the APP gene or PSEN1 gene postcodon 200 had more severe white matter hyperintensities than other mutations. CONCLUSION White matter hyperintensities were found in early onset AD with causative mutations. The severity was related to genotypes and spatial distributions. Axon degeneration following neuronal loss and ischemic injury might be the pathogenesis of white matter damage. Severer atrophy in the posterior cortex than medial temporal lobe can present in early onset AD.
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Dobrynina LA, Gnedovskaya EV, Zabitova MR, Kremneva EI, Shabalina AA, Makarova AG, Tzipushtanova MM, Filatov AS, Kalashnikova LA, Krotenkova MV. [Clustering of diagnostic MRI signs of cerebral microangiopathy and its relationship with markers of inflammation and angiogenesis]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:22-31. [PMID: 33449529 DOI: 10.17116/jnevro202012012222] [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: 11/17/2022]
Abstract
OBJECTIVE To perform cluster analysis of MRI signs of cerebral microangiopathy (small vessel disease, SVD) and to clarify the relationship between the isolated groups and circulating markers of inflammation and angiogenesis. MATERIAL AND METHODS The identification of groups of MRI signs (MRI types) using cluster hierarchical agglomerative analysis and iterative algorithm of k-means and assessment of their relationship with serum concentrations of tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor-A (VEGF-A), hypoxia-inducible factor 1-α (HIF1-α) determined by ELISA were performed in 96 patients with SVD (STRIVE, 2013) (65 women, average age 60.91±6.57 years). RESULTS Cluster analysis of MRI signs identified two MRI types of SVD with Fazekas grade 3 of white matter hyperintensity (WMH). MRI type 1 (n=18; 6 women, mean age 59.1±6.8 years) and MRI type 2 (n=22, 15 f., mean age 63.5±6.2 years) did not differ by age, sex, severity of hypertension, presence of other risk factors. MRI type 1 had a statistically significantly more pronounced WMH in the periventricular regions, multiple lacunes and microbleeds, atrophy, severe cognitive impairment and gait disorders compared with MRI type 2. Its formation was associated with a decrease in VEGF-A level. MRI type 2 had the significantly more pronounced juxtacortical WMH, white matter lacunes, in the absence of microbleeds and atrophy, and less severe clinical manifestations compared with MRI type 1. Its formation was associated with an increase in TNF-α level. CONCLUSION Clustering of diagnostic MRI signs into MRI types of SVD with significant differences in the severity of clinical manifestations suggests the pathogenetic heterogeneity of age-related SVD. The relationship of MRI types with circulating markers of different mechanisms of vascular wall and brain damage indicates the dominant role of depletion of angiogenesis in the formation of MRI type 1 and increased inflammation in the formation of MRI type 2. Further studies are needed to clarify the criteria and diagnostic value of differentiation of MRI types of SVD, and also their mechanisms with the definition of pathogenetically justified prevention and treatment of various forms of SVD.
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Affiliation(s)
| | | | | | | | | | | | | | - A S Filatov
- Research Center of Neurology, Moscow, Russia
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Kuchcinski G, Wright CB. Show Me Your White Matter, I Will Tell You Who You Are …. Stroke 2021; 52:631-633. [PMID: 33406865 DOI: 10.1161/strokeaha.120.033225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory Kuchcinski
- University of Lille, CHU Lille, Inserm U1172, Vascular and Degenerative Cognitive Disorders, Department of Neuroradiology, France (G.K.)
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
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White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies. Neurosci Biobehav Rev 2020; 120:16-27. [PMID: 33188821 DOI: 10.1016/j.neubiorev.2020.11.007] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/20/2020] [Accepted: 11/06/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND White matter hyperintensities of presumed vascular origin (WMH) are one of the imaging features of cerebral small vessel disease. Controversies persist about the effects of WMH on cognitive dysfunction. This meta-analysis aimed to identify the associations of WMH with risks of cognitive impairment and dementia. METHODS We searched PubMed, EMBASE and Cochrane Library for prospective studies. Primary analyses of cognitive dysfunction and sub-analyses of specific outcomes and study characteristics were conducted using random-effect models. RESULTS Thirty-six prospective studies with 19,040 participants were included. WMH at baseline conferred a 14 % elevated risk of cognitive impairment and all-cause dementia (ACD). WMH also conferred 25 % elevated risk of Alzheimer's disease and 73 % elevated risk of vascular dementia. Risk effects of high-grade WMH and continually increasing WMH (in volume or severity) on ACD were revealed. Periventricular WMH conferred a 1.51-fold excess risk for dementia. CONCLUSIONS WMH were associated with increased risk of cognitive dysfunction and could become a neuroimaging indicator of dementia.
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77
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Alqarni A, Jiang J, Crawford JD, Koch F, Brodaty H, Sachdev P, Wen W. Sex differences in risk factors for white matter hyperintensities in non-demented older individuals. Neurobiol Aging 2020; 98:197-204. [PMID: 33307330 DOI: 10.1016/j.neurobiolaging.2020.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
White matter hyperintensities (WMH) are generally considered to be associated with cerebral small vessel disease, especially, in older age. Although significant sex differences have been reported in the severity of WMH, it is not yet known if the risk factors for WMH differ in men and women. In this study, magnetic resonance imaging brain scans from 2 Australian cohorts were analyzed to extract WMH volumes. The objective of this study is to examine the moderation effect by sex in the association between known risk factors and WMH. The burden of WMH was significantly higher in women compared to men, especially in the deep WMH (DWMH). In the generalized linear model that included the interaction between sex and body mass index (BMI), there was a differential association of BMI with DWMH in men and women in the exploratory sample, that is, the Sydney Memory and Aging Study, n = 432, aged between 70 and 90. The finding of a higher BMI associated with a higher DWMH in men compared to women was replicated in the Older Australian Twins Study sample, n = 179, aged between 65 and 90. The risk factors of WMH pathology are suggested to have a different impact on the aging brains of men and women.
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Affiliation(s)
- Abdullah Alqarni
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Forrest Koch
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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White Matter Hyperintensities Contribute to Language Deficits in Primary Progressive Aphasia. Cogn Behav Neurol 2020; 33:179-191. [PMID: 32889950 DOI: 10.1097/wnn.0000000000000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the contribution of white matter hyperintensities (WMH) to language deficits while accounting for cortical atrophy in individuals with primary progressive aphasia (PPA). METHOD Forty-three individuals with PPA completed neuropsychological assessments of nonverbal semantics, naming, and sentence repetition plus T2-weighted and fluid-attenuated inversion recovery scans. Using three visual scales, we rated WMH and cerebral ventricle size for both scan types. We used Spearman correlations to evaluate associations between the scales and scans. To test whether visual ratings-particularly of WMH-are associated with language, we compared a base model (including gray matter component scores obtained via principal component analysis, age, and days between assessment and MRI as independent variables) with full models (ie, the base model plus visual ratings) for each language variable. RESULTS Visual ratings were significantly associated within and between scans and were significantly correlated with age but not with other vascular risk factors. Only the T2 scan ratings were associated with language abilities. Specifically, controlling for other variables, poorer naming was significantly related to larger ventricles (P = 0.033) and greater global (P = 0.033) and periventricular (P = 0.049) WMH. High global WMH (P = 0.034) were also correlated with worse sentence repetition skills. CONCLUSION Visual ratings of global brain health were associated with language deficits in PPA independent of cortical atrophy and age. While WMH are not unique to PPA, measuring WMH in conjunction with cortical atrophy may elucidate more accurate brain structure-behavior relationships in PPA than cortical atrophy measures alone.
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79
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Mito R, Dhollander T, Xia Y, Raffelt D, Salvado O, Churilov L, Rowe CC, Brodtmann A, Villemagne VL, Connelly A. In vivo microstructural heterogeneity of white matter lesions in healthy elderly and Alzheimer's disease participants using tissue compositional analysis of diffusion MRI data. Neuroimage Clin 2020; 28:102479. [PMID: 33395971 PMCID: PMC7652769 DOI: 10.1016/j.nicl.2020.102479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022]
Abstract
White matter hyperintensities (WMH) are regions of high signal intensity typically identified on fluid attenuated inversion recovery (FLAIR). Although commonly observed in elderly individuals, they are more prevalent in Alzheimer's disease (AD) patients. Given that WMH appear relatively homogeneous on FLAIR, they are commonly partitioned into location- or distance-based classes when investigating their relevance to disease. Since pathology indicates that such lesions are often heterogeneous, probing their microstructure in vivo may provide greater insight than relying on such arbitrary classification schemes. In this study, we investigated WMH in vivo using an advanced diffusion MRI method known as single-shell 3-tissue constrained spherical deconvolution (SS3T-CSD), which models white matter microstructure while accounting for grey matter and CSF compartments. Diffusion MRI data and FLAIR images were obtained from AD (n = 48) and healthy elderly control (n = 94) subjects. WMH were automatically segmented, and classified: (1) as either periventricular or deep; or (2) into three distance-based contours from the ventricles. The 3-tissue profile of WMH enabled their characterisation in terms of white matter-, grey matter-, and fluid-like characteristics of the diffusion signal. Our SS3T-CSD findings revealed substantial heterogeneity in the 3-tissue profile of WMH, both within lesions and across the various classes. Moreover, this heterogeneity information indicated that the use of different commonly used WMH classification schemes can result in different disease-based conclusions. We conclude that future studies of WMH in AD would benefit from inclusion of microstructural information when characterising lesions, which we demonstrate can be performed in vivo using SS3T-CSD.
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Affiliation(s)
- Remika Mito
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Thijs Dhollander
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ying Xia
- CSIRO, Health & Biosecurity, The Australian eHealth Research Centre, Brisbane, Queensland, Australia
| | - David Raffelt
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Olivier Salvado
- CSIRO, Health & Biosecurity, The Australian eHealth Research Centre, Brisbane, Queensland, Australia; CSIRO Data61, Sydney, New South Wales, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia
| | - Christopher C Rowe
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia; Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia; Eastern Clinical Research Unit, Monash University, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Victor L Villemagne
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Medicine, Austin Health, University of Melbourne, Victoria, Australia; Department of Molecular Imaging & Therapy, Centre for PET, Austin Health, Heidelberg, Victoria, Australia
| | - Alan Connelly
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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80
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Dinsdale NK, Bluemke E, Smith SM, Arya Z, Vidaurre D, Jenkinson M, Namburete AIL. Learning patterns of the ageing brain in MRI using deep convolutional networks. Neuroimage 2020; 224:117401. [PMID: 32979523 DOI: 10.1016/j.neuroimage.2020.117401] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 08/17/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022] Open
Abstract
Both normal ageing and neurodegenerative diseases cause morphological changes to the brain. Age-related brain changes are subtle, nonlinear, and spatially and temporally heterogenous, both within a subject and across a population. Machine learning models are particularly suited to capture these patterns and can produce a model that is sensitive to changes of interest, despite the large variety in healthy brain appearance. In this paper, the power of convolutional neural networks (CNNs) and the rich UK Biobank dataset, the largest database currently available, are harnessed to address the problem of predicting brain age. We developed a 3D CNN architecture to predict chronological age, using a training dataset of 12,802 T1-weighted MRI images and a further 6,885 images for testing. The proposed method shows competitive performance on age prediction, but, most importantly, the CNN prediction errors ΔBrainAge=AgePredicted-AgeTrue correlated significantly with many clinical measurements from the UK Biobank in the female and male groups. In addition, having used images from only one imaging modality in this experiment, we examined the relationship between ΔBrainAge and the image-derived phenotypes (IDPs) from all other imaging modalities in the UK Biobank, showing correlations consistent with known patterns of ageing. Furthermore, we show that the use of nonlinearly registered images to train CNNs can lead to the network being driven by artefacts of the registration process and missing subtle indicators of ageing, limiting the clinical relevance. Due to the longitudinal aspect of the UK Biobank study, in the future it will be possible to explore whether the ΔBrainAge from models such as this network were predictive of any health outcomes.
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Affiliation(s)
- Nicola K Dinsdale
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
| | - Emma Bluemke
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
| | - Stephen M Smith
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Zobair Arya
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Diego Vidaurre
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, University of Oxford, United Kingdom
| | - Mark Jenkinson
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Ana I L Namburete
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom
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81
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Dobrynina LA, Gadzhieva ZS, Shamtieva KV, Kremneva EI, Akhmetzyanov BM, Kalashnikova LA, Krotenkova MV. Microstructural Predictors of Cognitive Impairment in Cerebral Small Vessel Disease and the Conditions of Their Formation. Diagnostics (Basel) 2020; 10:diagnostics10090720. [PMID: 32961692 PMCID: PMC7554972 DOI: 10.3390/diagnostics10090720] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Cerebral small vessel disease (CSVD) is the leading cause of vascular and mixed degenerative cognitive impairment (CI). The variability in the rate of progression of CSVD justifies the search for sensitive predictors of CI. Materials: A total of 74 patients (48 women, average age 60.6 ± 6.9 years) with CSVD and CI of varying severity were examined using 3T MRI. The results of diffusion tensor imaging with a region of interest (ROI) analysis were used to construct a predictive model of CI using binary logistic regression, while phase-contrast magnetic resonance imaging and voxel-based morphometry were used to clarify the conditions for the formation of CI predictors. Results: According to the constructed model, the predictors of CI are axial diffusivity (AD) of the posterior frontal periventricular normal-appearing white matter (pvNAWM), right middle cingulum bundle (CB), and mid-posterior corpus callosum (CC). These predictors showed a significant correlation with the volume of white matter hyperintensity; arterial and venous blood flow, pulsatility index, and aqueduct cerebrospinal fluid (CSF) flow; and surface area of the aqueduct, volume of the lateral ventricles and CSF, and gray matter volume. Conclusion: Disturbances in the AD of pvNAWM, CB, and CC, associated with axonal damage, are a predominant factor in the development of CI in CSVD. The relationship between AD predictors and both blood flow and CSF flow indicates a disturbance in their relationship, while their location near the floor of the lateral ventricle and their link with indicators of internal atrophy, CSF volume, and aqueduct CSF flow suggest the importance of transependymal CSF transudation when these regions are damaged.
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82
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An Iatrogenic Model of Brain Small-Vessel Disease: Post-Radiation Encephalopathy. Int J Mol Sci 2020; 21:ijms21186506. [PMID: 32899565 PMCID: PMC7555594 DOI: 10.3390/ijms21186506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/21/2022] Open
Abstract
We studied 114 primitive cerebral neoplasia, that were surgically treated, and underwent radiotherapy (RT), and compared their results to those obtained by 190 patients diagnosed with subcortical vascular dementia (sVAD). Patients with any form of primitive cerebral neoplasia underwent whole-brain radiotherapy. All the tumor patients had regional field partial brain RT, which encompassed each tumor, with an average margin of 2.6 cm from the initial target tumor volume. We observed in our patients who have been exposed to a higher dose of RT (30–65 Gy) a cognitive and behavior decline similar to that observed in sVAD, with the frontal dysexecutive syndrome, apathy, and gait alterations, but with a more rapid onset and with an overwhelming effect. Multiple mechanisms are likely to be involved in radiation-induced cognitive impairment. The active site of RT brain damage is the white matter areas, particularly the internal capsule, basal ganglia, caudate, hippocampus, and subventricular zone. In all cases, radiation damage inside the brain mainly focuses on the cortical–subcortical frontal loops, which integrate and process the flow of information from the cortical areas, where executive functions are “elaborated” and prepared, towards the thalamus, subthalamus, and cerebellum, where they are continuously refined and executed. The active mechanisms that RT drives are similar to those observed in cerebral small vessel disease (SVD), leading to sVAD. The RT’s primary targets, outside the tumor mass, are the blood–brain barrier (BBB), the small vessels, and putative mechanisms that can be taken into account are oxidative stress and neuro-inflammation, strongly associated with the alteration of NMDA receptor subunit composition.
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83
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Linortner P, McDaniel C, Shahid M, Levine TF, Tian L, Cholerton B, Poston KL. White Matter Hyperintensities Related to Parkinson's Disease Executive Function. Mov Disord Clin Pract 2020; 7:629-638. [PMID: 32775508 PMCID: PMC7396844 DOI: 10.1002/mdc3.12956] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/05/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND People with Parkinson's disease (PD) can develop multidomain cognitive impairments; however, it is unclear whether different pathologies underlie domain-specific cognitive dysfunction. OBJECTIVES We investigated the contribution of vascular copathology severity and location, as measured by MRI white matter hyperintensities (WMHs), to domain-specific cognitive impairment in PD. METHODS We studied 85 PD (66.6 ± 9.2 years) and 18 control (65.9 ± 6.6) participants. Using the Fazekas scale for rating the severity of WMH, we subdivided PD into 14 PD-WMH+ and 71 PD-WMH-. Participants underwent global, executive, visuospatial, episodic memory, and language testing. We performed nonparametric permutation testing to create WMH probability maps based on PD-WMH group and cognitive test performance. RESULTS The PD-WMH+ group showed worse global and executive cognitive performance than the PD-WMH- group. On individual tests, the PD-WMH+ group showed worse Montreal Cognitive Assessment (MoCA), Stroop, Symbol Digit Modalities Test (SDMT), and Digit Span scores. WMH probability maps showed that in the PD-WMH+ group, worse Stroop was associated with lesions centered around the corticospinal tract (CST), forceps major, inferior-fronto-occipital fasciculus, and superior longitudinal fasciculus; worse SDMT with lesions around the CST, forceps major, and posterior corona radiata; worse Digit Span with lesions around the posterior corona radiata; and worse MoCA with lesions around the CST. CONCLUSIONS We found that WMH severity was associated with PD executive dysfunction, including worse attention, working memory, and processing speed. Disruption of key white matter tracts in proximity to vascular lesions could contribute to these specific cognitive impairments. Early treatment of vascular disease might mitigate some executive dysfunction in a subset of patients with PD.
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Affiliation(s)
- Patricia Linortner
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Colin McDaniel
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Marian Shahid
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
| | - Taylor F. Levine
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Psychological & Brain SciencesWashington UniversitySt. LouisMissouriUSA
| | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCaliforniaUSA
| | - Brenna Cholerton
- Department of PathologyStanford UniversityPalo AltoCaliforniaUSA
| | - Kathleen L. Poston
- Department of Neurology and Neurological SciencesStanford UniversityPalo AltoCaliforniaUSA
- Department of NeurosurgeryStanford UniversityPalo AltoCaliforniaUSA
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84
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Elliott ML. MRI-based biomarkers of accelerated aging and dementia risk in midlife: how close are we? Ageing Res Rev 2020; 61:101075. [PMID: 32325150 DOI: 10.1016/j.arr.2020.101075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/10/2020] [Accepted: 04/15/2020] [Indexed: 01/18/2023]
Abstract
The global population is aging, leading to an increasing burden of age-related neurodegenerative disease. Efforts to intervene against age-related dementias in older adults have generally proven ineffective. These failures suggest that a lifetime of brain aging may be difficult to reverse once widespread deterioration has occurred. To test interventions in younger populations, biomarkers of brain aging are needed that index subtle signs of accelerated brain deterioration that are part of the putative pathway to dementia. Here I review potential MRI-based biomarkers that could connect midlife brain aging to later life dementia. I survey the literature with three questions in mind, 1) Does the biomarker index age-related changes across the lifespan? 2) Does the biomarker index cognitive ability and cognitive decline? 3) Is the biomarker sensitive to known risk factors for dementia? I find that while there is preliminary support for some midlife MRI-based biomarkers for accelerated aging, the longitudinal research that would best answer these questions is still in its infancy and needs to be further developed. I conclude with suggestions for future research.
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Affiliation(s)
- Maxwell L Elliott
- Department of Psychology and Neuroscience, Duke University, 2020 West Main Street, Suite 030, Durham, NC, 27701, USA.
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85
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Kasahara H, Ikeda M, Nagashima K, Fujita Y, Makioka K, Tsukagoshi S, Yamazaki T, Takai E, Sanada E, Kobayashi A, Kishi K, Suto T, Higuchi T, Tsushima Y, Ikeda Y. Deep White Matter Lesions Are Associated with Early Recognition of Dementia in Alzheimer's Disease. J Alzheimers Dis 2020; 68:797-808. [PMID: 30775989 DOI: 10.3233/jad-180939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuroimages of cerebral amyloid-β (Aβ) accumulation and small vessel disease (SVD) were examined in patients with various types of cognitive disorders using 11C-labeled Pittsburgh Compound B-positron emission tomography (PiB-PET) and magnetic resonance imaging (MRI). The mean cortical standardized uptake value ratio (mcSUVR) was applied for a quantitative analysis of PiB-PET data. The severity of white matter lesions (WML) and enlarged perivascular spaces (EPVS) on MRI were assessed to evaluate complicating cerebral SVD using semiquantitative scales. In homozygous apolipoprotein E ɛ3/ɛ3 carriers, the incidence of more severe WML and EPVS was higher in PiB-positive than PiB-negative patients, indicating that WML and EPVS might be associated with enhanced Aβ accumulation. An association study between PiB-PET and MRI findings revealed that higher WML grades significantly correlate with lower mcSUVRs, especially in the frontal area, indicating that more severe ischemic MRI findings are associated with milder Aβ accumulation among patients with Alzheimer's disease. In these patients SVD may accelerate the occurrence of cognitive decline and facilitate early recognition of dementia.
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Affiliation(s)
- Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaki Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Setsuki Tsukagoshi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuneo Yamazaki
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Eriko Takai
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Etsuko Sanada
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayumi Kobayashi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuhiro Kishi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Zakharov VV, Vakhnina NV, Gogoleva AG, Mezhmidinova SK. Diagnostics and treatment of chronic cerebral ischemia. ACTA ACUST UNITED AC 2020. [DOI: 10.21518/2079-701x-2020-8-36-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
5560 patients with the diagnosis “Other cerebral vascular diseases” per 100 000 of elderly population were registered in RF in 2017. Usually this is a code for chronic brain ischemia (CBI) – the most popular diagnosis in Russian neurological practice. However, diagnostic criteria of CBI are not well defined and need to be ascertained. Recent studies show that the most reliable clinical feature of CBI could be cognitive impairment. It is developed before other clinical signs and correlate with severity of vascular brain lesions. Typically, cognitive impairment is subcortical with prominent bradyphrenia, attentional, dysexecutive and visuospatial deficit and relative sparing of memory. However clinical diagnosis of CBI could be only hypothetical. Diagnosis should be verified by MRI or other visualization technic. Diagnosis is verified if neuroimaging revealed silent strokes, microbleeds and vascular leukoencephalopathy. The most important objective of chronic brain ischemia management is the control of basic vascular disease. Besides this, pathogenetic therapy should be performed to improve cerebral microcirculation, neuronal metabolism and to provide neuroprotection. There is positive data on dipyridamole usage in chronic brain ischemia. It has desagregative, vasotropic, antioxidative and antiinflammation properties. Dypiridamole treatment in CBI patients lead to decrease of neuropsychiatric symptoms and improvement of well-being.
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Affiliation(s)
- V. V. Zakharov
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - N. V. Vakhnina
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - A. G. Gogoleva
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
| | - S. K. Mezhmidinova
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
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87
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Dobrynina LA, Zabitova MR, Shabalina AA, Kremneva EI, Akhmetzyanov BM, Gadzhieva ZS, Berdalin AB, Kalashnikova LA, Gnedovskaya EV, Krotenkova MV. MRI Types of Cerebral Small Vessel Disease and Circulating Markers of Vascular Wall Damage. Diagnostics (Basel) 2020; 10:E354. [PMID: 32485815 PMCID: PMC7345277 DOI: 10.3390/diagnostics10060354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
The evaluation of the clustering of magnetic resonance imaging (MRI) signs into MRI types and their relationship with circulating markers of vascular wall damage were performed in 96 patients with cerebral small vessel disease (cSVD) (31 men and 65 women; mean age, 60.91 ± 6.57 years). The serum concentrations of the tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor-A (VEGF-A), and hypoxia-inducible factor 1-α (HIF-1α) were investigated in 70 patients with Fazekas stages 2 and 3 of white matter hyperintensities (WMH) and 21 age- and sex-matched volunteers with normal brain MRI using ELISA. The cluster analysis excluded two patients from the further analysis due to restrictions in their scanning protocol. MRI signs of 94 patients were distributed into two clusters. In the first group there were 18 patients with Fazekas 3 stage WMH. The second group consisted of 76 patients with WMH of different stages. The uneven distribution of patients between clusters limited the subsequent steps of statistical analysis; therefore, a cluster comparison was performed in patients with Fazekas stage 3 WMH, designated as MRI type 1 and type 2 of Fazekas 3 stage. There were no differences in age, sex, degree of hypertension, or other risk factors. MRI type 1 had significantly more widespread WMH, lacunes in many areas, microbleeds, atrophy, severe cognitive and gait impairments, and was associated with downregulation of VEGF-A compared with MRI type 2. MRI type 2 had more severe deep WMH, lacunes in the white matter, no microbleeds or atrophy, and less severe clinical manifestations and was associated with upregulation of TNF-α compared with MRI type 1. The established differences reflect the pathogenetic heterogeneity of cSVD and explain the variations in the clinical manifestations observed in Fazekas stage 3 of this disease.
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Affiliation(s)
- Larisa A. Dobrynina
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Maryam R. Zabitova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Alla A. Shabalina
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Elena I. Kremneva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | | | - Zukhra Sh. Gadzhieva
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Alexander B. Berdalin
- Federal State Budgetary Institution “Federal Center for Cerebrovascular Pathology and Stroke”, 1, stroenie 10, Ostrovityanova, 117342 Moscow, Russia;
| | - Ludmila A. Kalashnikova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Elena V. Gnedovskaya
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
| | - Marina V. Krotenkova
- Research Center of Neurology, 80 Volokolamskoe shosse, 125367 Moscow, Russia; (M.R.Z.); (A.A.S.); (E.I.K.); (Z.S.G.); (L.A.K.); (E.V.G.); (M.V.K.)
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88
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Khan W, Egorova N, Khlif MS, Mito R, Dhollander T, Brodtmann A. Three-tissue compositional analysis reveals in-vivo microstructural heterogeneity of white matter hyperintensities following stroke. Neuroimage 2020; 218:116869. [PMID: 32334092 DOI: 10.1016/j.neuroimage.2020.116869] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
White matter hyperintensities (WMHs) are frequently observed on brain scans of older individuals and are associated with cognitive impairment and vascular brain burden. Recent studies have shown that WMHs may only represent an extreme end of a diffuse pathological spectrum of white matter (WM) degeneration. The present study investigated the microstructural characteristics of WMHs using an advanced diffusion MRI modelling approach known as Single-Shell 3-Tissue Constrained Spherical Deconvolution (SS3T-CSD), which provides information on different tissue compartments within each voxel. The SS3T-CSD method may provide complementary information in the interpretation of pathological tissue through the tissue-specific microstructural compositions of WMHs. Data were obtained from stroke patients enrolled in the Cognition and Neocortical Volume After Stroke (CANVAS) study, a study examining brain volume and cognition after stroke. WMHs were segmented using an automated method, based on fluid attenuated inversion recovery (FLAIR) images. Automated tissue segmentation was used to identify normal-appearing white matter (NAWM). WMHs were classified into juxtaventricular, periventricular and deep lesions, based on their distance from the ventricles (3-10 mm). We aimed to compare in stroke participants the microstructural composition of the different lesion classes of WMHs and compositions of NAWM to assess the in-vivo heterogeneity of these lesions. Results showed that the 3-tissue composition significantly differed between WMHs classes and NAWM. Specifically, the 3-tissue compositions for juxtaventricular and periventricular WMHs both exhibited a relatively greater fluid-like (free water) content, which is compatible with a presence of interstitial fluid accumulation, when compared to deep WMHs. These findings provide evidence of microstructural heterogeneity of WMHs in-vivo and may support new insights for understanding the role of WMH development in vascular neurodegeneration.
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Affiliation(s)
- Wasim Khan
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, UK.
| | - Natalia Egorova
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Mohamed Salah Khlif
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Remika Mito
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Thijs Dhollander
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Melbourne Dementia Research Centre, University of Melbourne, Victoria, Australia
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89
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Liu C, Shi L, Zhu W, Yang S, Sun P, Qin Y, Tang X, Zhang S, Yao Y, Wang Z, Zhu W, Wang D. Fiber Connectivity Density in Cerebral Small-Vessel Disease Patients With Mild Cognitive Impairment and Cerebral Small-Vessel Disease Patients With Normal Cognition. Front Neurosci 2020; 14:83. [PMID: 32116526 PMCID: PMC7028684 DOI: 10.3389/fnins.2020.00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/21/2020] [Indexed: 11/17/2022] Open
Abstract
Abnormal structural connectivity of cerebral small-vessel disease (CSVD) is associated with cognitive impairment. But the different characteristics of structural connectivity have not been elucidated in early CSVD patients. The current study aimed to investigate the potential differences of structural connectivity in CSVD patients with mild cognitive impairment (MCI) and CSVD patients with normal cognition. Twenty-two CSVD patients with MCI, 34 CSVD patients with normal cognition, and 35 controls, who were age, sex, and education matched underwent diffusion tensor imaging and high resolution T1-weighted imaging. Clinical characteristics, lacunar infarct volume, white matter hyperintensity (WMH) volume, and global atrophy were quantitatively evaluated. Maps of fiber connectivity density (FiCD) were constructed and compared across groups in vertex levels. Pearson correlation was used to estimate the imaging–clinical relationships with control of general characteristics. CSVD patients with MCI had higher lesion load of WMH and lacunar infarcts, and correspondingly lower global FiCD value than CSVD patients with normal cognition (P < 0.01). Lacunar infarct (r = −0.318, P < 0.01) and WMH (r = −0.400, P < 0.01), but not global atrophy, age, or sex, were significantly correlated with the global FiCD value. CSVD patients with normal cognition showed decreased FiCD value mainly in the prefrontal areas (P < 0.01 with Monte Carlo correction). Compared with CSVD patients with normal cognition, CSVD patients with MCI showed significantly decreased FiCD value in enlarged frontal and parietal areas (P < 0.01 with Monte Carlo correction). Inter-group comparisons showed regional enhanced impairment of connectivity density in CSVD patients with MCI in the left superior frontal gyrus, the left precuneus, and the orbital part of the right inferior frontal gyrus (P < 0.01 with Monte Carlo correction). Regional FiCD value of frontal and parietal areas was associated with the cognitive function (P < 0.01). In conclusion, cognitively normal CSVD patients already have disruptions of structural connectivity. The extent and intensity of connectivity disruptions in frontal and parietal areas may underlie the mechanism of cognitive impairment in CSVD. Fiber connectivity density measurements may be helpful for quantitative description of structural cortical connectivity.
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Affiliation(s)
- Chengxia Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiqi Yang
- Xianning Central Hospital, Xianning, China
| | - Pan Sun
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyu Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yihao Yao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenxiong Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
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90
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Shu Z, Xu Y, Shao Y, Pang P, Gong X. Radiomics from magnetic resonance imaging may be used to predict the progression of white matter hyperintensities and identify associated risk factors. Eur Radiol 2020; 30:3046-3058. [PMID: 32086580 DOI: 10.1007/s00330-020-06676-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/20/2019] [Accepted: 01/27/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The progression of white matter hyperintensities (WMH) varies considerably in adults. In this study, we aimed to predict the progression and related risk factors of WMH based on the radiomics of whole-brain white matter (WBWM). METHODS A retrospective analysis was conducted on 141 patients with WMH who underwent two consecutive brain magnetic resonance (MR) imaging sessions from March 2014 to May 2018. The WBWM was segmented to extract and score the radiomics features at baseline. Follow-up images were evaluated using the modified Fazekas scale, with progression indicated by scores ≥ 1. Patients were divided into progressive (n = 65) and non-progressive (n = 76) groups. The progressive group was subdivided into any WMH (AWMH), periventricular WMH (PWMH), and deep WMH (DWMH). Independent risk factors were identified using logistic regression. RESULTS The area under the curve (AUC) values for the radiomics signatures of the training sets were 0.758, 0.749, and 0.775 for AWMH, PWMH, and DWMH, respectively. The AUC values of the validation set were 0.714, 0.697, and 0.717, respectively. Age and hyperlipidemia were independent predictors of progression for AWMH. Age and body mass index (BMI) were independent predictors of progression for DWMH, while hyperlipidemia was an independent predictor of progression for PWMH. After combining clinical factors and radiomics signatures, the AUC values were 0.848, 0.863, and 0.861, respectively, for the training set, and 0.824, 0.818, and 0.833, respectively, for the validation set. CONCLUSIONS MRI-based radiomics of WBWM, along with specific risk factors, may allow physicians to predict the progression of WMH. KEY POINTS • Radiomics features detected by magnetic resonance imaging may be used to predict the progression of white matter hyperintensities. • Radiomics may be used to identify risk factors associated with the progression of white matter hyperintensities. • Radiomics may serve as non-invasive biomarkers to monitor white matter status.
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Affiliation(s)
- Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuyun Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
| | - Yuan Shao
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | - Xiangyang Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China. .,Institute of Artificial Intelligence and Remote Imaging, Hangzhou Medical College, Hangzhou, China.
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91
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Moretti R, Caruso P. Small Vessel Disease-Related Dementia: An Invalid Neurovascular Coupling? Int J Mol Sci 2020; 21:E1095. [PMID: 32046035 PMCID: PMC7036993 DOI: 10.3390/ijms21031095] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 12/18/2022] Open
Abstract
The arteriosclerosis-dependent alteration of brain perfusion is one of the major determinants in small vessel disease, since small vessels have a pivotal role in the brain's autoregulation. Nevertheless, as far as we know, endothelium distress can potentiate the flow dysregulation and lead to subcortical vascular dementia that is related to small vessel disease (SVD), also being defined as subcortical vascular dementia (sVAD), as well as microglia activation, chronic hypoxia and hypoperfusion, vessel-tone dysregulation, altered astrocytes, and pericytes functioning blood-brain barrier disruption. The molecular basis of this pathology remains controversial. The apparent consequence (or a first event, too) is the macroscopic alteration of the neurovascular coupling. Here, we examined the possible mechanisms that lead a healthy aging process towards subcortical dementia. We remarked that SVD and white matter abnormalities related to age could be accelerated and potentiated by different vascular risk factors. Vascular function changes can be heavily influenced by genetic and epigenetic factors, which are, to the best of our knowledge, mostly unknown. Metabolic demands, active neurovascular coupling, correct glymphatic process, and adequate oxidative and inflammatory responses could be bulwarks in defense of the correct aging process; their impairments lead to a potentially catastrophic and non-reversible condition.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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92
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Sartoretti E, Sartoretti T, Wyss M, Becker AS, Schwenk Á, van Smoorenburg L, Najafi A, Binkert C, Thoeny HC, Zhou J, Jiang S, Graf N, Czell D, Sartoretti-Schefer S, Reischauer C. Amide Proton Transfer Weighted Imaging Shows Differences in Multiple Sclerosis Lesions and White Matter Hyperintensities of Presumed Vascular Origin. Front Neurol 2019; 10:1307. [PMID: 31920930 PMCID: PMC6914856 DOI: 10.3389/fneur.2019.01307] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 11/26/2019] [Indexed: 01/14/2023] Open
Abstract
Objectives: To assess the ability of 3D amide proton transfer weighted (APTw) imaging based on magnetization transfer analysis to discriminate between multiple sclerosis lesions (MSL) and white matter hyperintensities of presumed vascular origin (WMH) and to compare APTw signal intensity of healthy white matter (healthy WM) with APTw signal intensity of MSL and WHM. Materials and Methods: A total of 27 patients (16 female, 11 males, mean age 39.6 years) with multiple sclerosis, 35 patients (17 females, 18 males, mean age 66.6 years) with small vessel disease (SVD) and 20 healthy young volunteers (9 females, 11 males, mean age 29 years) were included in the MSL, the WMH, and the healthy WM group. MSL and WMH were segmented on fluid attenuated inversion recovery (FLAIR) images underlaid onto APTw images. Histogram parameters (mean, median, 10th, 25th, 75th, 90th percentile) were calculated. Mean APTw signal intensity values in healthy WM were defined by "Region of interest" (ROI) measurements. Wilcoxon rank sum tests and receiver operating characteristics (ROC) curve analyses of clustered data were applied. Results: All histogram parameters except the 75 and 90th percentile were significantly different between MSL and WMH (p = 0.018-p = 0.034). MSL presented with higher median values in all parameters. The histogram parameters offered only low diagnostic performance in discriminating between MSL and WMH. The 10th percentile yielded the highest diagnostic performance with an AUC of 0.6245 (95% CI: [0.532, 0.717]). Mean APTw signal intensity values of MSL were significantly higher than mean values of healthy WM (p = 0.005). The mean values of WMH did not differ significantly from the values of healthy WM (p = 0.345). Conclusions: We found significant differences in APTw signal intensity, based on straightforward magnetization transfer analysis, between MSL and WMH and between MSL and healthy WM. Low AUC values from ROC analyses, however, suggest that it may be challenging to determine type of lesion with APTw imaging. More advanced analysis of the APT CEST signal may be helpful for further differentiation of MSL and WMH.
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Affiliation(s)
| | - Thomas Sartoretti
- Laboratory of Translational Nutrition Biology, Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, Switzerland
| | - Michael Wyss
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Philips Healthsystems, Zurich, Switzerland
| | - Anton S Becker
- Laboratory of Translational Nutrition Biology, Department of Health Sciences and Technology, ETH Zurich, Schwerzenbach, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Árpád Schwenk
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Arash Najafi
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph Binkert
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Harriet C Thoeny
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | | | - David Czell
- Department of Neurology, Spital Linth, Uznach, Switzerland
| | | | - Carolin Reischauer
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
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93
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Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS. Clinical Significance of Magnetic Resonance Imaging Markers of Vascular Brain Injury: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:81-94. [PMID: 30422209 DOI: 10.1001/jamaneurol.2018.3122] [Citation(s) in RCA: 383] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Covert vascular brain injury (VBI) is highly prevalent in community-dwelling older persons, but its clinical and therapeutic implications are debated. Objective To better understand the clinical significance of VBI to optimize prevention strategies for the most common age-related neurological diseases, stroke and dementia. Data Source We searched for articles in PubMed between 1966 and December 22, 2017, studying the association of 4 magnetic resonance imaging (MRI) markers of covert VBI (white matter hyperintensities [WMHs] of presumed vascular origin, MRI-defined covert brain infarcts [BIs], cerebral microbleeds [CMBs], and perivascular spaces [PVSs]) with incident stroke, dementia, or death. Study Selection Data were taken from prospective, longitudinal cohort studies including 50 or more adults. Data Extraction and Synthesis We performed inverse variance-weighted meta-analyses with random effects and z score-based meta-analyses for WMH burden. The significance threshold was P < .003 (17 independent tests). We complied with the Meta-analyses of Observational Studies in Epidemiology guidelines. Main Outcomes and Measures Stroke (hemorrhagic and ischemic), dementia (all and Alzheimer disease), and death. Results Of 2846 articles identified, 94 studies were eligible, with up to 14 529 participants for WMH, 16 012 participants for BI, 15 693 participants for CMB, and 4587 participants for PVS. Extensive WMH burden was associated with higher risk of incident stroke (hazard ratio [HR], 2.45; 95% CI, 1.93-3.12; P < .001), ischemic stroke (HR, 2.39; 95% CI, 1.65-3.47; P < .001), intracerebral hemorrhage (HR, 3.17; 95% CI, 1.54-6.52; P = .002), dementia (HR, 1.84; 95% CI, 1.40-2.43; P < .001), Alzheimer disease (HR, 1.50; 95% CI, 1.22-1.84; P < .001), and death (HR, 2.00; 95% CI, 1.69-2.36; P < .001). Presence of MRI-defined BIs was associated with higher risk of incident stroke (HR, 2.38; 95% CI, 1.87-3.04; P < .001), ischemic stroke (HR, 2.18; 95% CI, 1.67-2.85; P < .001), intracerebral hemorrhage (HR, 3.81; 95% CI, 1.75-8.27; P < .001), and death (HR, 1.64; 95% CI, 1.40-1.91; P < .001). Presence of CMBs was associated with increased risk of stroke (HR, 1.98; 95% CI, 1.55-2.53; P < .001), ischemic stroke (HR, 1.92; 95% CI, 1.40-2.63; P < .001), intracerebral hemorrhage (HR, 3.82; 95% CI, 2.15-6.80; P < .001), and death (HR, 1.53; 95% CI, 1.31-1.80; P < .001). Data on PVS were limited and insufficient to conduct meta-analyses but suggested an association of high PVS burden with increased risk of stroke, dementia, and death; this requires confirmation. Conclusions and Relevance We report evidence that MRI markers of VBI have major clinical significance. This research prompts careful evaluation of the benefit-risk ratio for available prevention strategies in individuals with covert VBI.
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Affiliation(s)
- Stéphanie Debette
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France.,Department of Neurology, Memory Clinic, Bordeaux University Hospital, Bordeaux, France
| | - Sabrina Schilling
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Marie-Gabrielle Duperron
- University of Bordeaux, Inserm 1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Susanna C Larsson
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
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94
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Rajani RM, Ratelade J, Domenga-Denier V, Hase Y, Kalimo H, Kalaria RN, Joutel A. Blood brain barrier leakage is not a consistent feature of white matter lesions in CADASIL. Acta Neuropathol Commun 2019; 7:187. [PMID: 31753008 PMCID: PMC6873485 DOI: 10.1186/s40478-019-0844-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 01/08/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic paradigm of small vessel disease (SVD) caused by NOTCH3 mutations that stereotypically lead to the vascular accumulation of NOTCH3 around smooth muscle cells and pericytes. White matter (WM) lesions (WMLs) are the earliest and most frequent abnormalities, and can be associated with lacunar infarcts and enlarged perivascular spaces (ePVS). The prevailing view is that blood brain barrier (BBB) leakage, possibly mediated by pericyte deficiency, plays a pivotal role in the formation of WMLs. Herein, we investigated the involvement of BBB leakage and pericyte loss in CADASIL WMLs. Using post-mortem brain tissue from 12 CADASIL patients and 10 age-matched controls, we found that WMLs are heterogeneous, and that BBB leakage reflects the heterogeneity. Specifically, while fibrinogen extravasation was significantly increased in WMLs surrounding ePVS and lacunes, levels of fibrinogen leakage were comparable in WMLs without other pathology ("pure" WMLs) to those seen in the normal appearing WM of patients and controls. In a mouse model of CADASIL, which develops WMLs but no lacunes or ePVS, we detected no extravasation of endogenous fibrinogen, nor of injected small or large tracers in WMLs. Moreover, there was no evidence of pericyte coverage modification in any type of WML in either CADASIL patients or mice. These data together indicate that WMLs in CADASIL encompass distinct classes of WM changes and argue against the prevailing hypothesis that pericyte coverage loss and BBB leakage are the primary drivers of WMLs. Our results also have important implications for the interpretation of studies on the BBB in living patients, which may misinterpret evidence of BBB leakage within WM hyperintensities as suggesting a BBB related mechanism for all WMLs, when in fact this may only apply to a subset of these lesions.
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95
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Lampe L, Zhang R, Beyer F, Huhn S, Kharabian Masouleh S, Preusser S, Bazin PL, Schroeter ML, Villringer A, Witte AV. Visceral obesity relates to deep white matter hyperintensities via inflammation. Ann Neurol 2019; 85:194-203. [PMID: 30556596 PMCID: PMC6590485 DOI: 10.1002/ana.25396] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/15/2022]
Abstract
Objective White matter hyperintensities (WMHs) are linked to vascular risk factors and increase the risk of cognitive decline, dementia, and stroke. We here aimed to determine whether obesity contributes to regional WMHs using a whole‐brain approach in a well‐characterized population‐based cohort. Methods Waist‐to‐hip ratio (WHR), body mass index (BMI), systolic/diastolic blood pressure, hypertension, diabetes and smoking status, blood glucose and inflammatory markers, as well as distribution of WMH were assessed in 1,825 participants of the LIFE‐adult study (age, 20–82 years; BMI, 18.4–55.4 kg/m2) using high‐resolution 3‐Tesla magnetic resonance imaging. Voxel‐wise analyses tested if obesity predicts regional probability of WMH. Additionally, mediation effects of high‐sensitive C‐reactive protein and interleukin‐6 (IL6) measured in blood were related to obesity and WMH using linear regression and structural equation models. Results WHR related to higher WMH probability predominantly in the deep white matter, even after adjusting for effects of age, sex, and systolic blood pressure (mean ß = 0.0043 [0.0008 SE], 95% confidence interval, [0.00427, 0.0043]; threshold‐free cluster enhancement, family‐wise error‐corrected p < 0.05). Conversely, higher systolic blood pressure was associated with WMH in periventricular white matter regions. Mediation analyses indicated that both higher WHR and higher BMI contributed to increased deep‐to‐periventricular WMH ratio through elevated IL6. Interpretation Our results indicate an increased WMH burden selectively in the deep white matter in obese subjects with high visceral fat accumulation, independent of common obesity comorbidities such as hypertension. Mediation analyses proposed that visceral obesity contributes to deep white matter lesions through increases in proinflammatory cytokines, suggesting a pathomechanistic link. Longitudinal studies need to confirm this hypothesis. ANN NEUROL 2019;85:194–203.
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Affiliation(s)
- Leonie Lampe
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Rui Zhang
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Frauke Beyer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sebastian Huhn
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Shahrzad Kharabian Masouleh
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Research Center Jülich, Institute of Neuroscience and Medicine (INM-7), Jülich, Germany
| | - Sven Preusser
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Pierre-Louis Bazin
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Spinoza Centre for Neuroimaging, Amsterdam, The Netherlands
| | - Matthias L Schroeter
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - A Veronica Witte
- Department of Neurology, Max-Planck-Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Dalby RB, Eskildsen SF, Videbech P, Frandsen J, Mouridsen K, Sørensen L, Jeppesen P, Bek T, Rosenberg R, Østergaard L. Oxygenation differs among white matter hyperintensities, intersected fiber tracts and unaffected white matter. Brain Commun 2019; 1:fcz033. [PMID: 32954272 PMCID: PMC7425421 DOI: 10.1093/braincomms/fcz033] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 08/27/2019] [Accepted: 10/01/2019] [Indexed: 01/15/2023] Open
Abstract
White matter hyperintensities of presumed vascular origin are frequently observed on magnetic resonance imaging in normal aging. They are typically found in cerebral small vessel disease and suspected culprits in the etiology of complex age- and small vessel disease-related conditions, such as late-onset depression. White matter hyperintensities may interfere with surrounding white matter metabolic demands by disrupting fiber tract integrity. Meanwhile, risk factors for small vessel disease are thought to reduce tissue oxygenation, not only by reducing regional blood supply, but also by impairing capillary function. To address white matter oxygen supply–demand balance, we estimated voxel-wise capillary density as an index of resting white matter metabolism, and combined estimates of blood supply and capillary function to calculate white matter oxygen availability. We conducted a cross-sectional study with structural, perfusion- and diffusion-weighted magnetic resonance imaging in 21 patients with late-onset depression and 21 controls. We outlined white matter hyperintensities and used tractography to identify the tracts they intersect. Perfusion data comprised cerebral blood flow, blood volume, mean transit time and relative transit time heterogeneity—the latter a marker of capillary dysfunction. Based on these, white matter oxygenation was calculated as the steady state cerebral metabolic rate of oxygen under the assumption of normal tissue oxygen tension and vice versa. The number, volume and perfusion characteristics of white matter hyperintensities did not differ significantly between groups. Hemodynamic data showed white matter hyperintensities to have lower blood flow and blood volume, but higher relative transit time heterogeneity, than normal-appearing white matter, resulting in either reduced capillary metabolic rate of oxygen or oxygen tension. Intersected tracts showed significantly lower blood flow, blood volume and capillary metabolic rate of oxygen than normal-appearing white matter. Across groups, lower lesion oxygen tension was associated with higher lesion number and volume. Compared with normal-appearing white matter, tissue oxygenation is significantly reduced in white matter hyperintensities as well as the fiber tracts they intersect, independent of parallel late-onset depression. In white matter hyperintensities, reduced microvascular blood volume and concomitant capillary dysfunction indicate a severe oxygen supply–demand imbalance with hypoxic tissue injury. In intersected fiber tracts, parallel reductions in oxygenation and microvascular blood volume are consistent with adaptations to reduced metabolic demands. We speculate, that aging and vascular risk factors impair white matter hyperintensity perfusion and capillary function to create hypoxic tissue injury, which in turn affect the function and metabolic demands of the white matter tracts they disrupt.
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Affiliation(s)
- Rikke B Dalby
- Center of Functionally Integrative Neuroscience & MINDLab, Aarhus University Hospital, 8200 Aarhus C., Denmark.,Centre for Psychiatric Research, Aarhus University Hospital, 8340 Risskov, Denmark.,Department of Neuroradiology, Aarhus University Hospital, 8200 Aarhus N., Denmark
| | - Simon F Eskildsen
- Center of Functionally Integrative Neuroscience & MINDLab, Aarhus University Hospital, 8200 Aarhus C., Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center Glostrup, 2600 Glostrup, Denmark
| | - Jesper Frandsen
- Center of Functionally Integrative Neuroscience & MINDLab, Aarhus University Hospital, 8200 Aarhus C., Denmark
| | - Kim Mouridsen
- Center of Functionally Integrative Neuroscience & MINDLab, Aarhus University Hospital, 8200 Aarhus C., Denmark
| | - Leif Sørensen
- Department of Neuroradiology, Aarhus University Hospital, 8200 Aarhus N., Denmark
| | - Peter Jeppesen
- Department of Ophthalmology, Aarhus University Hospital, 8200 Aarhus N., Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, 8200 Aarhus N., Denmark
| | - Raben Rosenberg
- Centre of Psychiatry Amager, Mental Health Services in the Capital Region of Denmark, 2300 Copenhagen S., Denmark
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience & MINDLab, Aarhus University Hospital, 8200 Aarhus C., Denmark.,Department of Neuroradiology, Aarhus University Hospital, 8200 Aarhus N., Denmark
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97
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Moretti R, Peinkhofer C. B Vitamins and Fatty Acids: What Do They Share with Small Vessel Disease-Related Dementia? Int J Mol Sci 2019; 20:E5797. [PMID: 31752183 PMCID: PMC6888477 DOI: 10.3390/ijms20225797] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/21/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022] Open
Abstract
Many studies have been written on vitamin supplementation, fatty acid, and dementia, but results are still under debate, and no definite conclusion has yet been drawn. Nevertheless, a significant amount of lab evidence confirms that vitamins of the B group are tightly related to gene control for endothelium protection, act as antioxidants, play a co-enzymatic role in the most critical biochemical reactions inside the brain, and cooperate with many other elements, such as choline, for the synthesis of polyunsaturated phosphatidylcholine, through S-adenosyl-methionine (SAM) methyl donation. B-vitamins have anti-inflammatory properties and act in protective roles against neurodegenerative mechanisms, for example, through modulation of the glutamate currents and a reduction of the calcium currents. In addition, they also have extraordinary antioxidant properties. However, laboratory data are far from clinical practice. Many studies have tried to apply these results in everyday clinical activity, but results have been discouraging and far from a possible resolution of the associated mysteries, like those represented by Alzheimer's disease (AD) or small vessel disease dementia. Above all, two significant problems emerge from the research: No consensus exists on general diagnostic criteria-MCI or AD? Which diagnostic criteria should be applied for small vessel disease-related dementia? In addition, no general schema exists for determining a possible correct time of implementation to have effective results. Here we present an up-to-date review of the literature on such topics, shedding some light on the possible interaction of vitamins and phosphatidylcholine, and their role in brain metabolism and catabolism. Further studies should take into account all of these questions, with well-designed and world-homogeneous trials.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, 34149 Trieste, Italy;
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Lee KO, Woo MH, Chung D, Choi JW, Kim NK, Kim OJ, Oh SH. Differential Impact of Plasma Homocysteine Levels on the Periventricular and Subcortical White Matter Hyperintensities on the Brain. Front Neurol 2019; 10:1174. [PMID: 31787924 PMCID: PMC6856638 DOI: 10.3389/fneur.2019.01174] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background: The clinical significance of cerebral white matter hyperintensities (WMH) on brain magnetic resonance imaging (MRI) has recently increased, and recognized now as a risk factor for future stroke and dementia. High levels of plasma homocysteine (Hcyt) are associated with cerebral WMH. Recent studies suggest a different anatomy and physiology in the arteriolar system may be supplied to the periventricular and deep subcortical white matter. We hypothesize that plasma Hcyt levels have differing impacts on periventricular WMH (PVWMH) than on deep subcortical WMH (DSWMH). Methods: We evaluated plasma Hcyt levels from 937 neurologically healthy participants. The severity of PVWMH and DSWMH was evaluated by the use of a manual grading scale. Moderate to severe PVWMH and DSWMH levels were defined when the Fazekas score was two or three, respectively. Predominant PVWMH (pred-PVWMH) and predominant DSWMH (pred-DSWMH) were defined as having a difference of Fazekas score between PVWMH and DSWMH of two or more. Other confounding variables including age, sex, vascular risk factors, and estimated glomerular filtration rate (eGFR) were also analyzed. Results: Logistic regression revealed that, after adjusting for the confounding variables, PVWMH was associated with old age, hypertension, diabetes mellitus, low eGFR, and high plasma Hcyt levels. DSWMH was associated with old age, hypertension, and hypercholesterolemia but not with plasma Hcyt levels. Plasma Hcyt levels were associated with pred-PVWMH but not with pred-DSWMH. Conclusions: High plasma Hcyt levels are strongly associated with the development of PVWMH but not DSWMH. Our results suggest the possibility that different pathogeneses exist for PVWMH and DSWMH and that dysregulated Hcyt metabolism associated with the development of PVWMH.
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Affiliation(s)
- Kee Ook Lee
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Min-Hee Woo
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Darda Chung
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Jung-Won Choi
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Nam-Keun Kim
- Institute for Clinical Research, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Ok-Joon Kim
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
| | - Seung-Hun Oh
- Department of Neurology, CHA Bundang Medical Center, Cha University, Seongnam-si, South Korea
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99
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Response: Late-onset Pompe disease manifests in the brain. Mol Genet Metab Rep 2019; 21:100516. [PMID: 31660291 PMCID: PMC6807269 DOI: 10.1016/j.ymgmr.2019.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
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100
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Kremneva E, Akhmetzyanov B, Dobrynina L, Krotenkova M. Associations between blood and cerebrospinal fluid flow impairments assessed with phase-contrast MRI and brain damage in patients with age-related cerebral small vessel disease. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2019. [DOI: 10.24075/brsmu.2019.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hemodynamic parameters of blood and cerebrospinal fluid (CSF) flow can be measured in vivo using phase-contrast MRI (PC-MRI). This opens new horizons for studying the mechanisms implicated in the development and progression of age-related cerebral small vessel disease (SVD). In this paper, we analyze associations between cerebral arterial, venous and CSF flow impairments and SVD features visible on MRI. The study was carried out in 96 patients with SVD (aged 60.91 ± 6.57 years) and 23 healthy volunteers (59.13 ± 6.56 years). The protocol of the MRI examination included routine MRI sequences (T2, FLAIR, T1, SWI, and DWI) applied to assess the severity of brain damage according to STRIVE advisory standards and PC-MRI used to quantify blood flow in the major arteries and veins of the neck, the straight and upper sagittal sinuses, and CSF flow at the aqueduct level. We analyzed the associations between linear and volumetric parameters of blood/CSF flow and the degree of brain matter damage using the Fazekas scale. We observed a reduction in tABF, stVBF, sssVBF, aqLF, Saq, and ICC values and a rise in Pi associated with WMH progression, as well as a gradual decline in tABF and an increase in Pi, Saq and ICC associated with a growing number of lacunes (р < 0.05). Patients with early (< 5) MB had lower sssVBF and stVBF rates in comparison with patients without MB; aqLF, Saq, and ICC values were elevated in patients with 5 to 10 MB, as compared to patients without MB or early (< 5) MB. The established associations between MRI findings in patients with SVD and blood/CSF flow impairments suggest the important role of mechanisms implicated in the disruption of Monro–Kellie intracranial homeostasis in promoting SVD.
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