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Age-induced differences in brain neural activation elicited by visual emotional stimuli: A high-density EEG study. Neuroscience 2017; 340:268-278. [PMID: 27810392 DOI: 10.1016/j.neuroscience.2016.10.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/22/2022]
Abstract
Identifying the brain sources of neural activation during processing of emotional information remains a very challenging task. In this work, we investigated the response to different emotional stimuli and the effect of age on the neuronal activation. Two negative emotion conditions, i.e., 'anger' and 'fear' faces were presented to 22 adult female participants (11 young and 11 elderly) while acquiring high-density electroencephalogram (EEG) data of 256 channels. Brain source localization was utilized to study the modulations in the early N170 event-related-potential component. The results revealed alterations in the amplitude of N170 and the localization of areas with maximum neural activation. Furthermore, age-induced differences are shown in the topographic maps and the neural activation for both emotional stimuli. Overall, aging appeared to affect the limbic area and its implication to emotional processing. These findings can serve as a step toward the understanding of the way the brain functions and evolves with age which is a significant element in the design of assistive environments.
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 423] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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Ho BL, Kao YH, Chou MC, Yang YH. Cerebral White Matter Changes on Therapeutic Response to Rivastigmine in Alzheimer’s Disease. J Alzheimers Dis 2016; 54:351-7. [DOI: 10.3233/jad-160364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bo-Lin Ho
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hui Kao
- Department of Neurology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Mei-Chuan Chou
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of and Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Longitudinal imaging of the ageing mouse. Mech Ageing Dev 2016; 160:93-116. [PMID: 27530773 DOI: 10.1016/j.mad.2016.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/30/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
Several non-invasive imaging techniques are used to investigate the effect of pathologies and treatments over time in mouse models. Each preclinical in vivo technique provides longitudinal and quantitative measurements of changes in tissues and organs, which are fundamental for the evaluation of alterations in phenotype due to pathologies, interventions and treatments. However, it is still unclear how these imaging modalities can be used to study ageing with mice models. Almost all age related pathologies in mice such as osteoporosis, arthritis, diabetes, cancer, thrombi, dementia, to name a few, can be imaged in vivo by at least one longitudinal imaging modality. These measurements are the basis for quantification of treatment effects in the development phase of a novel treatment prior to its clinical testing. Furthermore, the non-invasive nature of such investigations allows the assessment of different tissue and organ phenotypes in the same animal and over time, providing the opportunity to study the dysfunction of multiple tissues associated with the ageing process. This review paper aims to provide an overview of the applications of the most commonly used in vivo imaging modalities used in mouse studies: micro-computed-tomography, preclinical magnetic-resonance-imaging, preclinical positron-emission-tomography, preclinical single photon emission computed tomography, ultrasound, intravital microscopy, and whole body optical imaging.
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Scott BM, Maye J, Jones J, Thomas K, Mangal PC, Trifilio E, Hass C, Marsiske M, Bowers D. Post-exercise pulse pressure is a better predictor of executive function than pre-exercise pulse pressure in cognitively normal older adults. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2016; 23:464-76. [PMID: 26629911 PMCID: PMC4856549 DOI: 10.1080/13825585.2015.1118007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Exercise "stress tests" are widely used to assess cardiovascular function and to detect abnormalities. In line with the view of exercise as a stressor, the present study examined the relationship between cognitive function and cardiovascular activity before and after light physical exercise in a sample of 84 non-demented community-dwelling older adults. Based on known relationships between hypertension, executive function and cerebral white matter changes, we hypothesized that greater post-exercise reactivity, as indexed by higher pulse pressure, would be more related to worse performance on frontal-executive tasks than pre-exercise physiologic measures. All participants were administered a comprehensive neuropsychological battery and underwent a Six Minute Walk Test (6MWT), with blood pressure (BP) measures obtained immediately before and after the walk. Pulse pressure (PP) was derived from BP as an indicator of vascular auto-regulation and composite scores were computed for each cognitive domain assessed. As predicted, worse executive function scores exhibited a stronger relationship with post-exercise PP than pre-exercise PP. Results suggest that PP following system stress in the form of walking may be more reflective of the state of vascular integrity and associated executive dysfunction in older adults than baseline physiologic measures.
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Affiliation(s)
- Bonnie M. Scott
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Jacqueline Maye
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Jacob Jones
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Kelsey Thomas
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Paul C. Mangal
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Erin Trifilio
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Chris Hass
- University of Florida, Department of Applied Physiology and Kinesiology, P.O. Box 118205, Gainesville, Florida, 32611
| | - Michael Marsiske
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
| | - Dawn Bowers
- University of Florida, Department of Clinical and Health Psychology, P.O. Box 100165, Gainesville, Florida, 32610
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Daulatzai MA. Cerebral hypoperfusion and glucose hypometabolism: Key pathophysiological modulators promote neurodegeneration, cognitive impairment, and Alzheimer's disease. J Neurosci Res 2016; 95:943-972. [PMID: 27350397 DOI: 10.1002/jnr.23777] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 02/06/2023]
Abstract
Aging, hypertension, diabetes, hypoxia/obstructive sleep apnea (OSA), obesity, vitamin B12/folate deficiency, depression, and traumatic brain injury synergistically promote diverse pathological mechanisms including cerebral hypoperfusion and glucose hypometabolism. These risk factors trigger neuroinflammation and oxidative-nitrosative stress that in turn decrease nitric oxide and enhance endothelin, Amyloid-β deposition, cerebral amyloid angiopathy, and blood-brain barrier disruption. Proinflammatory cytokines, endothelin-1, and oxidative-nitrosative stress trigger several pathological feedforward and feedback loops. These upstream factors persist in the brain for decades, upregulating amyloid and tau, before the cognitive decline. These cascades lead to neuronal Ca2+ increase, neurodegeneration, cognitive/memory decline, and Alzheimer's disease (AD). However, strategies are available to attenuate cerebral hypoperfusion and glucose hypometabolism and ameliorate cognitive decline. AD is the leading cause of dementia among the elderly. There is significant evidence that pathways involving inflammation and oxidative-nitrosative stress (ONS) play a key pathophysiological role in promoting cognitive dysfunction. Aging and several comorbid conditions mentioned above promote diverse pathologies. These include inflammation, ONS, hypoperfusion, and hypometabolism in the brain. In AD, chronic cerebral hypoperfusion and glucose hypometabolism precede decades before the cognitive decline. These comorbid disease conditions may share and synergistically activate these pathophysiological pathways. Inflammation upregulates cerebrovascular pathology through proinflammatory cytokines, endothelin-1, and nitric oxide (NO). Inflammation-triggered ONS promotes long-term damage involving fatty acids, proteins, DNA, and mitochondria; these amplify and perpetuate several feedforward and feedback pathological loops. The latter includes dysfunctional energy metabolism (compromised mitochondrial ATP production), amyloid-β generation, endothelial dysfunction, and blood-brain-barrier disruption. These lead to decreased cerebral blood flow and chronic cerebral hypoperfusion- that would modulate metabolic dysfunction and neurodegeneration. In essence, hypoperfusion deprives the brain from its two paramount trophic substances, viz., oxygen and nutrients. Consequently, the brain suffers from synaptic dysfunction and neuronal degeneration/loss, leading to both gray and white matter atrophy, cognitive dysfunction, and AD. This Review underscores the importance of treating the above-mentioned comorbid disease conditions to attenuate inflammation and ONS and ameliorate decreased cerebral blood flow and hypometabolism. Additionally, several strategies are described here to control chronic hypoperfusion of the brain and enhance cognition. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE Dept/MSE, The University of Melbourne, Parkville, Victoria, Australia
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Smith CD, Johnson ES, Van Eldik LJ, Jicha GA, Schmitt FA, Nelson PT, Kryscio RJ, Murphy RR, Wellnitz CV. Peripheral (deep) but not periventricular MRI white matter hyperintensities are increased in clinical vascular dementia compared to Alzheimer's disease. Brain Behav 2016; 6:e00438. [PMID: 26925303 PMCID: PMC4754499 DOI: 10.1002/brb3.438] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Vascular dementia (VAD) is a complex diagnosis at times difficult to distinguish from Alzheimer's disease (AD). MRI scans often show white matter hyperintensities (WMH) in both conditions. WMH increase with age, and both VAD and AD are associated with aging, thus presenting an attribution conundrum. In this study, we sought to show whether the amount of WMH in deep white matter (dWMH), versus periventricular white matter (PVH), would aid in the distinction between VAD and AD, independent of age. METHODS Blinded semiquantitative ratings of WMH validated by objective quantitation of WMH volume from standardized MRI image acquisitions. PVH and dWMH were rated separately and independently by two different examiners using the Scheltens scale. Receiver operator characteristic (ROC) curves were generated using logistic regression to assess classification of VAD (13 patients) versus AD (129 patients). Clinical diagnoses were made in a specialty memory disorders clinic. RESULTS Using PVH rating alone, overall classification (area under the ROC curve, AUC) was 75%, due only to the difference in age between VAD and AD patients in our study and not PVH. In contrast, dWMH rating produced 86% classification accuracy with no independent contribution from age. A global Longstreth rating that combines dWMH and PVH gave an 88% AUC. CONCLUSIONS Increased dWMH indicate a higher likelihood of VAD versus AD. Assessment of dWMH on MRI scans using Scheltens and Longstreth scales may aid the clinician in distinguishing the two conditions.
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Affiliation(s)
- Charles D Smith
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Eleanor S Johnson
- Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Linda J Van Eldik
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington Kentucky
| | - Gregory A Jicha
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Frederick A Schmitt
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Peter T Nelson
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Pathology & Laboratory Medicine University of Kentucky College of Medicine Lexington Kentucky
| | - Richard J Kryscio
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Statistics University of Kentucky Lexington Kentucky
| | - Ronan R Murphy
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
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Hughes TM, Sink KM. Hypertension and Its Role in Cognitive Function: Current Evidence and Challenges for the Future. Am J Hypertens 2016; 29:149-57. [PMID: 26563965 DOI: 10.1093/ajh/hpv180] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
This review summarizes evidence from studies of blood pressure and dementia-related biomarkers into our understanding of cognitive health and highlights the challenges facing studies, particularly randomized trials, of hypertension and cognition. Several lines of research suggest that elevated blood pressure, especially at midlife, is associated with cognitive decline and dementia and that treatment of hypertension could prevent these conditions. Further, studies of hypertension and brain structure show that blood pressure is associated with several forms of small vessel disease that can result in vascular dementia or interact with Alzheimer's pathology to lower the pathologic threshold at which Alzheimer's signs and symptoms manifest. In addition, recent studies of hypertension and Alzheimer's biomarkers show that elevated blood pressure and pulse pressure are associated with the extent of brain beta amyloid (Aβ) deposition and altered cerebral spinal fluid profiles of Aβ and tau indicative of Alzheimer's pathology. However, in spite of strong evidence of biological mechanisms, results from randomized trials of antihypertensive therapy for the prevention of cardiovascular or cerebrovascular disease that include cognitive endpoints do not strongly support the observational evidence that treatment of hypertension should be better for cognition. We propose that future clinical trials should consider including dementia biomarkers and assess genetic and cardiometabolic risk factors that have been associated with progression of the underlying disease pathology to help bridge these gaps.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kaycee M Sink
- Department of Internal Medicine, Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Chou PS, Chen CH, Wu MN, Lin YH, Lai CL, Lin RT, Yang YH. Determinants of cerebral white matter changes in patients with stroke. Intern Med J 2016; 45:390-5. [PMID: 25644475 DOI: 10.1111/imj.12704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/28/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND/AIM Cerebral white matter changes (WMC) are commonly observed in magnetic resonance imaging (MRI) scans of elderly people. Information about the prevalence of WMC is limited, and little is known about site-specific risk factors for the subcortical and periventricular regions in patients with ischaemic stroke. The study aims to analyse the prevalence and severity of WMC and investigate the risk factors of periventricular WMC (PVWMC) and deep WMC (DWMC) separately in patients with ischaemic stroke. METHODS The data were collected between January and December 2013 from a medical centre in southern Taiwan. Every patient underwent a cerebral MRI scan, and WMC was separately rated as PVWMC and DWMC by using the modified Fazekas scale. RESULTS In total, 527 patients who had experienced ischaemic stroke were included. The mean age of the patients was 67.0 ± 12.5 years (range: 31-94) and 62% of them were men. The mean age was significantly different among the four grades of severity in both the PVWMC (P < 0.001) and DWMC (P < 0.001) groups after adjustments for sex and vascular risk factors. Hypertension was independently correlated with severity of DWMC (P = 0.032) but not with PVWMC (P = 0.222). In multiple logistic regressions model, hypertension was a significant independent indicator of DWMC (odds ratio = 4.30; 95% confidence interval = 1.70-10.89). CONCLUSION Our results suggest a region-specific pathogenesis of cerebral white matter in Asian patients with ischaemic stroke that may differ from those in the general population.
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Affiliation(s)
- P-S Chou
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Khalaf A, Edelman K, Tudorascu D, Andreescu C, Reynolds CF, Aizenstein H. White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression. Neuropsychopharmacology 2015; 40:3027-35. [PMID: 26058663 PMCID: PMC4864637 DOI: 10.1038/npp.2015.158] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/26/2015] [Accepted: 05/30/2015] [Indexed: 12/19/2022]
Abstract
White matter hyperintensities (WMHs) have been shown to be associated with the development of late-life depression (LLD) and eventual treatment outcomes. This study sought to investigate longitudinal WMH changes in patients with LLD during a 12-week antidepressant treatment course. Forty-seven depressed elderly patients were included in this analysis. All depressed subjects started pharmacological treatment for depression shortly after a baseline magnetic resonance imaging (MRI) scan. At 12 weeks, patients underwent a follow-up MRI scan, and were categorized as either treatment remitters (n=23) or non-remitters (n=24). Among all patients, there was as a significant increase in WMHs over 12 weeks (t(46)=2.36, P=0.02). When patients were stratified by remission status, non-remitters demonstrated a significant increase in WMHs (t(23)=2.17, P=0.04), but this was not observed in remitters (t(22)=1.09, P=0.29). Other markers of brain integrity were also investigated including whole brain gray matter volume, hippocampal volume, and fractional anisotropy. No significant differences were observed in any of these markers during treatment, including when patients were stratified based on remission status. These results add to existing literature showing the association between WMH accumulation and LLD treatment outcomes. Moreover, this is the first study to demonstrate similar findings over a short interval (ie 12 weeks), which corresponds to the typical length of an antidepressant trial. These findings serve to highlight the acute interplay of cerebrovascular ischemic disease and LLD.
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Affiliation(s)
- Alexander Khalaf
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn Edelman
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana Tudorascu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen Andreescu
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles F Reynolds
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard Aizenstein
- Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA,Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Room 459, Pittsburgh, PA 15213, USA, Tel: +1 412 246 5464, Fax: + 1 412 586 9111, E-mail:
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Loos CMJ, Klarenbeek P, van Oostenbrugge RJ, Staals J. Association between Perivascular Spaces and Progression of White Matter Hyperintensities in Lacunar Stroke Patients. PLoS One 2015; 10:e0137323. [PMID: 26352265 PMCID: PMC4564273 DOI: 10.1371/journal.pone.0137323] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/16/2015] [Indexed: 12/11/2022] Open
Abstract
Objectives Perivascular spaces are associated with MRI markers of cerebral small vessel disease, including white matter hyperintensities. Although perivascular spaces are considered to be an early MRI marker of cerebral small vessel disease, it is unknown whether they are associated with further progression of MRI markers, especially white matter hyperintensities. We determined the association between perivascular spaces and progression of white matter hyperintensities after 2-year follow-up in lacunar stroke patients. Methods In 118 lacunar stroke patients we obtained brain MRI and 24-hour ambulatory blood pressure measurements at baseline, and a follow-up brain MRI 2 years later. We visually graded perivascular spaces and white matter hyperintensities at baseline. Progression of white matter hyperintensities was assessed using a visual white matter hyperintensity change scale. Associations with white matter hyperintensity progression were tested with binary logistic regression analysis. Results Extensive basal ganglia perivascular spaces were associated with progression of white matter hyperintensities (OR 4.29; 95% CI: 1.28–14.32; p<0.05), after adjustment for age, gender, 24-hour blood pressure and vascular risk factors. This association lost significance after additional adjustment for baseline white matter hyperintensities. Centrum semiovale perivascular spaces were not associated with progression of white matter hyperintensities. Conclusions Our study shows that extensive basal ganglia perivascular spaces are associated with progression of white matter hyperintensities in cerebral small vessel disease. However, this association was not independent of baseline white matter hyperintensities. Therefore, presence of white matter hyperintensities at baseline remains an important determinant of further progression of white matter hyperintensities in cerebral small vessel disease.
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Affiliation(s)
- Caroline M. J. Loos
- Department of Neurology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands
- * E-mail:
| | - Pim Klarenbeek
- Department of Neurology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Robert J. van Oostenbrugge
- Department of Neurology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands
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Del Bene A, Ciolli L, Borgheresi L, Poggesi A, Inzitari D, Pantoni L. Is type 2 diabetes related to leukoaraiosis? an updated review. Acta Neurol Scand 2015; 132:147-55. [PMID: 25772411 DOI: 10.1111/ane.12398] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 02/04/2023]
Abstract
A significantly increased interest has been dedicated to the study of the effects of diabetes mellitus (DM) on the brain. DM is associated with an increased risk of stroke and cognitive decline. In patients with DM, neuroimaging discloses with high-frequency structural changes, such as cerebral atrophy, infarcts and white matter lesions, also called leukoaraiosis (LA), an expression of small vessel disease. A previous review showed a relation between DM and both cerebral atrophy and lacunar infarcts, while the question about the relation between DM and LA remained unanswered. In this review, we provide an update on data on this last association. In the reviewed studies, we examined the presence of DM, other disease characteristics, such as duration and complications, and laboratory markers of the disease such as blood glycated hemoglobin (HbA1c), insulin resistance, insulin concentrations and their association with LA. About 40% of the reviewed studies reported a statistically significant association between DM and LA. Long-standing DM and a poor glycemic control were associated with severe LA. Studies using innovative MRI techniques, such as diffusion tensor imaging (DTI), reported a significant association between microstructural white matter alterations and DM. This review highlights more firmly than previously reported the existence of a relation between DM and both presence and severity of LA. These results are possibly due to more sensitive and advanced imaging techniques recently used to study the extent of LA. However, because of the heterogeneous methodology used in the reviewed studies, a definitive conclusion cannot be drawn.
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Affiliation(s)
- A. Del Bene
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - L. Ciolli
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - L. Borgheresi
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - A. Poggesi
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - D. Inzitari
- NEUROFARBA Department; Neuroscience Section; University of Florence; Florence Italy
| | - L. Pantoni
- Stroke Unit and Neurology; Azienda Ospedaliero Universitaria Careggi; Florence Italy
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Foster-Dingley JC, van der Grond J, Moonen JEF, van den Berg-Huijsmans AA, de Ruijter W, van Buchem MA, de Craen AJM, van der Mast RC. Lower Blood Pressure Is Associated With Smaller Subcortical Brain Volumes in Older Persons. Am J Hypertens 2015; 28:1127-33. [PMID: 25714132 DOI: 10.1093/ajh/hpv006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both high and low blood pressure (BP) have been positively as well as negatively associated with brain volumes in a variety of populations. The objective of this study was to investigate whether BP is associated with cortical and subcortical brain volumes in older old persons with mild cognitive deficits. METHODS Within the Discontinuation of Antihypertensive Treatment in the Elderly trial, the cross-sectional relation of BP parameters with both cortical and subcortical brain volumes was investigated in 220 older old persons with mild cognitive deficits (43% men, mean age = 80.7 (SD = 4.1), median Mini-Mental State Examination score = 26 (interquartile range: 25-27)), using linear regression analysis. All analyses were adjusted for age, gender, volume of white matter hyperintensities, and duration of antihypertensive treatment. Brain volumes were determined on 3DT1-weighted brain magnetic resonance imaging scans. RESULTS Lower systolic BP, diastolic BP, and mean arterial pressure (MAP) were significantly associated with lower volumes of thalamus and putamen (all P ≤ 0.01). In addition, lower MAP was also associated with reduced hippocampal volume (P = 0.035). There were no associations between any of the BP parameters with cortical gray matter or white matter volume. CONCLUSION In an older population using antihypertensive medication with mild cognitive deficits, a lower BP, rather than a high BP is associated with reduced volumes of thalamus, putamen, and hippocampus.
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Affiliation(s)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Justine E F Moonen
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Wouter de Ruijter
- Department of Public health and Primary care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Janowitz D, Wittfeld K, Terock J, Freyberger HJ, Hegenscheid K, Völzke H, Habes M, Hosten N, Friedrich N, Nauck M, Domanska G, Grabe HJ. Association between waist circumference and gray matter volume in 2344 individuals from two adult community-based samples. Neuroimage 2015; 122:149-57. [PMID: 26256530 DOI: 10.1016/j.neuroimage.2015.07.086] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 01/22/2023] Open
Abstract
We analyzed the putative association between abdominal obesity (measured in waist circumference) and gray matter volume (Study of Health in Pomerania: SHIP-2, N=758) adjusted for age and gender by applying volumetric analysis and voxel-based morphometry (VBM) with VBM8 to brain magnetic resonance (MR) imaging. We sought replication in a second, independent population sample (SHIP-TREND, N=1586). In a combined analysis (SHIP-2 and SHIP-TREND) we investigated the impact of hypertension, type II diabetes and blood lipids on the association between waist circumference and gray matter. Volumetric analysis revealed a significant inverse association between waist circumference and gray matter volume. VBM in SHIP-2 indicated distinct inverse associations in the following structures for both hemispheres: frontal lobe, temporal lobes, pre- and postcentral gyrus, supplementary motor area, supramarginal gyrus, insula, cingulate gyrus, caudate nucleus, olfactory sulcus, para-/hippocampus, gyrus rectus, amygdala, globus pallidus, putamen, cerebellum, fusiform and lingual gyrus, (pre-) cuneus and thalamus. These areas were replicated in SHIP-TREND. More than 76% of the voxels with significant gray matter volume reduction in SHIP-2 were also distinct in TREND. These brain areas are involved in cognition, attention to interoceptive signals as satiety or reward and control food intake. Due to our cross-sectional design we cannot clarify the causal direction of the association. However, previous studies described an association between subjects with higher waist circumference and future cognitive decline suggesting a progressive brain alteration in obese subjects. Pathomechanisms may involve chronic inflammation, increased oxidative stress or cellular autophagy associated with obesity.
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Affiliation(s)
- Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany.
| | - Katharina Wittfeld
- German Center for Neurodegenerative Diseases DZNE, Site Rostock/Greifswald, Germany
| | - Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hospital Stralsund, Germany
| | - Harald Jürgen Freyberger
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hospital Stralsund, Germany
| | - Katrin Hegenscheid
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Mohamad Habes
- Institute for Community Medicine, University Medicine Greifswald, Germany; Section of Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Grazyna Domanska
- Department of Immunology, University Medicine Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany; German Center for Neurodegenerative Diseases DZNE, Site Rostock/Greifswald, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Hospital Stralsund, Germany
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Gonzalez CE, Pacheco J, Beason-Held LL, Resnick SM. Longitudinal changes in cortical thinning associated with hypertension. J Hypertens 2015; 33:1242-8. [PMID: 25693060 PMCID: PMC5912213 DOI: 10.1097/hjh.0000000000000531] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cross-sectional studies of the association between hypertension (HTN) and brain atrophy have shown reductions in prefrontal, temporal, and hippocampal volumes, and have identified thinner cortices across the cortical mantle. METHOD In the current study, we followed 96 participants enrolled in the Baltimore Longitudinal Study of Aging over a mean interval of 8 years (mean age at baseline = 68.7) and compared those who are hypertensive (n = 49) throughout the study with those who are normotensive (n = 47). RESULTS Hypertensive individuals show an increased rate of thinning compared with normotensive individuals in several regions, including the frontomarginal gyrus in the left hemisphere, and the superior temporal, fusiform, and lateral orbitofrontal cortex in the right hemisphere. We also investigated the effects of midlife blood pressure (BP), intervisit variability in BP prior to imaging, and duration of HTN on areas that show subsequent differences in the rates of cortical thinning between groups. We found that higher midlife BP and longer durations of HTN predicted a higher rate of thinning in the right superior temporal gyrus. We also found that greater variability in SBP but not DBP predicted a higher rate of thinning in the right superior temporal gyrus, frontomarginal gyrus, and occipital pole. CONCLUSION These findings demonstrate that hypertensive individuals show increased rates of thinning compared with normotensive individuals and suggest intervisit BP variability and midlife BP contribute to these longitudinal differences.
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Affiliation(s)
- Christopher E Gonzalez
- aLaboratory of Behavioral Neuroscience, National Institute on Aging, NIH, Baltimore bNational Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Nunley KA, Ryan CM, Orchard TJ, Aizenstein HJ, Jennings JR, Ryan J, Zgibor JC, Boudreau RM, Costacou T, Maynard JD, Miller RG, Rosano C. White matter hyperintensities in middle-aged adults with childhood-onset type 1 diabetes. Neurology 2015; 84:2062-9. [PMID: 25904692 PMCID: PMC4442104 DOI: 10.1212/wnl.0000000000001582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 02/06/2015] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Although microvascular complications are common in type 1 diabetes mellitus (T1DM), few studies have quantified the severity, risk factors, and implications of cerebral microvascular damage in these patients. As life expectancy in patients with T1DM increases, patients are exposed to age- and disease-related factors that may contribute to cerebral microvascular disease. METHODS Severity and volume of white matter hyperintensities (WMH) and infarcts were quantified in 97 middle-aged patients with childhood-onset T1DM (mean age and duration: 50 and 41 years, respectively) and 81 non-T1DM adults (mean age: 48 years), concurrent with cognitive and health-related measures. RESULTS Compared with non-T1DM participants, patients had more severe WMH (Fazekas scores 2 and 3 compared with Fazekas score 1, p < 0.0001) and slower information processing (digit symbol substitution, number correct: 65.7 ± 10.9 and 54.9 ± 13.6; pegboard, seconds: 66.0 ± 9.9 and 88.5 ± 34.2; both p < 0.0001) independent of age, education, or other factors. WMH were associated with slower information processing; adjusting for WMH attenuated the group differences in processing speed (13% for digit symbol, 11% for pegboard, both p ≤ 0.05). Among patients, prevalent neuropathies and smoking tripled the odds of high WMH burden, independent of age or disease duration. Associations between measures of blood pressure or hyperglycemia and WMH were not significant. CONCLUSIONS Clinically relevant WMH are evident earlier among middle-aged patients with childhood-onset T1DM and are related to the slower information processing frequently observed in T1DM. Brain imaging in patients with T1DM who have cognitive difficulties, especially those with neuropathies, may help uncover cerebral microvascular damage. Longitudinal studies are warranted to fully characterize WMH development, risk factors, and long-term effects on cognition.
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Affiliation(s)
- Karen A Nunley
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Christopher M Ryan
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Trevor J Orchard
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Howard J Aizenstein
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - J Richard Jennings
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - John Ryan
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Janice C Zgibor
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Robert M Boudreau
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Tina Costacou
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - John D Maynard
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Rachel G Miller
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM
| | - Caterina Rosano
- From the Department of Epidemiology, Graduate School of Public Health (K.A.N., T.J.O., J.C.Z., R.M.B., T.C., R.G.M., C.R.) and Department of Psychiatry, School of Medicine (C.M.R., H.J.A., J.R.J., J.R.), University of Pittsburgh, Pittsburgh, PA; and VeraLight Inc. (J.D.M.), Albuquerque, NM.
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Allan CL, Zsoldos E, Filippini N, Sexton CE, Topiwala A, Valkanova V, Singh-Manoux A, Tabák AG, Shipley MJ, Mackay C, Ebmeier KP, Kivimäki M. Lifetime hypertension as a predictor of brain structure in older adults: cohort study with a 28-year follow-up. Br J Psychiatry 2015; 206:308-15. [PMID: 25497301 PMCID: PMC4381190 DOI: 10.1192/bjp.bp.114.153536] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/23/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hypertension is associated with an increased risk of dementia and depression with uncertain longitudinal associations with brain structure. AIMS To examine lifetime blood pressure as a predictor of brain structure in old age. METHOD A total of 190 participants (mean age 69.3 years) from the Whitehall II study were screened for hypertension six times (1985-2013). In 2012-2013, participants had a 3T-magnetic resonance imaging (MRI) brain scan. Data from the MRI were analysed using automated and visual measures of global atrophy, hippocampal atrophy and white matter hyperintensities. RESULTS Longitudinally, higher mean arterial pressure predicted increased automated white matter hyperintensities (P<0.002). Cross-sectionally, hypertensive participants had increased automated white matter hyperintensities and visually rated deep white matter hyperintensities. There was no significant association with global or hippocampal atrophy. CONCLUSIONS Long-term exposure to high blood pressure predicts hyperintensities, particularly in deep white matter. The greatest changes are seen in those with severe forms of hypertension, suggesting a dose-response pattern.
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Macro- and micro-structural white matter differences correlate with cognitive performance in healthy aging. Brain Imaging Behav 2015; 10:168-81. [DOI: 10.1007/s11682-015-9378-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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69
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De Ciuceis C, Cornali C, Porteri E, Mardighian D, Pinardi C, Fontanella MM, Rodella LF, Rezzani R, Rizzoni D, Boari GEM, Rosei EA, Gasparotti R. Cerebral small-resistance artery structure and cerebral blood flow in normotensive subjects and hypertensive patients. Neuroradiology 2014; 56:1103-11. [PMID: 25204449 DOI: 10.1007/s00234-014-1423-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to prospectively investigate whether the structure of cerebral small-resistance arteries is related to cerebral perfusion parameters as measured with dynamic susceptibility-weighted contrast magnetic resonance imaging (DSC-MRI) in a selected cohort of hypertensive and normotensive patients. METHODS Ten hypertensive and 10 normotensive patients were included in the study. All patients underwent neurosurgical intervention for an intracranial tumor and were investigated with DSC-MRI at 1.5 T. Cerebral small-resistance arteries were dissected from a small portion of morphologically normal cerebral tissue and mounted on an isometric myograph for the measurement of the media-to-lumen (M/L) ratio. A quantitative assessment of cerebral blood flow (CBF) and volume (CBV) was performed with a region-of-interest approach. Correlation coefficients were calculated for normally distributed variables. The institutional review board approved the study, and informed consent was obtained from all patients. RESULTS Compared with normotensive subjects, hypertensive patients had significantly lower regional CBF (mL/100 g/min) in the cortical grey matter (55.63 ± 1.90 vs 58.37 ± 2.19, p < 0.05), basal ganglia (53.34 ± 4.39 vs 58.22. ± 4.33, p < 0.05), thalami (50.65 ± 3.23 vs 57.56 ± 4.45, p < 0.01), subcortical white matter (19.32 ± 2.54 vs 22.24 ± 1.9, p < 0.05), greater M/L ratio (0.099 ± 0.013 vs 0.085 ± 0.012, p < 0.05), and lower microvessel density (1.66 ± 0.67 vs 2.52 ± 1.28, p < 0.05). A statistically significant negative correlation was observed between M/L ratio of cerebral arteries and CBF in the cortical grey matter (r = -0.516, p < 0.05), basal ganglia (r = -0.521, p < 0.05), thalami (r = -0.527 p < 0.05), and subcortical white matter (r = -0.612, p < 0.01). CONCLUSION Our results indicate that microvascular structure might play a role in controlling CBF, with possible clinical consequences.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Alosco ML, Gunstad J, Xu X, Clark US, Labbe DR, Riskin-Jones HH, Terrero G, Schwarz NF, Walsh EG, Poppas A, Cohen RA, Sweet LH. The impact of hypertension on cerebral perfusion and cortical thickness in older adults. ACTA ACUST UNITED AC 2014; 8:561-70. [PMID: 25151318 DOI: 10.1016/j.jash.2014.04.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/23/2014] [Accepted: 04/07/2014] [Indexed: 12/25/2022]
Abstract
Hypertension may increase risk for dementia possibly because of its association with decreased cortical thickness. Disturbed cerebral autoregulation is one plausible mechanism by which hypertension impacts the cerebral structure, but the associations among hypertension, brain perfusion, and cortical thickness are poorly understood. The current sample consisted of 58 older adults with varying levels of vascular disease. Diagnostic history of hypertension and antihypertensive medication status was ascertained through self-report, and when available, confirmed by medical record review. All participants underwent arterial spin labeling and T1-weighted magnetic resonance imaging to quantify total and regional cortical perfusion and thickness. Analysis of covariance adjusting for medical variables showed that participants with hypertension exhibited reduced temporal and occipital brain perfusion and total and regional cortical thickness relative to those without hypertension. The effects of hypertension on total brain perfusion remained unchanged even after adjustment for age, although no such pattern emerged for cortical thickness. Decreased total brain perfusion predicted reduced thickness of the total brain and of the frontal, temporal, and parietal lobe cortices. Antihypertensive treatment was not associated with total cerebral perfusion or cortical thickness. This study provides initial evidence for the adverse effects of a diagnostic history of hypertension on brain hypoperfusion and reduced cortical thickness. Longitudinal studies are needed to investigate the role of hypertension and its interaction with other contributing factors (e.g., age) in the manifestation of cerebral hypoperfusion and reduced cortical thickness.
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Affiliation(s)
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Uraina S Clark
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donald R Labbe
- Alpert Medical School of Brown University, the Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Hannah H Riskin-Jones
- Brain Behavior and Aging Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gretel Terrero
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Edward G Walsh
- Brown University, Departments of Neuroscience and Diagnostic Imaging., Providence, RI, USA
| | - Athena Poppas
- Alpert Medical School of Brown University, Department of Medicine, Providence, RI, USA
| | - Ronald A Cohen
- Cognitive Aging and Memory Program, Clinical Translational Research Program, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Lawrence H Sweet
- Alpert Medical School of Brown University, the Department of Psychiatry and Human Behavior, Providence, RI, USA; Department of Psychology, University of Georgia, Athens, GA, USA
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Longitudinal changes in brain volumes and cerebrovascular lesions on MRI in patients with manifest arterial disease: The SMART-MR study. J Neurol Sci 2014; 337:112-8. [DOI: 10.1016/j.jns.2013.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/04/2013] [Accepted: 11/19/2013] [Indexed: 12/28/2022]
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Wang R, Fratiglioni L, Laveskog A, Kalpouzos G, Ehrenkrona CH, Zhang Y, Bronge L, Wahlund LO, Bäckman L, Qiu C. Do cardiovascular risk factors explain the link between white matter hyperintensities and brain volumes in old age? A population-based study. Eur J Neurol 2013; 21:1076-1082. [PMID: 24313901 DOI: 10.1111/ene.12319] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMHs) and brain atrophy frequently coexist in older people. However, it is unclear whether the association between these two brain lesions is dependent on the aging process, a vascular mechanism or genetic susceptibility. It was therefore investigated whether the association between load of WMHs and brain atrophy measures is related to age, vascular risk factors (VRFs) or the APOE-ε4 allele. METHODS This population-based study included 492 participants (age ≥60 years, 59.6% women) free of dementia and stroke. Data on demographics, VRFs and APOE genotypes were collected through interviews, clinical examination and laboratory tests. WMHs on magnetic resonance images were assessed using manual visual rating and automatic volumetric segmentation. Hippocampal and ventricular volumes were manually delineated, whereas total gray matter (GM) volume was measured by automatic segmentation. Data were analyzed with multivariate linear regression models. RESULTS More global WMHs, assessed using either a visual rating scale or a volumetric approach, were significantly associated with lower GM volume and higher ventricular volume; the associations remained significant after adjusting for age, VRFs and the APOE-ε4 allele. In contrast, the association between global WMHs and hippocampal volume was no longer significant after adjusting for age, whereas adjustment for VRFs and APOE-ε4 had no influential effect. CONCLUSION The association of global WMHs with lower GM volume and higher ventricular volume is independent of age, VRFs and APOE-ε4 allele, suggesting that the process of cerebral microvascular disease and neurodegeneration are associated independently of the normal aging process, vascular mechanisms or genetic susceptibility.
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Affiliation(s)
- R Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden
| | - L Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - A Laveskog
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, KI, Stockholm, Sweden
| | - G Kalpouzos
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden
| | - C-H Ehrenkrona
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden
| | - Y Zhang
- Department of Diagnostic Radiology, Radiation Sciences, Umeå University, Umeå, Sweden
| | - L Bronge
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, KI, Stockholm, Sweden
| | - L-O Wahlund
- Division of Clinical Geriatrics, NVS, Karolinska University Hospital at Huddinge, Stockholm, Sweden
| | - L Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - C Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet (KI) - Stockholm University, Stockholm, Sweden
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Sato N, Morishita R. Roles of vascular and metabolic components in cognitive dysfunction of Alzheimer disease: short- and long-term modification by non-genetic risk factors. Front Aging Neurosci 2013; 5:64. [PMID: 24204343 PMCID: PMC3817366 DOI: 10.3389/fnagi.2013.00064] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 10/08/2013] [Indexed: 01/09/2023] Open
Abstract
It is well known that a specific set of genetic and non-genetic risk factors contributes to the onset of Alzheimer disease (AD). Non-genetic risk factors include diabetes, hypertension in mid-life, and probably dyslipidemia in mid-life. This review focuses on the vascular and metabolic components of non-genetic risk factors. The mechanisms whereby non-genetic risk factors modify cognitive dysfunction are divided into four components, short- and long-term effects of vascular and metabolic factors. These consist of (1) compromised vascular reactivity, (2) vascular lesions, (3) hypo/hyperglycemia, and (4) exacerbated AD histopathological features, respectively. Vascular factors compromise cerebrovascular reactivity in response to neuronal activity and also cause irreversible vascular lesions. On the other hand, representative short-term effects of metabolic factors on cognitive dysfunction occur due to hypoglycemia or hyperglycemia. Non-genetic risk factors also modify the pathological manifestations of AD in the long-term. Therefore, vascular and metabolic factors contribute to aggravation of cognitive dysfunction in AD through short-term and long-term effects. β-amyloid could be involved in both vascular and metabolic components. It might be beneficial to support treatment in AD patients by appropriate therapeutic management of non-genetic risk factors, considering the contributions of these four elements to the manifestation of cognitive dysfunction in individual patients, though all components are not always present. It should be clarified how these four components interact with each other. To answer this question, a clinical prospective study that follows up clinical features with respect to these four components: (1) functional MRI or SPECT for cerebrovascular reactivity, (2) MRI for ischemic lesions and atrophy, (3) clinical episodes of hypoglycemia and hyperglycemia, (4) amyloid-PET and tau-PET for pathological features of AD, would be required.
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Affiliation(s)
- Naoyuki Sato
- Department of Clinical Gene Therapy, Graduate School of Medicine, Osaka University Osaka, Japan ; Department of Geriatric Medicine, Graduate School of Medicine, Osaka University Osaka, Japan
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Daulatzai MA. Neurotoxic Saboteurs: Straws that Break the Hippo’s (Hippocampus) Back Drive Cognitive Impairment and Alzheimer’s Disease. Neurotox Res 2013; 24:407-59. [DOI: 10.1007/s12640-013-9407-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 12/29/2022]
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Verhaaren BF, Vernooij MW, de Boer R, Hofman A, Niessen WJ, van der Lugt A, Ikram MA. High Blood Pressure and Cerebral White Matter Lesion Progression in the General Population. Hypertension 2013; 61:1354-9. [PMID: 23529163 DOI: 10.1161/hypertensionaha.111.00430] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High blood pressure is considered an important risk factor for cerebral white matter lesions (WMLs) in the aging population. In a longitudinal population-based study of 665 nondemented persons, we investigated the longitudinal relationship of systolic blood pressure, diastolic blood pressure, and pulse pressure with annual progression of WMLs. Means of blood pressure were calculated over a 5-year period before longitudinal MRI scanning. WML progression was subsequently measured on 2 scans 3.5 years apart. We performed analyses with linear regression models and evaluated adjustments for age, sex, cardiovascular risk factors, and baseline WML volume. In addition, we evaluated whether treatment of hypertension is related to less WML progression. Both systolic and diastolic blood pressures were significantly associated with annual WML progression (regression coefficient [95% confidence interval], 0.08 [0.03; 0.14] mL/y and 0.09 [0.03; 0.15] mL/y per SD increase in systolic and diastolic blood pressure, respectively). Pulse pressure was also significantly associated with WML progression, but not independent from hypertension. After adjustment for baseline WML volume, only systolic blood pressure remained significantly associated: 0.05 (0.00; 0.09) mL/y per SD increase. People with uncontrolled untreated hypertension had significantly more WML progression than people with uncontrolled treated hypertension (difference [95% confidence interval], 0.12 [0.00; 0.23] mL/y). The present study further establishes high blood pressure to precede WMLs and implies that hypertension treatment could reduce WML progression in the general population.
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Affiliation(s)
- Benjamin F.J. Verhaaren
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - Meike W. Vernooij
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - Renske de Boer
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - Albert Hofman
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - Wiro J. Niessen
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
| | - M. Arfan Ikram
- From the Departments of Epidemiology (B.F.J.V., M.W.V., A.H., M.A.I.), Radiology (B.F.J.V., M.W.V., R.d.B., W.J.N., A.v.de.L., M.A.I.), and Medical Informatics (R.d.B., W.J.N.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; and Faculty of Applied Sciences, University of Technology, Delft, The Netherlands (W.J.N.)
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Tam AKH, Kapadia A, Ilodigwe D, Li Z, Schweizer TA, Macdonald RL. Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage. J Neurosurg 2013; 119:198-206. [PMID: 23662822 DOI: 10.3171/2013.3.jns121950] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Atrophy in specific brain areas correlates with poor neuropsychological outcome after subarachnoid hemorrhage (SAH). Few studies have compared global atrophy in SAH with outcome. The authors examined the relationship between global brain atrophy, clinical factors, and outcome after SAH. METHODS This study was a post hoc exploratory analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial, a randomized, double-blind, placebo-controlled trial of 413 patients with aneurysmal SAH. Patients with infarctions or areas of encephalomalacia on CT, and those with large clip/coil artifacts, were excluded. The 97 remaining patients underwent CT at baseline and 6 weeks, which was analyzed using voxel-based volumetric measurements. The percentage difference in volume between time points was compared against clinical variables. The relationship with clinical outcome was modeled using univariate and multivariate analysis. RESULTS Older age, male sex, and systemic inflammatory response syndrome (SIRS) during intensive care stay were significantly associated with brain atrophy. Greater brain atrophy was significantly associated with poor outcome on the modified Rankin scale (mRS), severity of deficits on the National Institutes of Health Stroke Scale (NIHSS), worse executive functioning, and lower EuroQol Group-5D (EQ-5D) score. Adjusted for confounders, brain atrophy was not significantly associated with Mini-Mental State Examination and Functional Status Examination scores. Brain atrophy was not associated with angiographic vasospasm or delayed ischemic neurological deficit. CONCLUSIONS Worse mRS score, NIHSS score, executive functioning, and EQ-5D scores were associated with greater brain atrophy and older age, male sex, and SIRS burden. These data suggest outcome is associated with factors that cause global brain injury independent of focal brain injury.
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Affiliation(s)
- Alan K H Tam
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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White matter hyperintensity burden and disability in older adults: is chronic pain a contributor? PM R 2013; 5:471-80; quiz 480. [PMID: 23474209 DOI: 10.1016/j.pmrj.2013.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To primarily explore differences in global and regional white matter hyperintensities (WMH) in older adults with self-reported disabling and nondisabling chronic low back pain (CLBP) and to examine the association of WMH with gait speed in all participants with CLBP. To secondarily compare WMH of the participants with CLBP with the pain-free controls. DESIGN A cross-sectional, case-control study. SETTING University of Pittsburgh. PARTICIPANTS Twenty-four community-dwelling older adults: 8 with self-reported disabling CLBP, 8 with nondisabling CLBP, and 8 were pain-free. Exclusions were psychiatric or neurologic disorders (either central or peripheral), substance abuse, opioid use, or diabetes mellitus. METHODS All participants underwent structural brain magnetic resonance imaging, and all participants with CLBP underwent the 4-m walk test. MAIN OUTCOME MEASUREMENTS All the participants were assessed for both global and regional WMH by using an automated localization and segmentation method, and gait speed of participants with CLBP. RESULTS The disabled group demonstrated statistically significant regional WMH in a number of left hemispheric tracts: anterior thalamic radiation (P = .0391), lower cingulate (P = .0336), inferior longitudinal fasciculus (P = .0367), superior longitudinal fasciculus (P = .0011), and the superior longitudinal fasciculus branch to the temporal lobe (P = .0072). Also, there was a statistically significant negative association (rs = -0.57; P = .0225) between the left lower cingulate WMH and the gait speed in all the participants with CLBP. There was a statistical difference in global WMH burden (P = .0014) and nearly all regional tracts (both left and right hemispheres) when comparing CLBP with pain-free participants. CONCLUSIONS Our findings suggest that WMH is associated with, and hence, may be accelerated by chronic pain manifesting as perceived disability, given the self-reported disabled CLBP patients had the greatest burden, and the pain free the least, and manifesting as measurable disability, given increasing WMH was associated with decreasing gait speed in all chronic pain participants.
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79
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Valkanova V, Ebmeier KP. Vascular risk factors and depression in later life: a systematic review and meta-analysis. Biol Psychiatry 2013; 73:406-13. [PMID: 23237315 DOI: 10.1016/j.biopsych.2012.10.028] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/22/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years; 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27-1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99-1.57), hypertension (OR: 1.14; 95% CI: .94-1.40), or dyslipidemia (OR: 1.08; 95% CI: .91-1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00-1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30-1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52-2.04), and stroke (OR: 2.11; 95% CI: 1.61-2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.
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Affiliation(s)
- Vyara Valkanova
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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80
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Murray AD, Staff RT, McNeil CJ, Salarirad S, Phillips LH, Starr J, Deary IJ, Whalley LJ. Depressive symptoms in late life and cerebrovascular disease: the importance of intelligence and lesion location. Depress Anxiety 2013; 30:77-84. [PMID: 23165823 DOI: 10.1002/da.22022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/03/2012] [Accepted: 10/12/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The influence of white matter lesions on depressive symptoms in healthy ageing populations remains unclear. In this study, we examined the relationship between depressive symptoms and magnetic resonance imaging (MRI) detected cerebrovascular disease in a normal population living independently in the community, and measured the influence of location of brain abnormalities, fluid intelligence, living alone, and sex. METHODS Prospective cohort: 497 community dwelling individuals all born in 1936, who took part in the Scottish Mental Survey of 1947, were followed up in 2000 and at biannual intervals in a longitudinal study of health and cognitive aging. Two hundred forty-four volunteered for brain MRI in 2004-2006. Suitable data were available in 219/244, of whom 115 were men. Brain hyperintensities in lobar white matter, basal ganglia , periventricular, and infratentorial regions were measured using Scheltens' scale. Depressed mood was assessed using the Hospital Anxiety and Depression Scale (HADS) on three biannual intervals. Relationships between Scheltens' scores, HADS-D scores, fluid intelligence, living alone, and sex were assessed using general linear modeling. RESULTS The main predictor of depressive symptom scores was poorer fluid intelligence (partial η(2) =0.023-0.028, P < .05). Ischemic change in the brainstem (partial η(2) = 0.026, P ≤.05) and basal ganglia (partial η(2) =0.018, P ≤ .05) also predicted HADS-D scores. There was no relationship with sex or living alone. CONCLUSIONS Hyperintensities in the brainstem and basal ganglia are associated with depressive symptoms. Higher fluid intelligence is associated with lower depressive symptoms in this normal, ageing population.
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Affiliation(s)
- Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, Scotland, UK.
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81
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Macey PM, Kumar R, Yan-Go FL, Woo MA, Harper RM. Sex differences in white matter alterations accompanying obstructive sleep apnea. Sleep 2012. [PMID: 23204603 DOI: 10.5665/sleep.2228] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
STUDY OBJECTIVES Females with obstructive sleep apnea (OSA) show different psychological and physiological symptoms from males, which may be associated with sex-related variations in neural injury occurring with the disorder. To determine whether male- or female-specific brain injury is present in OSA, we assessed influences of sex on white matter changes in the condition. DESIGN Two-group factorial. SETTING University medical center. PATIENTS OR PARTICIPANTS 80 subjects total, with newly diagnosed, untreated OSA groups of 10 female (age mean ± SE: 52.6 ± 2.4 years, AHI 22.5 ± 4.1 events/h) and 20 male (age 48.9 ± 1.7, AHI 25.5 ± 2.9) patients, and 20 female (age 50.3 ± 1.7) and 30 male (age 49.2 ± 1.4) healthy control subjects. INTERVENTIONS None. MEASUREMENTS AND RESULTS Brain fiber integrity was assessed with fractional anisotropy (FA), a diffusion tensor imaging-derived measure. Sleep quality, daytime sleepiness, depression, and anxiety were assessed with questionnaires. We identified regions of differing injury in male versus female OSA patients by assessing brain regions with significant interaction effects of OSA and sex on FA. Areas of sex-specific, OSA-related FA reductions appeared in females relative to males, including in the bilateral cingulum bundle adjacent to the mid hippocampus, right stria terminalis near the amygdala, prefrontal and posterior-parietal white matter, corpus callosum, and left superior cerebellar peduncle. Females with OSA showed higher daytime sleepiness, anxiety and depression levels, and reduced sleep quality. CONCLUSIONS Sex differences in white matter structural integrity appeared in OSA patients, with females more affected than males. These female-specific structural changes may contribute to or derive from neuropsychological and physiological symptom differences between sexes.
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Affiliation(s)
- Paul M Macey
- School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095-1702, USA
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82
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Rosano C, Watson N, Chang Y, Newman AB, Aizenstein HJ, Du Y, Venkatraman V, Harris TB, Barinas-Mitchell E, Sutton-Tyrrell K. Aortic pulse wave velocity predicts focal white matter hyperintensities in a biracial cohort of older adults. Hypertension 2012; 61:160-5. [PMID: 23172923 DOI: 10.1161/hypertensionaha.112.198069] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the cross-sectional relationship of arterial stiffness with cerebral small vessel disease is consistently shown in middle-aged and young-old adults, it is less clear whether these associations remain significant over time in very old adults. We hypothesize that arterial stiffness is longitudinally associated with white matter characteristics, and associations are stronger within watershed areas. Neuroimaging was obtained in 2006-2008 from 303 elderly (mean age 82.9 years, 59% women, 41% black) with pulse wave velocity (PWV) measures in 1997-1998. Multivariable regression models estimated the coefficients for PWV (cm/sec) in relationship to presence, severity, and spatial distribution of white matter hyperintensities (WMH), gray matter volume, and fractional anisotropy from diffusion tensor, adjusting for demographic, cardiovascular risk factors, and diseases from 1997-1998 to 2006-2008. Higher PWV in 1997-1998 was associated with greater WMH volume in 2006-2008 within the left superior longitudinal fasciculus (age and total brain WMH adjusted, P=0.023), but not with WMH in other tracts or with fractional anisotropy or gray matter volume from total brain (P>0.2). Associations were stronger in blacks than in whites, remaining significant in fully adjusted models. Elderly with WMH in tracts related to processing speed and memory are more likely to have had higher PWV values 10 years prior, before neuroimaging data being available. Future studies should address whether arterial stiffness can serve as an early biomarker of covert brain structural abnormalities and whether early arterial stiffness control can promote successful brain aging, especially in black elderly.
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Affiliation(s)
- Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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Celle S, Annweiler C, Pichot V, Bartha R, Barthélémy JC, Roche F, Beauchet O. Association between ambulatory 24-hour blood pressure levels and brain volume reduction: a cross-sectional elderly population-based study. Hypertension 2012; 60:1324-31. [PMID: 23045461 DOI: 10.1161/hypertensionaha.112.193409] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous literature has shown mixed results regarding the association between blood pressure levels and brain volume reduction. The objectives of this study were to determine whether high blood pressure levels were associated with focal brain volume reduction and whether high blood pressure-related focal brain volume reduction was associated with a decline in executive function performance. On the basis of a cross-sectional design, 24-hour ambulatory blood pressure measurements, as well as brain morphology from 3-dimensional magnetic resonance images, were assessed among 183 participants (mean, 65 ± 0.6 years; 62.4% women). Average levels of systolic and diastolic blood pressures, as well as dip, pulse pressure, and mean arterial blood pressure, were used as outcomes. Cortical gray and white matter volumes were determined by automatic calculation using Statistical Parametric Mapping segmentation. Folstein's Mini-Mental State Examination, digit span, part B of Trail Making, and Stroop tests were used to assess executive function performance. Sex, use of antihypertensive drugs, duration of hypertension, leukoaraiosis, body mass index, education level, and total brain matter volume were used as potential confounders. A significant blood pressure-related decrease in gray matter volume of the left supplementary motor areas (Brodmann area 6) and of the left superior and middle frontal gyrus (Brodmann area 8) was shown. No significant decrease was found with white matter volume. Blood pressure-related decreases in gray matter volume were significantly associated with a decline in executive function performance. The association of high blood pressure with brain volume reduction may in part explain blood pressure-related cognitive decline leading to dementia.
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Affiliation(s)
- Sébastien Celle
- Service de Physiologie Clinique et de l’Exercice, CHU Saint-Etienne, Faculté de Médecine Jacque Lisfranc, EA SNA EPIS 4607, UJM, Saint-Etienne, Pres de LYON, France
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84
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Portet F, Brickman AM, Stern Y, Scarmeas N, Muraskin J, Provenzano FA, Berr C, Bonafé A, Artero S, Ritchie K, Akbaraly TN. Metabolic syndrome and localization of white matter hyperintensities in the elderly population. Alzheimers Dement 2012; 8:S88-95.e1. [PMID: 22682962 PMCID: PMC4108160 DOI: 10.1016/j.jalz.2011.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/20/2011] [Accepted: 11/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined as a clustering of metabolic disorders: abdominal obesity, dyslipidemia, hypertension, and hyperglycemia. Although specific components of MetS have been associated with white matter hyperintensities (WMH), less is known about the association between MetS as a whole and WMH, especially in normal aging. We aimed to: (1) investigate this association in a cohort of healthy elderly individuals, and (2) examine the relationship between MetS and the regional distribution of WMH, to further understanding of the relationship between MetS and structural brain changes. METHODS Analyses were carried out on 308 participants (48.1% men, age: 71.0 ± 3.9 years) from the French longitudinal ESPRIT (Enquête de Santé Psychologique--Risques, Incidence et Traitement) study, who were free of cerebrovascular disease cognitive and functional impairment. Logistic regression models were used to examine the cross-sectional association between MetS (defined using the National Cholesterol Education Program-Adult Treatment Panel III criteria) and (1) WMH volumes, and (2) WMH volumes according to their localization in insulofrontal and temporoparietal regions. RESULTS After adjusting for potential confounders, participants with MetS had a twofold increased chance of presenting with high levels of WMH volume compared with those without (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.25-6.03). MetS was specifically associated with an increase of temporoparietal WMH volumes, but no association was found between MetS and WMH localized in the insulofrontal region. CONCLUSION Our findings suggest that effective management of MetS may reduce WMH accumulation in brain areas already vulnerable to the aging process.
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Affiliation(s)
- Florence Portet
- Inserm, Unit 1061, Neuropsychiatry: epidemiological and clinical research, Montpellier, France
- Université Montpellier I, Montpellier, France
- Unité Transversale des Troubles Neurologiques du Sujet Âgé, CHU Caremeau, Centre Ruffi, Pôle de Gériatrie, CHU Nîmes, France
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Nikolaos Scarmeas
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Jordan Muraskin
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Frank A. Provenzano
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Claudine Berr
- Inserm, Unit 1061, Neuropsychiatry: epidemiological and clinical research, Montpellier, France
- Université Montpellier I, Montpellier, France
| | - Alain Bonafé
- Department of Neuroradiology, Montpellier University Hospital, Montpellier, France
| | - Sylvaine Artero
- Inserm, Unit 1061, Neuropsychiatry: epidemiological and clinical research, Montpellier, France
- Université Montpellier I, Montpellier, France
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: epidemiological and clinical research, Montpellier, France
- Université Montpellier I, Montpellier, France
- Faculty of Medicine, Imperial College, St Mary’s Hospital, London, United Kingdom
| | - Tasnime N. Akbaraly
- Inserm, Unit 1061, Neuropsychiatry: epidemiological and clinical research, Montpellier, France
- Université Montpellier I, Montpellier, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Firbank MJ, Teodorczuk A, van der Flier WM, Gouw AA, Wallin A, Erkinjuntti T, Inzitari D, Wahlund LO, Pantoni L, Poggesi A, Pracucci G, Langhorne P, O'Brien JT. Relationship between progression of brain white matter changes and late-life depression: 3-year results from the LADIS study. Br J Psychiatry 2012; 201:40-5. [PMID: 22626634 DOI: 10.1192/bjp.bp.111.098897] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Brain white matter changes (WMC) and depressive symptoms are linked, but the directionality of this association remains unclear. AIMS To investigate the relationship between baseline and incident depression and progression of white matter changes. METHOD In a longitudinal multicentre pan-European study (Leukoaraiosis and Disability in the elderly, LADIS), participants aged over 64 underwent baseline magnetic resonance imaging (MRI) and clinical assessments. Repeat scans were obtained at 3 years. Depressive outcomes were assessed in terms of depressive episodes and the Geriatric Depression Scale (GDS). Progression of WMC was measured using the modified Rotterdam Progression scale. RESULTS Progression of WMC was significantly associated with incident depression during year 3 of the study (P = 0.002) and remained significant after controlling for transition to disability, baseline WMC and baseline history of depression. There was no significant association between progression of WMC and GDS score, and no significant relationship between progression of WMC and history of depression at baseline. CONCLUSIONS Our results support the vascular depression hypothesis and implicate WMC as causal in the pathogenesis of late-life depression.
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Affiliation(s)
- Michael J Firbank
- Institute for Ageing and Health, Newcastle University Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.
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Davis JC, Nagamatsu LS, Hsu CL, Beattie BL, Liu-Ambrose T. Self-efficacy is independently associated with brain volume in older women. Age Ageing 2012; 41:495-501. [PMID: 22436405 DOI: 10.1093/ageing/afs029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND ageing is highly associated with neurodegeneration and atrophy of the brain. Evidence suggests that personality variables are risk factors for reduced brain volume. We examine whether falls-related self-efficacy is independently associated with brain volume. METHOD a cross-sectional analysis of whether falls-related self-efficacy is independently associated with brain volumes (total, grey and white matter). Three multivariate regression models were constructed. Covariates included in the models were age, global cognition, systolic blood pressure, functional comorbidity index and current physical activity level. MRI scans were acquired from 79 community-dwelling senior women aged 65-75 years old. Falls-related self-efficacy was assessed by the activities-specific balance confidence (ABC) scale. RESULTS after accounting for covariates, falls-related self-efficacy was independently associated with both total brain volume and total grey matter volume. The final model for total brain volume accounted for 17% of the variance, with the ABC score accounting for 8%. For total grey matter volume, the final model accounted for 24% of the variance, with the ABC score accounting for 10%. CONCLUSION we provide novel evidence that falls-related self-efficacy, a modifiable risk factor for healthy ageing, is positively associated with total brain volume and total grey matter volume. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00426881.
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Affiliation(s)
- Jennifer C Davis
- Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), 357-2647 Willow Street, Vancouver, BC, Canada
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Bourdel-Marchasson I, Dugaret E, Regueme S. Disability in older people with diabetes: issues for the clinician. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/1474651412448404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetes may become a disabling disease due to diverse mechanisms. Many patients have evidence of physical or cognitive impairments that can markedly influence their ability to diabetes self manage and adversely affect possible outcomes of diabetes care. A screening process for impairment is therefore needed and in frail patients a comprehensive gerontological assessment should be used to improve the efficiency of care. A diabetes educational programme adapted to this population, which has involved the main care-giver has shown its efficacy to improve risk factor control and quality of life in a safer way. The experience of case-managers according to a model of heart failure may be promising for the future.
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Affiliation(s)
- Isabelle Bourdel-Marchasson
- CHU de Bordeaux, Pôle de Gérontologie Clinique, F-33000 Pessac, France
- Bordeaux Segalen University, RMSB, UMR 5536, F-33000 Bordeaux, France
- CNRS, RMSB, UMR 5536, F-33000 Bordeaux, France
| | - Elodie Dugaret
- CHU de Bordeaux, Pôle de Gérontologie Clinique, F-33000 Pessac, France
- Bordeaux Segalen University, RMSB, UMR 5536, F-33000 Bordeaux, France
| | - Sophie Regueme
- CHU de Bordeaux, Pôle de Gérontologie Clinique, F-33000 Pessac, France
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88
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Morra L, Zade D, McGlinchey RE, Milberg WP. Normal aging and cognition: the unacknowledged contribution of cerebrovascular risk factors. AGING NEUROPSYCHOLOGY AND COGNITION 2012; 20:271-97. [PMID: 22708889 DOI: 10.1080/13825585.2012.693905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite the widespread assumption that cognitive decline is an inherent part of the normal aging process, research suggests that part of the variance in age-related cognitive decline is attributable to modifiable factors common in geriatric populations such as cerebrovascular risk factors. We completed a literature search using Science Citation Index and evaluated the most cited articles from the last 10 years to determine the extent to which investigations of normal aging and cognition account for the influence of cerebrovascular risk factors. We found that the majority of the most frequently cited literature does not adequately account for the contribution of cerebrovascular risk factors and therefore, it is possible that many conclusions about normal aging and cognition are flawed or incomplete. Further investigation of the role of cerebrovascular risk factors in age-related cognitive decline is imperative to more accurately understand the effect of aging on cognition.
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Affiliation(s)
- L Morra
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA.
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89
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Murray AD, Staff RT, McNeil CJ, Salarirad S, Starr JM, Deary IJ, Whalley LJ. Brain lesions, hypertension and cognitive ageing in the 1921 and 1936 Aberdeen birth cohorts. AGE (DORDRECHT, NETHERLANDS) 2012; 34:451-459. [PMID: 21424787 PMCID: PMC3312630 DOI: 10.1007/s11357-011-9233-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/02/2011] [Indexed: 05/30/2023]
Abstract
The objectives of this study are to model the relative effects of positive (childhood intelligence) and negative (magnetic resonance imaging (MRI)-derived white matter hyperintensities (WMH)) predictors of late-life intelligence in two well-characterised normal cohorts aged 68 and 78 and to measure the influence of hypertension on WMH and lifelong cognitive change. The Scottish Mental Surveys of 1932 and 1947 tested the intelligence of almost all school children at age 11. One hundred and one participants born in 1921 and 233 participants born in 1936 had brain MRI, with measurement of WMH using Scheltens' scale, and tests of late-life fluid intelligence. Structural equation models of the effect of childhood intelligence and brain WMH on the general intelligence factor 'g' in late life in the two samples were constructed using AMOS 18. Similar models were constructed to test the effect of hypertension on WMH and lifelong cognitive change. Fluid intelligence scores were lower and WMH scores were higher in the older samples. Hypertensive participants in both samples had more WMH than normotensive participants. The positive influence of childhood intelligence on 'g' was greater in the younger sample. The negative effect of WMH on 'g' was linear and greater in the older sample due to greater WMH burden. The negative effect of hypertension on lifelong cognitive ageing was all mediated via MRI-derived brain WMH. The positive relationship between childhood and late-life intelligence decreases with age. The negative relationship between WMH and late-life intelligence is linear and increases with age.
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Affiliation(s)
- Alison D. Murray
- University of Aberdeen, Aberdeen, UK
- Aberdeen Biomedical Imaging Centre, Lilian Sutton Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Roger T. Staff
- University of Aberdeen, Aberdeen, UK
- NHS Grampian, Aberdeen, UK
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90
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Williams VJ, Leritz EC, Shepel J, McGlinchey RE, Milberg WP, Rudolph JL, Lipsitz LA, Salat DH. Interindividual variation in serum cholesterol is associated with regional white matter tissue integrity in older adults. Hum Brain Mapp 2012; 34:1826-41. [PMID: 22438182 DOI: 10.1002/hbm.22030] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 01/24/2023] Open
Abstract
Prior research has demonstrated links among vascular health and the occurrence of stroke, mild cognitive decline, and dementia in older adults. However, little is known about whether normal variation in vascular indicators may be related to changes in neural tissue integrity. Even less is known about how the brain is affected by cholesterol levels in the normal to moderate risk range, leading up to overt disease pathology. This study examined associations between serum lipid levels and DTI indicators of white matter (WM) structural integrity in a sample of 125 generally healthy older adults aged 43-87 years. Whole-brain voxelwise analysis, controlling for age and gender, revealed low density lipoprotein levels (LDL) as the most robust correlate of regional WM structural integrity of the measured lipids. Higher LDL was associated with decreased WM integrity in right frontal and temporal regions, the superior longitudinal fasciculus and internal/external capsules. Increasing LDL was associated with increased radial and axial diffusivity; however, more widespread statistical effects were found for radial diffusivity. These findings suggest that normal interindividual variation in lipid levels is associated with compromised regional WM integrity, even in individuals below clinical thresholds for hyperlipidemia. Given the prevalence of cholesterol-associated sequelae in older adults, and mounting evidence suggesting a vascular role in the etiology of dementia, the current data suggest that understanding the relationship between cholesterol and brain tissue microstructure may have important clinical implications for early detection of vascular-related cognitive disorders and optimal regulation of serum lipids to maintain neural health in older adults.
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Affiliation(s)
- Victoria J Williams
- Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, Massachusetts, USA
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91
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The association between blood pressure and incident Alzheimer disease: a systematic review and meta-analysis. Epidemiology 2012; 22:646-59. [PMID: 21705906 DOI: 10.1097/ede.0b013e31822708b5] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many epidemiologic studies have considered the association between blood pressure (BP) and Alzheimer disease, yet the relationship remains poorly understood. METHODS In parallel with work on the AlzRisk online database (www.alzrisk.org), we conducted a systematic review to identify all epidemiologic studies meeting prespecified criteria reporting on the association between hypertension, systolic BP, or diastolic BP and incident Alzheimer disease. When possible, we computed summary measures using random-effects models and explored potential heterogeneity related to age at BP assessment. RESULTS Eighteen studies reporting on 19 populations met the eligibility criteria. We computed summary relative risks (RR(Σ)) for 3 measures of BP: hypertension (RR(Σ) = 0.97 [95% confidence interval = 0.80-1.16]); a 10-mm Hg increase in systolic BP (RR(Σ) = 0.95 [0.91-1.00]); and a 10-mm Hg increase in diastolic BP (RR(Σ) = 0.94 [0.85-1.04]). We were unable to compute summary estimates for the association between categories of systolic or diastolic BP and Alzheimer disease; however, there did not appear to be a consistent pattern across studies. After stratifying on age at BP assessment, we found a suggestion of an inverse association between late-life hypertension and Alzheimer disease and a suggestion of an adverse association between midlife diastolic hypertension and Alzheimer disease. CONCLUSIONS Based on existing epidemiologic research, we cannot determine whether there is a causal association between BP and Alzheimer disease. Selection bias and reverse causation may account for the suggested inverse association between late-life hypertension on Alzheimer disease, but, given the expected direction of these biases, they are less likely to account for the suggestion that midlife hypertension increases risk. We advocate continuing systematic review; the AlzRisk database entry on this topic (www.alzrisk.org), which was completed in parallel with this work, will be updated as new studies are published.
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92
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Abstract
There are many reports of relations between age and cognitive variables and of relations between age and variables representing different aspects of brain structure and a few reports of relations between brain structure variables and cognitive variables. These findings have sometimes led to inferences that the age-related brain changes cause the age-related cognitive changes. Although this conclusion may well be true, it is widely recognized that simple correlations are not sufficient to warrant causal conclusions, and other types of correlational information, such as mediation and correlations between longitudinal brain changes and longitudinal cognitive changes, also have limitations with respect to causal inferences. These issues are discussed, and the existing results on relations of regional volume, white matter hyperintensities, and diffusion tensor imaging measures of white matter integrity to age and to measures of cognitive functioning are reviewed. It is concluded that at the current time the evidence that these aspects of brain structure are neuroanatomical substrates of age-related cognitive decline is weak. The final section contains several suggestions concerning measurement and methodology that may lead to stronger conclusions in the future.
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Affiliation(s)
- Timothy A Salthouse
- Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400, USA.
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93
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Narayan SK, Firbank MJ, Saxby BK, Stansby G, Hansrani M, O'Brien JT, Ford GA. Elevated plasma homocysteine is associated with increased brain atrophy rates in older subjects with mild hypertension. Dement Geriatr Cogn Disord 2011; 31:341-8. [PMID: 21597295 DOI: 10.1159/000328118] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2011] [Indexed: 11/19/2022] Open
Abstract
We determined using serial MR imaging whether raised plasma homocysteine levels are associated with increased brain atrophy, white matter lesion (WML) progression or incidence of silent brain infarcts (SBIs) in older hypertensive subjects. Brain atrophy rates (0.58 ± 0.48% per year, mean ± SD) were significantly correlated with homocysteine (β = 0.46, p = 0.001 homocysteine; β = 0.44, p = 0.007 homocysteine/folate/B12 models) but not with folate or B12 levels. Progression of WML (0.08 ± 0.16%) was not associated with homocysteine level (B = 0.01, p = 0.29). New SBIs were uncommon. In older hypertensive individuals, plasma homocysteine levels are associated with increased rates of whole-brain atrophy but not WML progression.
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94
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Jacobs HIL, Leritz EC, Williams VJ, Van Boxtel MPJ, van der Elst W, Jolles J, Verhey FRJ, McGlinchey RE, Milberg WP, Salat DH. Association between white matter microstructure, executive functions, and processing speed in older adults: the impact of vascular health. Hum Brain Mapp 2011; 34:77-95. [PMID: 21954054 DOI: 10.1002/hbm.21412] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 06/08/2011] [Accepted: 07/01/2011] [Indexed: 11/12/2022] Open
Abstract
Cerebral white matter damage is not only a commonly reported consequence of healthy aging, but is also associated with cognitive decline and dementia. The aetiology of this damage is unclear; however, individuals with hypertension have a greater burden of white matter signal abnormalities (WMSA) on MR imaging than those without hypertension. It is therefore possible that elevated blood pressure (BP) impacts white matter tissue structure which in turn has a negative impact on cognition. However, little information exists about whether vascular health indexed by BP mediates the relationship between cognition and white matter tissue structure. We used diffusion tensor imaging to examine the impact of vascular health on regional associations between white matter integrity and cognition in healthy older adults spanning the normotensive to moderate-severe hypertensive BP range (43-87 years; N = 128). We examined how white matter structure was associated with performance on tests of two cognitive domains, executive functioning (EF) and processing speed (PS), and how patterns of regional associations were modified by BP and WMSA. Multiple linear regression and structural equation models demonstrated associations between tissue structure, EF and PS in frontal, temporal, parietal, and occipital white matter regions. Radial diffusivity was more prominently associated with performance than axial diffusivity. BP only minimally influenced the relationship between white matter integrity, EF and PS. However, WMSA volume had a major impact on neurocognitive associations. This suggests that, although BP and WMSA are causally related, these differential metrics of vascular health may act via independent pathways to influence brain structure, EF and PS.
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Affiliation(s)
- Heidi I L Jacobs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, University Maastricht, 6200 MD Maastricht, The Netherlands.
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95
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Vuorinen M, Solomon A, Rovio S, Nieminen L, Kåreholt I, Tuomilehto J, Soininen H, Kivipelto M. Changes in vascular risk factors from midlife to late life and white matter lesions: a 20-year follow-up study. Dement Geriatr Cogn Disord 2011; 31:119-25. [PMID: 21273771 DOI: 10.1159/000323810] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This study investigated the relation of midlife blood pressure, total cholesterol, body mass index (BMI), their changes over time, apolipoprotein E, and white matter lesions (WML). METHODS Participants of the Cardiovascular Risk Factors, Aging and Incidence of Dementia study were derived from random, population-based samples previously surveyed in 1972, 1977, 1982 or 1987. In 1998, 1,449 (73%) individuals aged 65-79 years were re-examined (average follow-up 21 years). A subpopulation (n = 112) was scanned with a 1.5-tesla MRI scanner in 1998, and WML were assessed from fluid-attenuated inversion recovery images using a semi-quantitative visual rating scale. RESULTS Risk of late-life WML was related to midlife overweight (relative risk = 2.53; 95% CI = 1.70-2.89), obesity (2.94; 2.44-3.03), and hypertension (2.73; 1.81-3.08), even after adjustments for several confounding factors. Elevated BMI (>25) (2.26; 1.42-2.62) and hypertension (3.14; 1.83-3.40) from midlife to late life also increased the risk of WML. In addition, an association with WML was seen for decreasing blood pressure (hypertension at midlife but not at late life) (3.25; 2.46-3.41), even after controlling for antihypertensive treatment. Lipid-lowering drugs had a protective effect against WML (0.13; 0.02-0.59). CONCLUSIONS These results indicate that early and sustained vascular risk factor control is associated with a lower likelihood of having more severe WML in late life.
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Affiliation(s)
- Miika Vuorinen
- Aging Research Center, NVS, Karolinska Institute, Stockholm, Sweden.
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96
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Vasilopoulos T, Kremen WS, Kim K, Panizzon MS, Stein PK, Xian H, Grant MD, Lyons MJ, Toomey R, Eaves LJ, Franz CE, Jacobson KC. Untreated hypertension decreases heritability of cognition in late middle age. Behav Genet 2011; 42:107-20. [PMID: 21688193 DOI: 10.1007/s10519-011-9479-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 06/01/2011] [Indexed: 10/18/2022]
Abstract
Hypertension is a risk factor for cognitive decline, but the mechanisms underlying the effects of hypertension on cognition, particularly in midlife, are unclear. We examined whether hypertension modifies genetic influences on individual differences in cognition. Nine cognitive domains and general cognitive ability were assessed in a sample of 1,237 male twins aged 51-60 who were divided into three blood pressure groups: non-hypertensive; medicated hypertensive; and unmedicated hypertensive. Heritability was significantly lower among unmedicated hypertensives compared to medicated hypertensives and non-hypertensives for visual-spatial ability (p = 0.013) and episodic memory (p = 0.004). There were no heritability differences between non-hypertensives and medicated hypertensives. In addition, there were no significant differences in mean level cognition across the three blood pressure groups. These results suggest that in middle-aged men, untreated hypertension suppresses normal genetic influences on individual differences in certain domains of cognition prior to the emergence of hypertension-related effects on cognitive performance. These results further suggest that antihypertensive medication may protect against or reverse this effect.
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Affiliation(s)
- Terrie Vasilopoulos
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, MC 3077, rm 603, Chicago, IL 60637, USA.
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97
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Glodzik L, Mosconi L, Tsui W, de Santi S, Zinkowski R, Pirraglia E, Rich KE, McHugh P, Li Y, Williams S, Ali F, Zetterberg H, Blennow K, Mehta P, de Leon MJ. Alzheimer's disease markers, hypertension, and gray matter damage in normal elderly. Neurobiol Aging 2011; 33:1215-27. [PMID: 21530003 DOI: 10.1016/j.neurobiolaging.2011.02.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 02/06/2011] [Accepted: 02/16/2011] [Indexed: 11/30/2022]
Abstract
It is not well known whether Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers are associated with brain damage in cognitively normal elderly. The combined influence of CSF biomarkers and hypertension (HTN) on the gray matter (GM) is also not well described. One hundred fifteen cognitively healthy subjects (mean age 62.6 ± 9.5%, 62% women) received clinical assessment, a high resolution magnetic resonance imaging (MRI), and a lumbar puncture. The CSF levels of total tau (t-tau), hyperphosphorylated tau (p-tau(231)), amyloid beta (Aβ42/Aβ40), p-tau(231)/Aβ42, and t-tau/Aβ42 were dichotomized as "high" and "low" based on accepted cut off values. Statistical parametric mapping was used to examine MRI scans for regional GM density, studied as a function of the CSF markers, HTN, and combination of both. Global and medial temporal lobe (MTL) GM was also assessed. Voxel based morphometry revealed that higher t-tau was associated with lower GM density in the precunei. Subjects with higher p-tau(231) and p-tau(231)/Aβ42 had less GM in temporal lobes. Low Aβ42/Aβ40 was related to less GM in the thalami, caudate, and midbrain. Subjects with hypertension showed more GM atrophy in the cerebellum, occipital, and frontal regions. Simultaneous presence of elevated CSF AD biomarkers and HTN was associated with more GM atrophy than either marker individually, but no interaction effects were identified. In conclusion, in normal elderly CSF tau markers were associated predominantly with lower GM estimates in structures typically affected early in the AD process. In this presymptomatic stage when no cognitive impairment is present, AD biomarkers and HTN have additive effects on gray matter damage.
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Affiliation(s)
- Lidia Glodzik
- Center of Excellence on Aging, Center for Brain Health, Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
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98
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Hyperglycaemia, microangiopathy, diabetes and dementia risk. DIABETES & METABOLISM 2011; 36 Suppl 3:S112-8. [PMID: 21211732 DOI: 10.1016/s1262-3636(10)70477-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Brain microangiopathy increases in frequency and severity with older age, with the presence of hypertension and to a lesser extent with diabetes. Magnetic resonance imaging is used to provide anatomical descriptions, but at this time only clinical examination and neuropsychological testing can assess white matter functioning. Clinical correlates of microangiopathy appear as subcortical cognitive alterations, but data are controversial about dementia risk. Brain microangiopathy seems to be however a complication of chronic hyperglycaemia, probably due to similar mechanisms occurring in retinopathy and other microvascular complications. To date, many questions have been raised: How can brain microangiopathy progression be monitored? Is there a reversible stage of brain microangiopathy? Which preventive actions should be implemented in aging patients with diabetes? Finally, what type of care should be provided for people with diabetes and mild cognitive impairment or overt dementia to slow down cognitive worsening?
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99
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Patel B, Markus HS. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke 2011; 6:47-59. [PMID: 21205241 DOI: 10.1111/j.1747-4949.2010.00552.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cerebral small vessel disease is an important cause of vascular cognitive impairment and dementia. On brain imaging, discrete lacunar infarcts and/or more diffuse regions of white matter hyperintensities or leucoaraiosis are seen. Magnetic resonance imaging plays a crucial role in diagnosis, and advanced magnetic resonance imaging techniques are providing new information on disease mechanisms and offering potential as surrogate disease markers. Longitudinal studies have demonstrated detectable progression of lesion load over short time periods, and weak correlations with cognition. Stronger correlations with cognition have been found with diffusion tensor imaging, which is more sensitive to white matter tract structure, supporting a role for disconnection in the pathogenesis of cognitive impairment. Brain volume also consistently correlates with cognition in asymptomatic small vessel disease, sporadic small vessel disease, and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Gradient echo magnetic resonance imaging identifies microbleeds in a significant proportion of patients with small vessel disease, although their role in clinical management remains to be determined. Surrogate markers to monitor disease progression and evaluate new therapies would have major clinical use. The greater sensitivity of diffusion tensor imaging parameters and brain volume to change, and the stronger correlation of these parameters with cognition, suggest that they may be more powerful surrogates. However, data from longitudinal and intervention studies are required to determine if this is indeed the case. In this systematic review, we describe the use of both conventional and advanced magnetic resonance imaging techniques in patient groups with the full spectrum of clinical small vessel disease, from normal populations with WMH to patients groups with lacunar stroke and dementia.
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Affiliation(s)
- Bhavini Patel
- Clinical Neuroscience, St George's University of London, London, UK
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100
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Jennings JR, Mendelson DN, Muldoon MF, Ryan CM, Gianaros PJ, Raz N, Aizenstein H. Regional grey matter shrinks in hypertensive individuals despite successful lowering of blood pressure. J Hum Hypertens 2011; 26:295-305. [PMID: 21490622 PMCID: PMC3137674 DOI: 10.1038/jhh.2011.31] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective To determine whether reduction in brain grey matter volume associated with hypertension persisted or was remediated among hypertensive patients newly treated over the course of a year. Methods Forty-one hypertensive patients were assessed over the course of a one-year successful anti-hypertensive treatment. Brain areas identified previously in cross-sectional studies as differing in volume between hypertensive and normotensive individuals were examined with a semi-automated measurement technique (ALP, automated labeling pathway). Volumes of grey matter regions were computed at baseline and after a year of treatment and compared to archival data from normotensive individuals. Results Reductions in regional grey matter volume over the follow-up period were observed despite successful treatment of blood pressure. The comparison group of older, but normotensive individuals showed no significant changes over a year in the regions tested in the treated hypertensive group. Conclusions These novel results suggest that essential hypertension is associated with regional grey matter shrinkage and successful reduction of blood pressure may not completely counter that trend.
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Affiliation(s)
- J R Jennings
- Department of Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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