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Schoeppe F, Rossi A, Levin J, Reiser M, Stoecklein S, Ertl-Wagner B. Increased cerebral microbleeds and cortical superficial siderosis in pediatric patients with Down syndrome. Eur J Paediatr Neurol 2019; 23:158-164. [PMID: 30279085 DOI: 10.1016/j.ejpn.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/19/2018] [Accepted: 09/04/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with Down syndrome carry a third copy of the amyloid precursor protein gene, which is localized on chromosome 21. Consequently, these patients are prone to develop early-onset Alzheimer disease and cerebral amyloid angiopathy. Post-mortem studies suggest increased amyloid deposition to be already detectable in children with Down syndrome. The aim of our study was to evaluate if amyloid-related changes in pediatric Down syndrome patients can be detected in vivo using MRI biomarkers of cerebral microbleeds and cortical superficial siderosis. MATERIALS AND METHODS This retrospective study included 12 patients with Down syndrome (mean age = 5.0 years) and 12 age-matched control subjects (mean age = 4.8 years). Frequency and location of microbleeds and siderosis were assessed on blood-sensitive MRI sequences in a consensus reading by two radiologists applying a modified Microbleed Anatomical Rating Scale. RESULTS Down syndrome patients showed a significantly higher mean microbleeds count and likelihood of siderosis than age-matched controls. Across groups, the highest microbleeds count was found in lobar regions (gray and white matter of frontal, parietal, temporal, and occipital lobes, and the insula), while fewer microbleeds were located in subcortical and infratentorial regions. The number of microbleeds increased over time in all three Down syndrome patients with a follow-up exam. CONCLUSION In vivo MRI biomarkers can support the diagnosis of early-onset cerebral amyloid angiopathy, which might already be present in pediatric Down syndrome patients. This might contribute to clinical decision-making and potentially to the development of therapeutic and prophylactic approaches, as cerebral amyloid angiopathy increases the risk for intracranial hemorrhage and may be associated with increased risk of developing Alzheimer disease.
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Affiliation(s)
- Franziska Schoeppe
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Andrea Rossi
- Department of Pediatric Neuroradiology, Instituto Giannina Gaslini, Via G. Gaslini 5, I-16147, Genoa, Italy
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Birgit Ertl-Wagner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany; Department of Radiology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G1X8, Canada
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Kulesh AA, Drobakha VE, Shestakov VV. Hemorrhagic manifestations of cerebral amyloid angiopathy: from pathogenesis to clinical significance. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-3-4-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The paper characterizes the neuropathological aspects of cerebral amyloid angiopathy (CAA) and its pathogenesis. It presents in detail the current neuroimaging markers of CAA and their neuropathological correlates. The phenotypic heterogeneity of the disease and its main clinical manifestations are considered; the updated Boston diagnostic criteria are formulated. The issues of intracerebral hemorrhages, cerebral microbleeding, and cortical superficial siderosis, which are associated with CAA, are elucidated in detail. CAA is noted to be of clinical significance for the determination of therapeutic policy in hemorrhagic stroke, systemic thrombolytic therapy, and cognitive impairment.
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Affiliation(s)
- A. A. Kulesh
- Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia, Perm
| | - V. E. Drobakha
- Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia, Perm
| | - V. V. Shestakov
- Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia, Perm
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Charidimou A, Giese AK, Pasi M, van Veluw SJ, Xiong L, Fotiadis P, Marini S, Schirmer MD, Viswanathan A. Journal Club: Florbetapir imaging in cerebral amyloid angiopathy-related hemorrhages. Neurology 2018; 91:574-577. [PMID: 30224502 DOI: 10.1212/wnl.0000000000006195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston.
| | - Anne-Katrin Giese
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Marco Pasi
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Susanne J van Veluw
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Li Xiong
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Sandro Marini
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Markus D Schirmer
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
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54
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Weber SA, Patel RK, Lutsep HL. Cerebral amyloid angiopathy: diagnosis and potential therapies. Expert Rev Neurother 2018; 18:503-513. [DOI: 10.1080/14737175.2018.1480938] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Stewart A. Weber
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Ranish K. Patel
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Helmi L. Lutsep
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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55
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Banerjee G, Wilson D, Werring DJ. Response by Banerjee et al to Letter Regarding Article, "Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy". Stroke 2018; 49:e208. [PMID: 29669878 DOI: 10.1161/strokeaha.118.021077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
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56
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Charidimou A, Farid K, Tsai HH, Tsai LK, Yen RF, Baron JC. Amyloid-PET burden and regional distribution in cerebral amyloid angiopathy: a systematic review and meta-analysis of biomarker performance. J Neurol Neurosurg Psychiatry 2018; 89:410-417. [PMID: 29070646 DOI: 10.1136/jnnp-2017-316851] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/28/2017] [Accepted: 10/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We performed a meta-analysis to synthesise current evidence on amyloid-positron emission tomography (PET) burden and presumed preferential occipital distribution in sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic search, we identified case-control studies with extractable data on global and occipital-to-global amyloid-PET uptake in symptomatic patients with CAA (per Boston criteria) versus control groups (healthy participants or patients with non-CAA deep intracerebral haemorrhage) and patients with Alzheimer's disease. To circumvent PET studies' methodological variation, we generated and used 'fold change', that is, ratio of mean amyloid uptake (global and occipital-to-global) of CAA relative to comparison groups. Amyloid-PET uptake biomarker performance was then quantified by random-effects meta-analysis on the ratios of the means. A ratio >1 indicates that amyloid-PET uptake (global or occipital/global) is higher in CAA than comparison groups, and a ratio <1 indicates the reverse. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 138 controls (96 healthy elderly, 42 deep intracerebral haemorrhage controls) and 72 patients with Alzheimer's disease, were included. Global amyloid-PET ratio between patients with CAA and controls was above 1, with an average effect size of 1.18 (95% CI 1.08 to 1.28; p<0.0001). Occipital-to-global amyloid-PET uptake ratio did not differ between patients with CAA versus patients with deep intracerebral haemorrhage or healthy controls. By contrast, occipital-to-global amyloid-PET uptake ratio was above 1 in patients with CAA versus those with Alzheimer's disease, with an average ratio of 1.10 (95% CI 1.03 to 1.19; p=0.009) and high statistical heterogeneity. CONCLUSIONS Our analysis provides exploratory actionable data on the overall effect sizes and strength of amyloid-PET burden and distribution in patients with CAA, useful for future larger studies.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Group, Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karim Farid
- Department of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Rouh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Jean-Claude Baron
- Department of Neurology, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
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Abbott NJ, Pizzo ME, Preston JE, Janigro D, Thorne RG. The role of brain barriers in fluid movement in the CNS: is there a 'glymphatic' system? Acta Neuropathol 2018; 135:387-407. [PMID: 29428972 DOI: 10.1007/s00401-018-1812-4] [Citation(s) in RCA: 341] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Brain fluids are rigidly regulated to provide stable environments for neuronal function, e.g., low K+, Ca2+, and protein to optimise signalling and minimise neurotoxicity. At the same time, neuronal and astroglial waste must be promptly removed. The interstitial fluid (ISF) of the brain tissue and the cerebrospinal fluid (CSF) bathing the CNS are integral to this homeostasis and the idea of a glia-lymph or 'glymphatic' system for waste clearance from brain has developed over the last 5 years. This links bulk (convective) flow of CSF into brain along the outside of penetrating arteries, glia-mediated convective transport of fluid and solutes through the brain extracellular space (ECS) involving the aquaporin-4 (AQP4) water channel, and finally delivery of fluid to venules for clearance along peri-venous spaces. However, recent evidence favours important amendments to the 'glymphatic' hypothesis, particularly concerning the role of glia and transfer of solutes within the ECS. This review discusses studies which question the role of AQP4 in ISF flow and the lack of evidence for its ability to transport solutes; summarizes attributes of brain ECS that strongly favour the diffusion of small and large molecules without ISF flow; discusses work on hydraulic conductivity and the nature of the extracellular matrix which may impede fluid movement; and reconsiders the roles of the perivascular space (PVS) in CSF-ISF exchange and drainage. We also consider the extent to which CSF-ISF exchange is possible and desirable, the impact of neuropathology on fluid drainage, and why using CSF as a proxy measure of brain components or drug delivery is problematic. We propose that new work and key historical studies both support the concept of a perivascular fluid system, whereby CSF enters the brain via PVS convective flow or dispersion along larger caliber arteries/arterioles, diffusion predominantly regulates CSF/ISF exchange at the level of the neurovascular unit associated with CNS microvessels, and, finally, a mixture of CSF/ISF/waste products is normally cleared along the PVS of venules/veins as well as other pathways; such a system may or may not constitute a true 'circulation', but, at the least, suggests a comprehensive re-evaluation of the previously proposed 'glymphatic' concepts in favour of a new system better taking into account basic cerebrovascular physiology and fluid transport considerations.
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Affiliation(s)
- N Joan Abbott
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Science, King's College London, Franklin Wilkins Building 3.82, 150 Stamford St, London, SE1 9NH, UK.
| | - Michelle E Pizzo
- Division of Pharmaceutical Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA
- Clinical Neuroengineering Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Jane E Preston
- Faculty of Life Sciences and Medicine, Institute of Pharmaceutical Science, King's College London, Franklin Wilkins Building 3.82, 150 Stamford St, London, SE1 9NH, UK
| | - Damir Janigro
- Flocel Inc., Cleveland, OH, USA
- Department of Physiology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert G Thorne
- Division of Pharmaceutical Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
- Clinical Neuroengineering Training Program, University of Wisconsin-Madison, Madison, WI, USA.
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA.
- Cellular and Molecular Pathology Graduate Training Program, University of Wisconsin-Madison, Madison, WI, USA.
- Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, USA.
- , 5113 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, USA.
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58
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Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke 2018; 49:491-497. [PMID: 29335334 PMCID: PMC5892842 DOI: 10.1161/strokeaha.117.016990] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston.
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston
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59
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Charidimou A, Friedrich JO, Greenberg SM, Viswanathan A. Core cerebrospinal fluid biomarker profile in cerebral amyloid angiopathy: A meta-analysis. Neurology 2018; 90:e754-e762. [PMID: 29386280 DOI: 10.1212/wnl.0000000000005030] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/28/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis of 4 core CSF biomarkers (β-amyloid [Aβ]42, Aβ40, total tau [t-tau], and phosphorylated tau [p-tau]) to assess which of these are most altered in sporadic cerebral amyloid angiopathy (CAA). METHODS We systematically searched PubMed for eligible studies reporting data on CSF biomarkers reflecting amyloid precursor protein metabolism (Aβ42, Aβ40), neurodegeneration (t-tau), and tangle pathology (p-tau) in symptomatic sporadic CAA cohorts vs controls and patients with Alzheimer disease (AD). Biomarker performance was assessed in random-effects meta-analysis based on ratio of mean (RoM) biomarker concentrations: (1) in patients with CAA vs healthy controls and (2) in patients with CAA vs patients with AD. RoM >1 indicates higher biomarker concentration in patients with CAA vs comparison population and RoM <1 indicates higher concentration in comparison groups. RESULTS Three studies met inclusion criteria. These comprised 5 CAA patient cohorts (n = 59 patients) vs healthy controls (n = 94 cases) and AD cohorts (n = 158). Three core biomarkers differentiated CAA from controls: CSF Aβ42 (RoM 0.49, 95% confidence interval [CI] 0.38-0.64, p < 0.003), Aβ40 (RoM 0.70, 95% CI 0.63-0.78, p < 0.0001), and t-tau (RoM 1.54, 95% CI 1.15-2.07, p = 0.004); p-tau was marginal (RoM 1.24, 95% CI 0.99-1.54, p = 0.062). Differentiation between CAA and AD was strong for CSF Aβ40 (RoM 0.76, 95% CI 0.69-0.83, p < 0.0001), but not Aβ42 (RoM 1.00; 95% CI 0.81-1.23, p = 0.970). For t-tau and p-tau, average CSF ratios in patients with CAA vs patients with AD were 0.63 (95% CI 0.54-0.74, p < 0.0001) and 0.60 (95% CI 0.50-0.71, p < 0.0001), respectively. CONCLUSION Specific CSF patterns of Aβ42, Aβ40, t-tau, and p-tau might serve as molecular biomarkers of CAA, but analyses in larger CAA cohorts are needed.
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Affiliation(s)
- Andreas Charidimou
- From the Stroke Research Center (A.C., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.O.F.) and Interdepartmental Division of Critical Care (J.O.F.), University of Toronto; and Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute (J.O.F.), St. Michael's Hospital, Toronto, Canada.
| | - Jan O Friedrich
- From the Stroke Research Center (A.C., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.O.F.) and Interdepartmental Division of Critical Care (J.O.F.), University of Toronto; and Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute (J.O.F.), St. Michael's Hospital, Toronto, Canada
| | - Steven M Greenberg
- From the Stroke Research Center (A.C., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.O.F.) and Interdepartmental Division of Critical Care (J.O.F.), University of Toronto; and Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute (J.O.F.), St. Michael's Hospital, Toronto, Canada
| | - Anand Viswanathan
- From the Stroke Research Center (A.C., S.M.G., A.V.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Medicine (J.O.F.) and Interdepartmental Division of Critical Care (J.O.F.), University of Toronto; and Critical Care and Medicine Departments and Li Ka Shing Knowledge Institute (J.O.F.), St. Michael's Hospital, Toronto, Canada
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60
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Werring DJ. CT scanning to diagnose CAA: back to the future? Lancet Neurol 2018; 17:197-198. [PMID: 29331632 DOI: 10.1016/s1474-4422(18)30005-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK.
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61
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Banerjee G, Carare R, Cordonnier C, Greenberg SM, Schneider JA, Smith EE, Buchem MV, Grond JVD, Verbeek MM, Werring DJ. The increasing impact of cerebral amyloid angiopathy: essential new insights for clinical practice. J Neurol Neurosurg Psychiatry 2017; 88:982-994. [PMID: 28844070 PMCID: PMC5740546 DOI: 10.1136/jnnp-2016-314697] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/26/2017] [Accepted: 05/18/2017] [Indexed: 12/29/2022]
Abstract
Cerebral amyloid angiopathy (CAA) has never been more relevant. The last 5 years have seen a rapid increase in publications and research in the field, with the development of new biomarkers for the disease, thanks to advances in MRI, amyloid positron emission tomography and cerebrospinal fluid biomarker analysis. The inadvertent development of CAA-like pathology in patients treated with amyloid-beta immunotherapy for Alzheimer's disease has highlighted the importance of establishing how and why CAA develops; without this information, the use of these treatments may be unnecessarily restricted. Our understanding of the clinical and radiological spectrum of CAA has continued to evolve, and there are new insights into the independent impact that CAA has on cognition in the context of ageing and intracerebral haemorrhage, as well as in Alzheimer's and other dementias. While the association between CAA and lobar intracerebral haemorrhage (with its high recurrence risk) is now well recognised, a number of management dilemmas remain, particularly when considering the use of antithrombotics, anticoagulants and statins. The Boston criteria for CAA, in use in one form or another for the last 20 years, are now being reviewed to reflect these new wide-ranging clinical and radiological findings. This review aims to provide a 5-year update on these recent advances, as well as a look towards future directions for CAA research and clinical practice.
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Affiliation(s)
- Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Roxana Carare
- Division of Clinical Neurosciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Charlotte Cordonnier
- Department of Neurology, Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Steven M Greenberg
- J P Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie A Schneider
- Departments of Pathology and Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel M Verbeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.,Departments of Neurology and Laboratory Medicine, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
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Williams RJ, Goodyear BG, Peca S, McCreary CR, Frayne R, Smith EE, Pike GB. Identification of neurovascular changes associated with cerebral amyloid angiopathy from subject-specific hemodynamic response functions. J Cereb Blood Flow Metab 2017; 37:3433-3445. [PMID: 28145796 PMCID: PMC5624392 DOI: 10.1177/0271678x17691056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is a small-vessel disease preferentially affecting posterior brain regions. Recent evidence has demonstrated the efficacy of functional MRI in detecting CAA-related neurovascular injury, however, it is unknown whether such perturbations are associated with changes in the hemodynamic response function (HRF). Here we estimated HRFs from two different brain regions from block design activation data, in light of recent findings demonstrating how block designs can accurately reflect HRF parameter estimates while maximizing signal detection. Patients with a diagnosis of probable CAA and healthy controls performed motor and visual stimulation tasks. Time-to-peak (TTP), full-width at half-maximum (FWHM), and area under the curve (AUC) of the estimated HRFs were compared between groups and to MRI features associated with CAA including cerebral microbleed (CMB) count. Motor HRFs in CAA patients showed significantly wider FWHM ( P = 0.006) and delayed TTP ( P = 0.03) compared to controls. In the patient group, visual HRF FWHM was positively associated with CMB count ( P = 0.03). These findings indicate that hemodynamic abnormalities in patients with CAA may be reflected in HRFs estimated from block designs across different brain regions. Moreover, visual FWHM may be linked to structural MR indications associated with CAA.
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Affiliation(s)
- Rebecca J Williams
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada
| | - Bradley G Goodyear
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Stefano Peca
- 5 Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Cheryl R McCreary
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Richard Frayne
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Eric E Smith
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - G Bruce Pike
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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63
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Charidimou A, Blacker D, Viswanathan A. Context is everything: From cardiovascular disease to cerebral microbleeds. Int J Stroke 2017; 13:6-10. [PMID: 28906204 DOI: 10.1177/1747493017730907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increasingly, our approach to cerebrovascular disease has become blurred by evidence published in literature often without careful consideration of what this evidence implies for specific patients at hand. In this essay, we analyze key contextual issues in cerebrovascular small vessel disease, in an attempt to highlight the symbolic gap that exists between research and clinical practice, a recurring theme in medicine. We highlight the importance of considering context when using data from epidemiologic, neuroimaging, and biomarker studies in determining relevance to the patient at hand. We argue, that while biomarkers and neuroimaging may eventually serve to help to identify individuals with specific cerebrovascular diseases, we must always continue to understand patients in a specific clinical context. These reflections are particularly relevant when considering cerebral microbleeds-a key marker of cerebrovascular small vessel disease whose detection often raises thorny clinical dilemmas.
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Affiliation(s)
- Andreas Charidimou
- 1 Massachusetts General Hospital, Stroke Research Center, Harvard Medical School, Boston, USA
| | - Deborah Blacker
- 2 Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, USA.,3 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.,4 Massachusetts Alzheimer's Disease Research Center, Boston, USA
| | - Anand Viswanathan
- 1 Massachusetts General Hospital, Stroke Research Center, Harvard Medical School, Boston, USA.,4 Massachusetts Alzheimer's Disease Research Center, Boston, USA
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Valenti R, Reijmer YD, Charidimou A, Boulouis G, Martinez SR, Xiong L, Fotiadis P, Jessel M, Ayres A, Riley G, Pantoni L, Edip Gurol M, Greenberg SM, Viswanathan A. Total small vessel disease burden and brain network efficiency in cerebral amyloid angiopathy. J Neurol Sci 2017; 382:10-12. [PMID: 29110998 DOI: 10.1016/j.jns.2017.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is associated with hemorrhagic and nonhemorrhagic markers small vessel disease (SVD). A composite score to quantify the total burden of SVD on MRI specifically for CAA patients was recently developed. Brain network alterations related to individual MRI markers of SVD in CAA were demonstrated. OBJECTIVES Considering diffusion based network measures sensitive to detect different relevant SVD-related brain injury, we investigated if increased overall SVD injury on MRI corresponds to worse global brain connectivity in CAA. METHODS Seventy-three patients (79.5% male, mean age 70.58±8.22years) with a diagnosis CAA were considered. SVD markers in total MRI SVD score included: lobar cerebral microbleeds, cortical superficial siderosis (cSS), white matter hyperintensities (WMH) and centrum semiovale-enlarged perivascular spaces. Diffusion imaging based network reconstruction was made. The associations between total MRI SVD score and global network efficiency (GNE) were analyzed. RESULTS A modest significant inverse correlation between total MRI SVD score and GNE existed (p=0.013; R2=0.07). GNE was related with the presence of cSS and moderate-severe WMHs. CONCLUSIONS An increased burden of SVD neuroimaging markers corresponds to more reductions in global brain connectivity, implying a possible cumulative effect of overall SVD markers on disrupted physiology. GNE was related with some components of the score, specifically cSS and moderate-severe WMHs.
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Affiliation(s)
- Raffaella Valenti
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA; NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Yael D Reijmer
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA; Université Paris-Descartes, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France
| | - Sergi Ramirez Martinez
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Li Xiong
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Panagiotis Fotiadis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Michael Jessel
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Alison Ayres
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Grace Riley
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
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Planton M, Raposo N, Danet L, Albucher JF, Péran P, Pariente J. Impact of spontaneous intracerebral hemorrhage on cognitive functioning: An update. Rev Neurol (Paris) 2017; 173:481-489. [PMID: 28838790 DOI: 10.1016/j.neurol.2017.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
Abstract
Intracerebral hemorrhage (ICH) accounts for 15% of all strokes and approximately 50% of stroke-related mortality and disability worldwide. Patients who have experienced ICH are at high risk of negative outcome, including stroke and cognitive disorders. Vascular cognitive impairment are frequently seen after brain hemorrhage, yet little is known about them, as most studies have focused on neuropsychological outcome in ischemic stroke survivors, using well-documented acute and chronic cognitive scores. However, recent evidence supports the notion that ICH and dementia are closely related and each increases the risk of the other. The location of the lesion also plays a significant role as regards the neuropsychological profile, while the pathophysiology of ICH can indicate a specific pattern of dysfunction. Several cognitive domains may be affected, such as language, memory, executive function, processing speed and gnosis.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France.
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - L Danet
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - P Péran
- Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
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Charidimou A, Boulouis G, Gurol ME, Ayata C, Bacskai BJ, Frosch MP, Viswanathan A, Greenberg SM. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 2017; 140:1829-1850. [PMID: 28334869 DOI: 10.1093/brain/awx047] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/17/2017] [Indexed: 12/27/2022] Open
Abstract
Sporadic cerebral amyloid angiopathy is a common, well-defined small vessel disease and a largely untreatable cause of intracerebral haemorrhage and contributor to age-related cognitive decline. The term 'cerebral amyloid angiopathy' now encompasses not only a specific cerebrovascular pathological finding, but also different clinical syndromes (both acute and progressive), brain parenchymal lesions seen on neuroimaging and a set of diagnostic criteria-the Boston criteria, which have resulted in increasingly detected disease during life. Over the past few years, it has become clear that, at the pathophysiological level, cerebral amyloid angiopathy appears to be in part a protein elimination failure angiopathy and that this dysfunction is a feed-forward process, which potentially leads to worsening vascular amyloid-β accumulation, activation of vascular injury pathways and impaired vascular physiology. From a clinical standpoint, cerebral amyloid angiopathy is characterized by individual focal lesions (microbleeds, cortical superficial siderosis, microinfarcts) and large-scale alterations (white matter hyperintensities, structural connectivity, cortical thickness), both cortical and subcortical. This review provides an interdisciplinary critical outlook on various emerging and changing concepts in the field, illustrating mechanisms associated with amyloid cerebrovascular pathology and neurological dysfunction.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian J Bacskai
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Matthew P Frosch
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA.,C.S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.,Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 114, 16th St., Charlestown, MA 02129, USA
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Charidimou A, Farid K, Baron JC. Amyloid-PET in sporadic cerebral amyloid angiopathy: A diagnostic accuracy meta-analysis. Neurology 2017; 89:1490-1498. [PMID: 28855406 DOI: 10.1212/wnl.0000000000004539] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis synthesizing evidence of the value and accuracy of amyloid-PET in diagnosing patients with sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic literature search, we identified all case-control studies with extractable data relevant for the sensitivity and specificity of amyloid-PET positivity in symptomatic patients with CAA (cases) vs healthy participants or patients with spontaneous deep intracerebral hemorrhage (ICH) (control groups). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 151 controls, were eligible and included in the meta-analysis. The studies were of moderate to high quality and varied in several methodological aspects, including definition of PET-positive and PET-negative cases and relevant cutoffs. The sensitivity of amyloid-PET for CAA diagnosis ranged from 60% to 91% and the specificity from 56% to 90%. The overall pooled sensitivity was 79% (95% confidence interval [CI] 62-89) and specificity was 78% (95% CI 67-86) for CAA diagnosis. A predefined subgroup analysis of studies restricted to symptomatic patients presenting with lobar ICH CAA (n = 58 vs 86 controls) resulted in 79% sensitivity (95% CI 61-90%) and 84% specificity (95% CI 65-93%). In prespecified bivariate diagnostic accuracy meta-analysis of 2 studies using 18F-florbetapir-PET, the sensitivity for CAA-ICH diagnosis was 90% (95% CI 76-100%) and specificity was 88% (95% CI 74-100%). CONCLUSIONS Amyloid-PET appears to have moderate to good diagnostic accuracy in differentiating patients with probable CAA from cognitively normal healthy controls or patients with deep ICH. Given that amyloid-PET labels both cerebrovascular and parenchymal amyloid, a negative scan might be useful to rule out CAA in the appropriate clinical setting.
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Affiliation(s)
- Andreas Charidimou
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France.
| | - Karim Farid
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
| | - Jean-Claude Baron
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
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Raposo N, Planton M, Péran P, Payoux P, Bonneville F, Lyoubi A, Albucher JF, Acket B, Salabert AS, Olivot JM, Hitzel A, Chollet F, Pariente J. Florbetapir imaging in cerebral amyloid angiopathy-related hemorrhages. Neurology 2017; 89:697-704. [PMID: 28724587 DOI: 10.1212/wnl.0000000000004228] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/24/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To assess whether 18F-florbetapir, a PET amyloid tracer, could bind vascular amyloid in cerebral amyloid angiopathy (CAA) by comparing cortical florbetapir retention during the acute phase between patients with CAA-related lobar intracerebral hemorrhage (ICH) and patients with hypertension-related deep ICH. METHODS Patients with acute CAA-related lobar ICH were prospectively enrolled and compared with patients with deep ICH. 18F-florbetapir PET, brain MRI, and APOE genotype were obtained for all participants. Cortical florbetapir standard uptake value ratio (SUVr) was calculated with the whole cerebellum used as a reference. Patients with CAA and those with deep ICH were compared for mean cortical florbetapir SUVr values. RESULTS Fifteen patients with acute lobar ICH fulfilling the modified Boston criteria for probable CAA (mean age = 67 ± 12 years) and 18 patients with acute deep ICH (mean age = 63 ± 11 years) were enrolled. Mean global cortical florbetapir SUVr was significantly higher among patients with CAA-related ICH than among patients with deep ICH (1.27 ± 0.12 vs 1.12 ± 0.12, p = 0.001). Cortical florbetapir SUVr differentiated patients with CAA-ICH from those with deep ICH (area under the curve = 0.811; 95% confidence interval [CI] 0.642-0.980) with a sensitivity of 0.733 (95% CI 0.475-0.893) and a specificity of 0.833 (95% CI 0.598-0.948). CONCLUSIONS Cortical florbetapir uptake is increased in patients with CAA-related ICH relative to those with deep ICH. Although 18F-florbetapir PET can label vascular β-amyloid and might serve as an outcome marker in future clinical trials, its diagnostic value in acute CAA-related ICH seems limited in clinical practice.
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Affiliation(s)
- Nicolas Raposo
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France.
| | - Mélanie Planton
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Patrice Péran
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Pierre Payoux
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Fabrice Bonneville
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Aicha Lyoubi
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jean François Albucher
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Blandine Acket
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Anne Sophie Salabert
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jean Marc Olivot
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Anne Hitzel
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - François Chollet
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
| | - Jérémie Pariente
- From the Neurology Department (N.R., M.P., A.L., J.F.A., B.A., J.M.O., F.C., J.P.), Nuclear Medicine Department (P. Payoux, A.S.S., A.H.), and Neuroradiology Department (F.B.), Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse; and Toulouse NeuroImaging Center (N.R., M.P., P. Péran, P. Payoux, F.B., A.L., J.F.A., B.A., A.S.S., J.M.O., A.H., F.C., J.P.), Université de Toulouse, Inserm, UPS, France
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Greenberg SM. William M. Feinberg Award for Excellence in Clinical Stroke: Big Pictures and Small Vessels. Stroke 2017; 48:2628-2631. [PMID: 28698255 DOI: 10.1161/strokeaha.117.017246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/10/2017] [Accepted: 06/22/2017] [Indexed: 01/05/2023]
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Prats-Sanchez L, Martínez-Domeño A, Camps-Renom P, Delgado-Mederos R, Guisado-Alonso D, Marín R, Dorado L, Rudilosso S, Gómez-González A, Purroy F, Gómez-Choco M, Cánovas D, Cocho D, Garces M, Abilleira S, Martí-Fàbregas J. Risk factors are different for deep and lobar remote hemorrhages after intravenous thrombolysis. PLoS One 2017. [PMID: 28640874 PMCID: PMC5480833 DOI: 10.1371/journal.pone.0178284] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and purpose Remote parenchymal haemorrhage (rPH) after intravenous thrombolysis is defined as hemorrhages that appear in brain regions without visible ischemic damage, remote from the area of ischemia causing the initial stroke symptom. The pathophysiology of rPH is not clear and may be explained by different underlying mechanisms. We hypothesized that rPH may have different risk factors according to the bleeding location. We report the variables that we found associated with deep and lobar rPH after intravenous thrombolysis. Methods This is a descriptive study of patients with ischemic stroke who were treated with intravenous thrombolysis. These patients were included in a multicenter prospective registry. We collected demographic, clinical and radiological data. We evaluated the number and distribution of cerebral microbleeds (CMB) from Magnetic Resonance Imaging. We excluded patients treated endovascularly, patients with parenchymal hemorrhage without concomitant rPH and stroke mimics. We compared the variables from patients with deep or lobar rPH with those with no intracranial hemorrhage. Results We studied 934 patients (mean age 73.9±12.6 years) and 52.8% were men. We observed rPH in 34 patients (3.6%); 9 (0.9%) were deep and 25 (2.7%) lobar. No hemorrhage was observed in 900 (96.6%) patients. Deep rPH were associated with hypertensive episodes within first 24 hours after intravenous thrombolysis (77.7% vs 23.3%, p<0.001). Lobar rPH were associated with the presence of CMB (53.8% vs 7.9%, p<0.001), multiple (>1) CMB (30.7% vs 4.4%, p = 0.003), lobar CMB (53.8% vs 3.0%, p<0.001) and severe leukoaraiosis (76.9% vs 42%, p = 0.02). Conclusions A high blood pressure within the first 24 hours after intravenous thrombolysis is associated with deep rPH, whereas lobar rPH are associated with imaging markers of amyloid deposition. Thus, our results suggest that deep and lobar rPH after intravenous thrombolysis may have different mechanisms.
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Affiliation(s)
- Luis Prats-Sanchez
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
- * E-mail:
| | - Alejandro Martínez-Domeño
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
| | - Pol Camps-Renom
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
| | - Raquel Delgado-Mederos
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
| | - Daniel Guisado-Alonso
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
| | - Rebeca Marín
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
| | - Laura Dorado
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Francisco Purroy
- Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - David Cánovas
- Department of Neurology, Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General Universitari de Granollers, Granollers, Spain
| | - Moises Garces
- Department of Neurology, Hospital Verge de la Cinta, Tortosa, Spain
| | - Sonia Abilleira
- Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Servei de neuorlogia, Hospital de la Santa Creu i Sant Pau (Biomedical Research Institute, IIB-Sant Pau), Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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71
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Farid K, Charidimou A, Baron JC. Amyloid positron emission tomography in sporadic cerebral amyloid angiopathy: A systematic critical update. NEUROIMAGE-CLINICAL 2017; 15:247-263. [PMID: 28560150 PMCID: PMC5435601 DOI: 10.1016/j.nicl.2017.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 01/07/2023]
Abstract
Sporadic cerebral amyloid angiopathy (CAA) is a very common small vessel disease of the brain, showing preferential and progressive amyloid-βdeposition in the wall of small arterioles and capillaries of the leptomeninges and cerebral cortex. CAA now encompasses not only a specific cerebrovascular pathological trait, but also different clinical syndromes - including spontaneous lobar intracerebral haemorrhage (ICH), dementia and ‘amyloid spells’ - an expanding spectrum of brain parenchymal MRI lesions and a set of diagnostic criteria – the Boston criteria, which have resulted in increasingly detecting CAA during life. Although currently available validated diagnostic criteria perform well in multiple lobar ICH, a formal diagnosis is currently lacking unless a brain biopsy is performed. This is partly because in practice CAA MRI biomarkers provide only indirect evidence for the disease. An accurate diagnosis of CAA in different clinical settings would have substantial impact for ICH risk stratification and antithrombotic drug use in elderly people, but also for sample homogeneity in drug trials. It has recently been demonstrated that vascular (in addition to parenchymal) amyloid-βdeposition can be detected and quantified in vivo by positron emission tomography (PET) amyloid tracers. This non-invasive approach has the potential to provide a molecular signature of CAA, and could in turn have major clinical impact. However, several issues around amyloid-PET in CAA remain unsettled and hence its diagnostic utility is limited. In this article we systematically review and critically appraise the published literature on amyloid-PET (PiB and other tracers) in sporadic CAA. We focus on two key areas: (a) the diagnostic utility of amyloid-PET in CAA and (b) the use of amyloid-PET as a window to understand pathophysiological mechanism of the disease. Key issues around amyloid-PET imaging in CAA, including relevant technical aspects are also covered in depth. A total of six small-scale studies have addressed (or reported data useful to address) the diagnostic utility of late-phase amyloid PET imaging in CAA, and one additional study dealt with early PiB images as a proxy of brain perfusion. Across these studies, amyloid PET imaging has definite diagnostic utility (currently tested only in probable CAA): it helps rule out CAA if negative, whether compared to healthy controls or to hypertensive deep ICH controls. If positive, however, differentiation from underlying incipient Alzheimer's disease (AD) can be challenging and so far, no approach (regional values, ratios, visual assessment) seems sufficient and specific enough, although early PiB data seem to hold promise. Based on the available evidence reviewed, we suggest a tentative diagnostic flow algorithm for amyloid-PET use in the clinical setting of suspected CAA, combining early- and late-phase PiB-PET images. We also identified ten mechanistic amyloid-PET studies providing early but promising proof-of-concept data on CAA pathophysiology and its various manifestations including key MRI lesions, cognitive impairment and large scale brain alterations. Key open questions that should be addressed in future studies of amyloid-PET imaging in CAA are identified and highlighted. CAA is a major cause of brain haemorrhage and cognitive impairment in aged subjects. Without brain biopsy, its current diagnosis largely relies on indirect MRI markers. Amyloid PET may provide a non-invasive molecular signature to formally diagnose CAA. Based on our review, amyloid PET has excellent sensitivity but specificity is unclear. Amyloid PET is also useful to investigate mechanisms underlying CAA manifestations.
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Affiliation(s)
- Karim Farid
- Department of Nuclear Medicine, Martinique University Hospital, Fort-de-France, Martinique
| | - Andreas Charidimou
- Massachusetts General Hospital, Department of Neurology, Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Jean-Claude Baron
- U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France.
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72
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Banerjee G, Kim HJ, Fox Z, Jäger HR, Wilson D, Charidimou A, Na HK, Na DL, Seo SW, Werring DJ. MRI-visible perivascular space location is associated with Alzheimer's disease independently of amyloid burden. Brain 2017; 140:1107-1116. [PMID: 28335021 DOI: 10.1093/brain/awx003] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/04/2016] [Indexed: 12/12/2022] Open
Abstract
Perivascular spaces that are visible on magnetic resonance imaging (MRI) are a neuroimaging marker of cerebral small vessel disease. Their location may relate to the type of underlying small vessel pathology: those in the white matter centrum semi-ovale have been associated with cerebral amyloid angiopathy, while those in the basal ganglia have been associated with deep perforating artery arteriolosclerosis. As cerebral amyloid angiopathy is an almost invariable pathological finding in Alzheimer's disease, we hypothesized that MRI-visible perivascular spaces in the centrum semi-ovale would be associated with a clinical diagnosis of Alzheimer's disease, whereas those in the basal ganglia would be associated with subcortical vascular cognitive impairment. We also hypothesized that MRI-visible perivascular spaces in the centrum semi-ovale would be associated with brain amyloid burden, as detected by amyloid positron emission tomography using 11C-Pittsburgh B compound (PiB-PET). Two hundred and twenty-six patients (Alzheimer's disease n = 110; subcortical vascular cognitive impairment n = 116) with standardized MRI and PiB-PET imaging were included. MRI-visible perivascular spaces were rated using a validated 4-point visual rating scale, and then categorized by severity ('none/mild', 'moderate' or 'frequent/severe'). Univariable and multivariable regression analyses were performed. Those with Alzheimer's disease-related cognitive impairment were younger, more likely to have a positive PiB-PET scan and carry at least one apolipoprotein E ɛ4 allele; those with subcortical vascular cognitive impairment were more likely to have hypertension, diabetes mellitus, hyperlipidaemia, prior stroke, lacunes, deep microbleeds, and carry the apolipoprotein E ɛ3 allele. In adjusted analyses, the severity of MRI-visible perivascular spaces in the centrum semi-ovale was independently associated with clinically diagnosed Alzheimer's disease (frequent/severe grade odds ratio 6.26, 95% confidence interval 1.66-23.58; P = 0.017, compared with none/mild grade), whereas the severity of MRI-visible perivascular spaces in the basal ganglia was associated with clinically diagnosed subcortical vascular cognitive impairment and negatively predicted Alzheimer's disease (frequent/severe grade odds ratio 0.03, 95% confidence interval 0.00-0.44; P = 0.009, compared with none/mild grade). MRI-visible perivascular space severity in either location did not predict PiB-PET. These findings provide further evidence that the anatomical distribution of MRI-visible perivascular spaces may reflect the underlying cerebral small vessel disease. Using MRI-visible perivascular space location and severity together with other imaging markers may improve the diagnostic value of neuroimaging in memory clinic populations, in particular in differentiating between clinically diagnosed Alzheimer's and subcortical vascular cognitive impairment.
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Affiliation(s)
- Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Hee Jin Kim
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Zoe Fox
- Biostatistics Group, University College London Hospitals and University College London Research Support Centre, University College London, Gower Street, London, WC1E 6BT, UK
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, WC1N 3BG, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Andreas Charidimou
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
| | - Han Kyu Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Russell Square House, 10-12 Russell Square, London WC1B 5EH, UK
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73
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Saito S, Yamamoto Y, Maki T, Hattori Y, Ito H, Mizuno K, Harada-Shiba M, Kalaria RN, Fukushima M, Takahashi R, Ihara M. Taxifolin inhibits amyloid-β oligomer formation and fully restores vascular integrity and memory in cerebral amyloid angiopathy. Acta Neuropathol Commun 2017; 5:26. [PMID: 28376923 PMCID: PMC5379578 DOI: 10.1186/s40478-017-0429-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/22/2017] [Indexed: 01/31/2023] Open
Abstract
Cerebral amyloid angiopathy (CAA) induces various forms of cerebral infarcts and hemorrhages from vascular amyloid-β accumulation, resulting in acceleration of cognitive impairment, which is currently untreatable. Soluble amyloid-β protein likely impairs cerebrovascular integrity as well as cognitive function in early stage Alzheimer’s disease. Taxifolin, a flavonol with strong anti-oxidative and anti-glycation activities, has been reported to disassemble amyloid-β in vitro but the in vivo relevance remains unknown. Here, we investigated whether taxifolin has therapeutic potential in attenuating CAA, hypothesizing that inhibiting amyloid-β assembly may facilitate its clearance through several elimination pathways. Vehicle- or taxifolin-treated Tg-SwDI mice (commonly used to model CAA) were used in this investigation. Cognitive and cerebrovascular function, as well as the solubility and oligomerization of brain amyloid-β proteins, were investigated. Spatial reference memory was assessed by water maze test. Cerebral blood flow was measured with laser speckle flowmetry and cerebrovascular reactivity evaluated by monitoring cerebral blood flow changes in response to hypercapnia. Significantly reduced cerebrovascular pan-amyloid-β and amyloid-β1-40 accumulation was found in taxifolin-treated Tg-SwDI mice compared to vehicle-treated counterparts (n = 5). Spatial reference memory was severely impaired in vehicle-treated Tg-SwDI mice but normalized after taxifolin treatment, with scoring similar to wild type mice (n = 10–17). Furthermore, taxifolin completely restored decreased cerebral blood flow and cerebrovascular reactivity in Tg-SwDI mice (n = 4–6). An in vitro thioflavin-T assay showed taxifolin treatment resulted in efficient inhibition of amyloid-β1-40 assembly. In addition, a filter trap assay and ELISA showed Tg-SwDI mouse brain homogenates exhibited significantly reduced levels of amyloid-β oligomers in vivo after taxifolin treatment (n = 4–5), suggesting the effects of taxifolin on CAA are attributable to the inhibition of amyloid-β oligomer formation. In conclusion, taxifolin prevents amyloid-β oligomer assembly and fully sustains cognitive and cerebrovascular function in a CAA model mice. Taxifolin thus appears a promising therapeutic approach for CAA.
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74
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Vascular basement membrane alterations and β-amyloid accumulations in an animal model of cerebral small vessel disease. Clin Sci (Lond) 2017; 131:1001-1013. [PMID: 28348005 DOI: 10.1042/cs20170004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 12/23/2022]
Abstract
Non-amyloid cerebral small vessel disease (CSVD) and cerebral amyloid angiopathy (CAA) may be interrelated through the damaged basement membranes (BMs) and extracellular matrix changes of small vessels, resulting in a failure of β-amyloid (Aβ) transport and degradation. We analyzed BM changes and the pattern of deposition of Aβ in the walls of blood vessels in spontaneously hypertensive stroke-prone rats (SHRSP), a non-transgenic CSVD model. In 45 SHRSP and 38 Wistar rats aged 18 to 32 weeks: (i) the percentage area immunostained for vascular collagen IV and laminin was quantified; (ii) the capillary BM thickness as well as endothelial and pericyte pathological changes were analysed using transmission electron microscopy (TEM); and (iii) the presence of vascular Aβ was assessed. Compared with controls, SHRSP exhibited a significantly higher percentage area immunostained with collagen IV in the striatum and thalamus. SHRSP also revealed an age-dependent increase of the capillary BM thickness and of endothelial vacuoles (caveolae) within subcortical regions. Endogenous Aβ deposits in the walls of small blood vessels were observed in the cortex (with the highest incidence found within fronto-parietal areas), striatum, thalamus and hippocampus. Vascular β-amyloid accumulations were frequently detected at sites of small vessel wall damage. Our data demonstrate changes in the expression of collagen IV and of the ultrastructure of BMs in the small vessels of SHRSP. Alterations are accompanied by vascular deposits of endogenous Aβ. Impaired β-amyloid clearance along perivascular and endothelial pathways and failure of extracellular Aβ degradation may be the key mechanisms connecting non-amyloid CSVD and CAA.
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75
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van Veluw SJ, Kuijf HJ, Charidimou A, Viswanathan A, Biessels GJ, Rozemuller AJM, Frosch MP, Greenberg SM. Reduced vascular amyloid burden at microhemorrhage sites in cerebral amyloid angiopathy. Acta Neuropathol 2017; 133:409-415. [PMID: 27771772 PMCID: PMC5325834 DOI: 10.1007/s00401-016-1635-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/11/2022]
Abstract
Microhemorrhages are strongly associated with advanced cerebral amyloid angiopathy (CAA). Although it has been frequently proposed that the deposition of Aβ in the walls of cortical vessels directly causes microhemorrhages, this has not been studied in great detail, mainly because the ruptured vessels are often missed on routine histopathologic examination. Here, we examined histopathological data from studies targeting microhemorrhages with high-resolution ex vivo 7 T MRI in nine cases with moderate-to-severe CAA, and assessed the presence of Aβ in the walls of involved vessels. We also assessed the density of Aβ positive cortical vessels in areas surrounding microhemorrhages compared to control areas. In seven out of 19 microhemorrhages, the presumed involved vessel could be identified on the histopathological section. Only one of these vessels was positive for Aβ at the site of rupture. Moreover, the density of Aβ positive cortical vessels was lower (1.0 per mm2) within a range of 315 µm surrounding the microhemorrhage, compared to control areas (2.0 per mm2; p < 0.05). These findings question the widely held assumption that the deposition of Aβ in the walls of cortical vessels directly causes microhemorrhages.
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76
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Bouvy WH, Zwanenburg JJM, Reinink R, Wisse LEM, Luijten PR, Kappelle LJ, Geerlings MI, Biessels GJ. Perivascular spaces on 7 Tesla brain MRI are related to markers of small vessel disease but not to age or cardiovascular risk factors. J Cereb Blood Flow Metab 2016; 36:1708-1717. [PMID: 27154503 PMCID: PMC5076789 DOI: 10.1177/0271678x16648970] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
Abstract
Cerebral perivascular spaces (PVS) are small physiological structures around blood vessels in the brain. MRI visible PVS are associated with ageing and cerebral small vessel disease (SVD). 7 Tesla (7T) MRI improves PVS detection. We investigated the association of age, vascular risk factors, and imaging markers of SVD with PVS counts on 7 T MRI, in 50 persons aged ≥ 40. The average PVS count ± SD in the right hemisphere was 17 ± 6 in the basal ganglia and 71 ± 28 in the semioval centre. We observed no relation between age or vascular risk factors and PVS counts. The presence of microbleeds was related to more PVS in the basal ganglia (standardized beta 0.32; p = 0.04) and semioval centre (standardized beta 0.39; p = 0.01), and white matter hyperintensity volume to more PVS in the basal ganglia (standardized beta 0.41; p = 0.02). We conclude that PVS counts on 7T MRI are high and are related SVD markers, but not to age and vascular risk factors. This latter finding may indicate that due to the high sensitivity of 7T MRI, the correlation of PVS counts with age or vascular risk factors may be attenuated by the detection of "normal", non-pathological PVS.
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Affiliation(s)
- Willem H Bouvy
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaco J M Zwanenburg
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rik Reinink
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura E M Wisse
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Peter R Luijten
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
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77
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Microbleeds in Alzheimer's Disease: A Neuropsychological Overview and Meta-Analysis. Can J Neurol Sci 2016; 43:753-759. [PMID: 27640605 DOI: 10.1017/cjn.2016.296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The current literature on the role of brain microbleeds (MB) on the neuropsychological outcomes of Alzheimer's disease (AD) is heterogeneous. We therefore meta-analytically examined the neuropsychological literature pertaining to MBs in AD. Using a priori selected criteria, studies with cross-sectional neuropsychological assessment on MBs and AD were reviewed. Six of 122 studies met selection criteria and provided neuropsychological data on either AD with MB and without MB, or in contrast to healthy controls. The global neuropsychological difference between AD with MB and AD without MB based on random effect model was nonsignificant, heterogeneous, and small (Effect Size =-0.155; 95% confidence interval =-0.465 to 0.155; p value =0.326; Heterogenity: Q-value =12.744; degrees of freedom =5; p =0.026; I2 =61%). The contribution of MBs to cognitive deficits in AD remains unclear. Future studies of MB in AD should strive to use standardized neuroimaging techniques with high sensitivity for MB, a common standard for MB definition, and neuropsychological tests sensitive for detecting subtle cognitive impairment.
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78
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van Veluw SJ, Charidimou A, van der Kouwe AJ, Lauer A, Reijmer YD, Costantino I, Gurol ME, Biessels GJ, Frosch MP, Viswanathan A, Greenberg SM. Microbleed and microinfarct detection in amyloid angiopathy: a high-resolution MRI-histopathology study. Brain 2016; 139:3151-3162. [PMID: 27645801 DOI: 10.1093/brain/aww229] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/05/2016] [Accepted: 07/31/2016] [Indexed: 01/31/2023] Open
Abstract
Cerebral amyloid angiopathy is a common neuropathological finding in the ageing human brain, associated with cognitive impairment. Neuroimaging markers of severe cerebral amyloid angiopathy are cortical microbleeds and microinfarcts. These parenchymal brain lesions are considered key contributors to cognitive impairment. Therefore, they are important targets for therapeutic strategies and may serve as surrogate neuroimaging markers in clinical trials. We aimed to gain more insight into the pathological basis of magnetic resonance imaging-defined microbleeds and microinfarcts in cerebral amyloid angiopathy, and to explore the pathological burden that remains undetected, by using high and ultra-high resolution ex vivo magnetic resonance imaging, as well as detailed histological sampling. Brain samples from five cases (mean age 85 ± 6 years) with pathology-proven cerebral amyloid angiopathy and multiple microbleeds on in vivo clinical magnetic resonance imaging were subjected to high-resolution ex vivo 7 T magnetic resonance imaging. On the obtained high-resolution (200 μm isotropic voxels) ex vivo magnetic resonance images, 171 microbleeds were detected compared to 66 microbleeds on the corresponding in vivo magnetic resonance images. Of 13 sampled microbleeds that were matched on histology, five proved to be acute and eight old microhaemorrhages. The iron-positive old microhaemorrhages appeared approximately four times larger on magnetic resonance imaging compared to their size on histology. In addition, 48 microinfarcts were observed on ex vivo magnetic resonance imaging in three out of five cases (two cases exhibited no microinfarcts). None of them were visible on in vivo 1.5 T magnetic resonance imaging after a retrospective analysis. Of nine sampled microinfarcts that were matched on histology, five were confirmed as acute and four as old microinfarcts. Finally, we explored the proportion of microhaemorrhage and microinfarct burden that is beyond the detection limits of ex vivo magnetic resonance imaging, by scanning a smaller sample at ultra-high resolution, followed by serial sectioning. At ultra-high resolution (75 μm isotropic voxels) magnetic resonance imaging we observed an additional 48 microbleeds (compared to high resolution), which proved to correspond to vasculopathic changes (i.e. morphological changes to the small vessels) instead of frank haemorrhages on histology. After assessing the serial sections of this particular sample, no additional haemorrhages were observed that were missed on magnetic resonance imaging. In contrast, nine microinfarcts were found in these sections, of which six were only retrospectively visible at ultra-high resolution. In conclusion, these findings suggest that microbleeds on in vivo magnetic resonance imaging are specific for microhaemorrhages in cerebral amyloid angiopathy, and that increasing the resolution of magnetic resonance images results in the detection of more 'non-haemorrhagic' pathology. In contrast, the vast majority of microinfarcts currently remain under the detection limits of clinical in vivo magnetic resonance imaging.
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Affiliation(s)
- Susanne J van Veluw
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA .,2 Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andreas Charidimou
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andre J van der Kouwe
- 3 Athinoula A. Martinos Center for Biomedical Research, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Arne Lauer
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yael D Reijmer
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Isabel Costantino
- 4 Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Edip Gurol
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- 2 Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew P Frosch
- 4 Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- 1 J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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79
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Gurol ME, Becker JA, Fotiadis P, Riley G, Schwab K, Johnson KA, Greenberg SM. Florbetapir-PET to diagnose cerebral amyloid angiopathy: A prospective study. Neurology 2016; 87:2043-2049. [PMID: 27605173 DOI: 10.1212/wnl.0000000000003197] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/27/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE We hypothesized that florbetapir, a Food and Drug Administration-approved PET tracer, could distinguish cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) from hypertensive ICH (HTN-ICH). METHODS We prospectively enrolled survivors of primary ICH related to probable CAA (per Boston Criteria, n = 10) and HTN-ICH (n = 9) without dementia. All patients underwent florbetapir-PET and multimodal MRI, and patients with CAA had additional Pittsburgh compound B (PiB) PET. Amyloid burden was assessed quantitatively (standard uptake value ratio [SUVR]) and visually classified as positive or negative. RESULTS The CAA and HTN-ICH groups had similar age (66.9 vs 67.1), sex, and leukoaraiosis volumes (31 vs 30 mL, all p > 0.8). Florbetapir uptake and PiB retention strongly correlated in patients with CAA both globally within cerebral cortex (r = 0.96, p < 0.001) and regionally in lobar cortices (all r > 0.8, all p ≤ 0.01). Mean global cortical florbetapir uptake was substantially higher in CAA than HTN-ICH (SUVR: 1.41 ± 0.17 vs 1.15 ± 0.08, p = 0.001), as was mean occipital SUVR (1.44 ± 0.12 vs 1.17 ± 0.08, p < 0.001), even after correcting for global SUVR (p = 0.03). Visual rating for positive/negative florbetapir demonstrated perfect interrater agreement (k = 1) and was positive for all 10 patients with CAA vs 1 of 9 HTN-ICH patients (sensitivity 100%, specificity 89%). CONCLUSIONS Florbetapir appears to label vascular amyloid in patients with CAA-related ICH. The approved florbetapir binary visual reading method can have diagnostic value in appropriate clinical settings. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that florbetapir-PET provides a sensitivity of 100% (95% confidence interval [CI] 66%-100%) and specificity of 89% (95% CI 51%-99%) for determination of probable CAA among cognitively normal patients.
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Affiliation(s)
- M Edip Gurol
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - J Alex Becker
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Grace Riley
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin Schwab
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Keith A Johnson
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Center, Department of Neurology (M.E.G., P.F., G.R., K.S., S.M.G.), and Division of Nuclear Medicine and Molecular Imaging (J.A.B., K.A.J.), Massachusetts General Hospital, Harvard Medical School, Boston
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80
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Reijmer YD, Fotiadis P, Riley GA, Xiong L, Charidimou A, Boulouis G, Ayres AM, Schwab K, Rosand J, Gurol ME, Viswanathan A, Greenberg SM. Progression of Brain Network Alterations in Cerebral Amyloid Angiopathy. Stroke 2016; 47:2470-5. [PMID: 27576378 DOI: 10.1161/strokeaha.116.014337] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE We recently showed that cerebral amyloid angiopathy (CAA) is associated with functionally relevant brain network impairments, in particular affecting posterior white matter connections. Here we examined how these brain network impairments progress over time. METHODS Thirty-three patients with probable CAA underwent multimodal brain magnetic resonance imaging at 2 time points (mean follow-up time: 1.3±0.4 years). Brain networks of the hemisphere free of intracerebral hemorrhages were reconstructed using fiber tractography and graph theory. The global efficiency of the network and mean fractional anisotropies of posterior-posterior, frontal-frontal, and posterior-frontal network connections were calculated. Patients with moderate versus severe CAA were defined based on microbleed count, dichotomized at the median (median=35). RESULTS Global efficiency of the intracerebral hemorrhage-free hemispheric network declined from baseline to follow-up (-0.008±0.003; P=0.029). The decline in global efficiency was most pronounced for patients with severe CAA (group×time interaction P=0.03). The decline in global network efficiency was associated with worse executive functioning (β=0.46; P=0.03). Examination of subgroups of network connections revealed a decline in fractional anisotropies of posterior-posterior connections at both levels of CAA severity (-0.006±0.002; P=0.017; group×time interaction P=0.16). The fractional anisotropies of posterior-frontal and frontal-frontal connections declined in patients with severe but not moderate CAA (group×time interaction P=0.007 and P=0.005). Associations were independent of change in white matter hyperintensity volume. CONCLUSIONS Brain network impairment in patients with CAA worsens measurably over just 1.3-year follow-up and seem to progress from posterior to frontal connections with increasing disease severity.
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Affiliation(s)
- Yael D Reijmer
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Grace A Riley
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Li Xiong
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alison M Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin Schwab
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.
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81
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Yang Y, Kimura-Ohba S, Thompson J, Rosenberg GA. Rodent Models of Vascular Cognitive Impairment. Transl Stroke Res 2016; 7:407-14. [PMID: 27498679 DOI: 10.1007/s12975-016-0486-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/09/2016] [Accepted: 07/19/2016] [Indexed: 01/03/2023]
Abstract
Vascular cognitive impairment dementia (VCID), which is an increasingly important cause of dementia in the elderly, lacks effective treatments. Many different types of vascular disease are included under the diagnosis of VCID, including large vessel disease with multiple strokes and small vessel disease with lacunar infarcts and white matter disease. Animal models have been developed to study the multiple forms of VCID. Because of its progressive course, small vessel disease (SVD) is thought to be the optimal form of VCID for treatment. One theory is that the pathophysiology involves hypoxic hypoperfusion resulting in injury to the white matter and neuronal death. Bilateral occlusion of the common carotid arteries (BCAO) in a normotensive rat, which reduces cerebral blood flow, induces hypoxia with white matter damage; this model has been used to test drugs to block the injury. Another model is the spontaneously hypertensive/stroke prone rat (SHR/SP). Hypertension leads to small vessel disease resulting in progressive damage to the white matter, cortex, and hippocampus. Bilateral carotid artery stenosis (BCAS) with coils or ameroid constrictors produces a slower development of changes than BCAO, avoiding the acute ischemia. A few studies have been done with the two-clip, two-vessel occlusion renal model for induction of hypertension. There are benefits and drawbacks to each of these models with the model selected depending on the type of vascular damage that is to be studied. This review describes the most commonly used models, and the drugs that have been used to reduce the damage.
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Affiliation(s)
- Yi Yang
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Shihoko Kimura-Ohba
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Jeffrey Thompson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | - Gary A Rosenberg
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
- Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
- Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA.
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82
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Charidimou A, Martinez-Ramirez S, Reijmer YD, Oliveira-Filho J, Lauer A, Roongpiboonsopit D, Frosch M, Vashkevich A, Ayres A, Rosand J, Gurol ME, Greenberg SM, Viswanathan A. Total Magnetic Resonance Imaging Burden of Small Vessel Disease in Cerebral Amyloid Angiopathy: An Imaging-Pathologic Study of Concept Validation. JAMA Neurol 2016; 73:994-1001. [PMID: 27366898 PMCID: PMC5283697 DOI: 10.1001/jamaneurol.2016.0832] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Cerebral amyloid angiopathy (CAA) is characteristically associated with magnetic resonance imaging (MRI) biomarkers of small vessel brain injury, including strictly lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities. Although these neuroimaging markers reflect distinct pathophysiologic aspects in CAA, no studies to date have combined these structural imaging features to gauge total brain small vessel disease burden in CAA. OBJECTIVES To investigate whether a composite score can be developed to capture the total brain MRI burden of small vessel disease in CAA and to explore whether this score contributes independent and complementary information about CAA severity, defined as intracerebral hemorrhage during life or bleeding-related neuropathologic changes. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study examined a single-center neuropathologic CAA cohort of eligible patients from the Massachusetts General Hospital from January 1, 1997, through December 31, 2012. Data analysis was performed from January 2, 2015, to January 9, 2016. Patients with pathologic evidence of CAA (ie, any presence of CAA from routinely collected brain biopsy specimen, biopsy specimen at hematoma evacuation, or autopsy) and available brain MRI sequences of adequate quality, including T2-weighted, T2*-weighted gradient-recalled echo, and/or susceptibility-weighted imaging and fluid-attenuated inversion recovery sequences, were considered for the study. MAIN OUTCOMES AND MEASURES Brain MRIs were rated for lobar cerebral microbleeds, cortical superficial siderosis, centrum semiovale perivascular spaces, and white matter hyperintensities. All 4 MRI lesions were incorporated into a prespecified ordinal total small vessel disease score, ranging from 0 to 6 points. Associations with severity of CAA-associated vasculopathic changes (fibrinoid necrosis and concentric splitting of the wall), clinical presentation, number of intracerebral hemorrhages, and other imaging markers not included in the score were explored using logistic and ordinal regression. RESULTS In total, 105 patients with pathologically defined CAA were included: 52 with autopsies, 22 with brain biopsy specimens, and 31 with pathologic samples from hematoma evacuations. The mean (range) age of the patients was 73 (71-74) years, and 55 (52.4%) were women. In multivariable ordinal regression analysis, severity of CAA-associated vasculopathic changes (odds ratio, 2.40; 95% CI, 1.06-5.45; P = .04) and CAA presentation with symptomatic intracerebral hemorrhage (odds ratio, 2.23; 95% CI, 1.07-4.64; P = .03) were independently associated with the total MRI small vessel disease score. The score was associated with small, acute, diffusion-weighted imaging lesions and posterior white matter hyperintensities in adjusted analyses. CONCLUSIONS AND RELEVANCE This study provides evidence of concept validity of a total MRI small vessel disease score in CAA. After further validation, this approach can be potentially used in prospective clinical studies.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Yael D. Reijmer
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Jamary Oliveira-Filho
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Arne Lauer
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Duangnapa Roongpiboonsopit
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Matthew Frosch
- C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anastasia Vashkevich
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Alison Ayres
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mahmut Edip Gurol
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Steven M. Greenberg
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA
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Shinohara M, Murray ME, Frank RD, Shinohara M, DeTure M, Yamazaki Y, Tachibana M, Atagi Y, Davis MD, Liu CC, Zhao N, Painter MM, Petersen RC, Fryer JD, Crook JE, Dickson DW, Bu G, Kanekiyo T. Impact of sex and APOE4 on cerebral amyloid angiopathy in Alzheimer's disease. Acta Neuropathol 2016; 132:225-234. [PMID: 27179972 DOI: 10.1007/s00401-016-1580-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 12/26/2022]
Abstract
Cerebral amyloid angiopathy (CAA) often coexists with Alzheimer's disease (AD). APOE4 is a strong genetic risk factor for both AD and CAA. Sex-dependent differences have been shown in AD as well as in cerebrovascular diseases. Therefore, we examined the effects of APOE4, sex, and pathological components on CAA in AD subjects. A total of 428 autopsied brain samples from pathologically confirmed AD cases were analyzed. CAA severity was histologically scored in inferior parietal, middle frontal, motor, superior temporal and visual cortexes. In addition, subgroups with severe CAA (n = 60) or without CAA (n = 39) were subjected to biochemical analysis of amyloid-β (Aβ) and apolipoprotein E (apoE) by ELISA in the temporal cortex. After adjusting for age, Braak neurofibrillary tangle stage and Thal amyloid phase, we found that overall CAA scores were higher in males than females. Furthermore, carrying one or more APOE4 alleles was associated with higher overall CAA scores. Biochemical analysis revealed that the levels of detergent-soluble and detergent-insoluble Aβ40, and insoluble apoE were significantly elevated in individuals with severe CAA or APOE4. The ratio of Aβ40/Aβ42 in insoluble fractions was also increased in the presence of CAA or APOE4, although it was negatively associated with male sex. Levels of insoluble Aβ40 were positively associated with those of insoluble apoE, which were strongly influenced by CAA status. Pertaining to insoluble Aβ42, the levels of apoE correlated regardless of CAA status. Our results indicate that sex and APOE genotypes differentially influence the presence and severity of CAA in AD, likely by affecting interaction and aggregation of Aβ40 and apoE.
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84
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Prats-Sánchez L, Camps-Renom P, Sotoca-Fernández J, Delgado-Mederos R, Martínez-Domeño A, Marín R, Almendrote M, Dorado L, Gomis M, Codas J, Llull L, Gómez González A, Roquer J, Purroy F, Gómez-Choco M, Cánovas D, Cocho D, Garces M, Abilleira S, Martí-Fàbregas J. Remote Intracerebral Hemorrhage After Intravenous Thrombolysis. Stroke 2016; 47:2003-9. [DOI: 10.1161/strokeaha.116.013952] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/07/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator.
Methods—
This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry. rPH was defined as any extraischemic hemorrhage detected in the follow-up computed tomography. We collected demographic, clinical, laboratory, radiological, and outcome variables. In the subset of patients who underwent a magnetic resonance imaging examination, we evaluated the distribution and burden of cerebral microbleeds, cortical superficial siderosis, leukoaraiosis, and recent silent ischemia in regions anatomically unrelated to the ischemic lesion that caused the initial symptoms. We compared patients with rPH with those without rPH or parenchymal hemorrhage. Independent risk factors for rPH were obtained by multivariable logistic regression analyses.
Results—
We evaluated 992 patients (mean age, 74.0±12.6 years; 52.9% were men), and 408 (41%) of them underwent a magnetic resonance imaging. Twenty-six patients (2.6%) had a rPH, 8 (0.8%) had both rPH and PH, 58 (5.8%) had PH, and 900 (90.7%) had no bleeding complication. Lobar cerebral microbleeds (odds ratio, 8.0; 95% confidence interval, 2.3–27.2) and recent silent ischemia (odds ratio, 4.8; 95% confidence interval, 1.6–14.1) increased the risk of rPH.
Conclusions—
The occurrence of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator in patients with ischemic stroke is associated with lobar cerebral microbleeds and multiple ischemic lesions in different regions.
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Affiliation(s)
- Luis Prats-Sánchez
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Pol Camps-Renom
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Javier Sotoca-Fernández
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Raquel Delgado-Mederos
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Alejandro Martínez-Domeño
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Rebeca Marín
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Miriam Almendrote
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Laura Dorado
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Meritxell Gomis
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Javier Codas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Laura Llull
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Alejandra Gómez González
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Jaume Roquer
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Francisco Purroy
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Manuel Gómez-Choco
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - David Cánovas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Dolores Cocho
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Moises Garces
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Sonia Abilleira
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
| | - Joan Martí-Fàbregas
- From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G
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Reuter B, Venus A, Heiler P, Schad L, Ebert A, Hennerici MG, Grudzenski S, Fatar M. Development of Cerebral Microbleeds in the APP23-Transgenic Mouse Model of Cerebral Amyloid Angiopathy-A 9.4 Tesla MRI Study. Front Aging Neurosci 2016; 8:170. [PMID: 27458375 PMCID: PMC4937037 DOI: 10.3389/fnagi.2016.00170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/27/2016] [Indexed: 01/28/2023] Open
Abstract
Background: Cerebral amyloid angiopathy (CAA) is characterized by extracellular deposition of amyloid β (Aβ) around cerebral arteries and capillaries and leads to an increased risk for vascular dementia, spontaneous lobar hemorrhage, convexal subarachnoid hemorrhage, and transient focal neurological episodes, which might be an indicator of imminent spontaneous intracerebral hemorrhage. In CAA cerebral microbleeds (cMBs) with a cortical/juxtacortical distribution are frequently observed in standard magnetic resonance imaging (MRI). In vivo MRI of transgenic mouse models of CAA may serve as a useful tool to investigate translational aspects of the disease. Materials and Methods: APP23-transgenic mice demonstrate cerebrovascular Aβ deposition with subsequent neuropathological changes characteristic for CAA. We performed a 9.4 Tesla high field MRI study using T2, T2* and time of flight-magnetic resonance angiograpy (TOF-MRA) sequences in APP23-transgenic mice and wildtype (wt) littermates at the age of 8, 12, 16, 20 and 24 months, respectively. Numbers, size, and location of cMBs are reported. Results: T2* imaging demonstrated cMBs (diameter 50–300 μm) located in the neocortex and, to a lesser degree, in the thalamus. cMBs were detected at the earliest at 16 months of age. Numbers increased exponentially with age, with 2.5 ± 2 (median ± interquartilrange) at 16 months, 15 ± 6 at 20 months, and 31.5 ± 17 at 24 months of age, respectively. Conclusion: We report the temporal and spatial development of cMBs in the aging APP23-transgenic mouse model which develops characteristic pathological patterns known from human CAA. We expect this mouse model to serve as a useful tool to non-invasively monitor mid- and longterm translational aspects of CAA and to investigate experimental therapeutic strategies in longitudinal studies.
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Affiliation(s)
- Björn Reuter
- Department of Neurology and Neurophysiology, Freiburg University Freiburg, Germany
| | - Alexander Venus
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University Mannheim, Germany
| | - Patrick Heiler
- Computer Assisted Clinical Medicine, Heidelberg University Mannheim, Germany
| | - Lothar Schad
- Computer Assisted Clinical Medicine, Heidelberg University Mannheim, Germany
| | - Anne Ebert
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University Mannheim, Germany
| | - Michael G Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University Mannheim, Germany
| | - Saskia Grudzenski
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University Mannheim, Germany
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University Mannheim, Germany
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Case NF, Charlton A, Zwiers A, Batool S, McCreary CR, Hogan DB, Ismail Z, Zerna C, Coutts SB, Frayne R, Goodyear B, Haffenden A, Smith EE. Cerebral Amyloid Angiopathy Is Associated With Executive Dysfunction and Mild Cognitive Impairment. Stroke 2016; 47:2010-6. [PMID: 27338926 DOI: 10.1161/strokeaha.116.012999] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Autopsy studies suggest that cerebral amyloid angiopathy (CAA) is associated with cognitive impairment and risk for dementia. We analyzed neuropsychological test data from a prospective cohort study of patients with CAA to identify the prevalence of cognitive impairment and its associations with brain magnetic resonance imaging features and the apolipoprotein E genotype. METHODS Data were analyzed from 34 CAA, 16 Alzheimer's disease, 69 mild cognitive impairment, and 27 ischemic stroke participants. Neuropsychological test results were expressed as z scores in relation to normative data provided by the test manuals and then grouped into domains of memory, executive function, and processing speed. RESULTS Mean test scores in CAA participants were significantly lower than norms for memory (-0.44±1.03; P=0.02), executive function (-1.14±1.07; P<0.001), and processing speed (-1.06±1.12; P<0.001). Twenty-seven CAA participants (79%) had mild cognitive impairment based on low cognitive performance accompanied by cognitive concerns. CAA participants had similarly low executive function scores as Alzheimer's disease, but relatively preserved memory. CAA participants' scores were lower than those of ischemic stroke controls for executive function and processing speed. Lower processing speed scores in CAA were associated with higher magnetic resonance imaging white matter hyperintensity volume. There were no associations with the apolipoprotein E ε4 allele. CONCLUSIONS Mild cognitive impairment is very prevalent in CAA. The overall cognitive profile of CAA is more similar to that seen in vascular cognitive impairment rather than Alzheimer's disease. White matter ischemic lesions may underlie some of the impaired processing speed in CAA.
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Affiliation(s)
- Nevicia F Case
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Anna Charlton
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Angela Zwiers
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Saima Batool
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Cheryl R McCreary
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - David B Hogan
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Zahinoor Ismail
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Charlotte Zerna
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Shelagh B Coutts
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Richard Frayne
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Brad Goodyear
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Angela Haffenden
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.)
| | - Eric E Smith
- From the Department of Psychiatry, McGill University, Canada (N.F.C.); Department of Clinical Neurosciences, University of Calgary (A.C., A.Z., C.R.M., C.Z., R.F., B.G., A.H., E.E.S.), Department of Radiology (S.B., C.R.M., R.F., B.G.), Department of Medicine (D.B.H.), Hotchkiss Brain Institute (C.R.M., D.B.H., Z.I., S.B.C., R.F., B.G., E.E.S.), Department of Psychiatry (Z.I., S.B.C., E.E.S.), and Department of Community Health Sciences (S.B.C., E.E.S.), University of Calgary, Alberta, Canada; and Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Alberta, Canada (C.R.M., R.F., B.G.).
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Al-Shahi Salman R, McGoohan K, Rodrigues M, Dichgans M. Dementia after stroke due to intracerebral haemorrhage. Lancet Neurol 2016; 15:779-780. [PMID: 27302345 DOI: 10.1016/s1474-4422(16)30092-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Katie McGoohan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Mark Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Munich, Germany
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88
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The H-ATOMIC Criteria for the Etiologic Classification of Patients with Intracerebral Hemorrhage. PLoS One 2016; 11:e0156992. [PMID: 27275863 PMCID: PMC4898692 DOI: 10.1371/journal.pone.0156992] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/23/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible(3), Probable(2) and Definite(1). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. RESULTS Our study included 439 patients (age 70.8 ± 14.5 years; 61.3% were men). A definite etiology was achieved in 176 (40.1% of the patients: Hypertension 28.2%, cerebral Amyloid angiopathy 0.2%, Tumour 0.2%, Oral anticoagulants 2.2%, vascular Malformation 4.5%, Infrequent causes 4.5%). A total of 7 patients (1.6%) were cryptogenic. In the remaining 58.3% of the patients, ICH was attributable to a single (n = 56, 12.7%) or the combination of ≥2 (n = 200, 45.5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H3A3, n = 38) or with probable CAA (H3A2, n = 29), and probable hypertension with probable OA (H2O2, n = 27). The most frequent category with any degree of certainty was hypertension (H1+2+3 = 80.6%) followed by cerebral amyloid angiopathy (A1+2+3 = 30.9%). CONCLUSIONS According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH.
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89
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Wu Y, Chen T. An Up-to-Date Review on Cerebral Microbleeds. J Stroke Cerebrovasc Dis 2016; 25:1301-6. [PMID: 27085816 DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/20/2016] [Accepted: 03/04/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are small cerebrovascular lesions. More and more CMBs have been found in patients with ischemic stroke, dementia, and cerebral amyloid angiopathy, as well as some normal elderly populations. The objective of this study is to summarize the main risk factor, impairment, and therapy of CMBs. METHODS We searched and scanned all the literature with the keyword "cerebral microbleeds" or "CMBs" in the database of PubMed and Elsevier. RESULTS The risks factors for CMBs are complicated, including those that cause large-vessel disease, such as hypertension and old age, and those that cause small-vessel disease, such as amyloid deposits, endothelial lesions, and atrial fibrillation. Moreover, drugs and therapies used to treat cerebrovascular diseases such as statin, intravenous thrombolysis, and coumarin may also increase risk of CMBs. The relationship between antiplatelet treatment and CMBs is now unclear. Gene polymorphisms have been considered to be associated with CMBs. Gene mutations involving collagen type IV alpha 1 and collagen type IV alpha 2, sortilin-related receptor gene, forkhead box C1, and paired-like homeodomain 2 were reported to affect CMBs with the modification of corresponding proteins and functions. The cognition impairment caused by CMBs draws great attention. White matter deterioration is the possible answer. However, different studies could not reach the same conclusion on the damage of cognition of CMBs. CONCLUSIONS Further research is needed to provide effectual therapeutic proposals for CMBs, which differ from the treatment for large-artery disease and dementia.
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Affiliation(s)
- Yan Wu
- Neurology Department, First Affiliated Hospital of Kunming Medical School, Kunming, China
| | - Tao Chen
- Neurology Department, First Affiliated Hospital of Kunming Medical School, Kunming, China.
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90
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Switzer AR, McCreary C, Batool S, Stafford RB, Frayne R, Goodyear BG, Smith EE. Longitudinal decrease in blood oxygenation level dependent response in cerebral amyloid angiopathy. NEUROIMAGE-CLINICAL 2016; 11:461-467. [PMID: 27104140 PMCID: PMC4827726 DOI: 10.1016/j.nicl.2016.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/05/2016] [Accepted: 02/29/2016] [Indexed: 02/07/2023]
Abstract
Lower blood oxygenation level dependent (BOLD) signal changes in response to a visual stimulus in functional magnetic resonance imaging (fMRI) have been observed in cross-sectional studies of cerebral amyloid angiopathy (CAA), and are presumed to reflect impaired vascular reactivity. We used fMRI to detect a longitudinal change in BOLD responses to a visual stimulus in CAA, and to determine any correlations between these changes and other established biomarkers of CAA progression. Data were acquired from 22 patients diagnosed with probable CAA (using the Boston Criteria) and 16 healthy controls at baseline and one year. BOLD data were generated from the 200 most active voxels of the primary visual cortex during the fMRI visual stimulus (passively viewing an alternating checkerboard pattern). In general, BOLD amplitudes were lower at one year compared to baseline in patients with CAA (p = 0.01) but were unchanged in controls (p = 0.18). The longitudinal difference in BOLD amplitudes was significantly lower in CAA compared to controls (p < 0.001). White matter hyperintensity (WMH) volumes and number of cerebral microbleeds, both presumed to reflect CAA-mediated vascular injury, increased over time in CAA (p = 0.007 and p = 0.001, respectively). Longitudinal increases in WMH (rs = 0.04, p = 0.86) or cerebral microbleeds (rs = − 0.18, p = 0.45) were not associated with the longitudinal decrease in BOLD amplitudes. Visual fMRI was performed in CAA and controls at baseline and at one year. BOLD response amplitude was lower at one year compared to baseline in CAA. BOLD response amplitude decreases were not seen in similarly-aged controls. Progressive impairment in vascular reactivity may be a feature of CAA. Decreased BOLD response amplitude was unrelated to other CAA-related vascular changes.
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Affiliation(s)
- Aaron R Switzer
- Neuroscience Graduate Program, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Cheryl McCreary
- Department of Radiology, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Saima Batool
- Department of Clinical Neurosciences, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Randall B Stafford
- Department of Clinical Neurosciences, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Richard Frayne
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Bradley G Goodyear
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada
| | - Eric E Smith
- Neuroscience Graduate Program, University of Calgary, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Canada.
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Abstract
PURPOSE OF REVIEW Epidemiological investigations have proposed strict control of vascular risk factors as a strategy to overcome dementia, because of the close interaction between cerebrovascular disease (CVD) and Alzheimer's disease. In light of recent advances in basic, translational, and clinical research in the area, this review focuses on the significance of CVD in Alzheimer's disease pathogenesis. RECENT FINDINGS Alzheimer's disease and CVD share several risk factors, and the coexistence of both pathologies is frequently noted. CVD and subsequent cerebral blood flow reduction would increase amyloid β (Aβ) production by modulating β and γ-secretase. Furthermore, CVD impairs Aβ clearance, which is mainly driven by vascular mediated systems, including active transport across the blood-brain barrier, and perivascular lymphatic/paravascular glymphatic drainage systems. Thus, CVD may disturb homeostasis between Aβ production and clearance, thereby aggravating Alzheimer's disease. Recent translational researches in this field aim to facilitate Aβ clearance. Several candidate drugs are being tested in clinical trials. SUMMARY Compared with Aβ pathology, little is known about the relationship between tau pathology and CVD, although some studies have shown that CVD has an influence on tau pathology. The close interrelationship between Alzheimer's disease and CVD suggests the necessity of the maintenance of cerebrovascular integrity, which may herald a new generation of dementia treatment strategies.
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Charidimou A, Fox Z, Werring DJ, Song M. Mapping the landscape of cerebral amyloid angiopathy research: an informetric analysis perspective. J Neurol Neurosurg Psychiatry 2016; 87:252-9. [PMID: 26071214 DOI: 10.1136/jnnp-2015-310690] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/26/2015] [Indexed: 11/03/2022]
Abstract
To quantitatively analyse the research output and major trends in the field of cerebral amyloid angiopathy (CAA) over six decades, from 1954 to 2014, using advanced informetrics methods, we systematically identified CAA-related articles from PubMed, collected metadata and performed productivity analysis, copublication analysis, and network and content analysis over defined time periods. Linear regression was used to investigate these relationships. Changes in CAA research themes (2000-2014) were defined using a topic modelling technique. A total of 2340 CAA papers were published between 1954 and 2014. The mean number (3.03; 95% CI 2.62 to 3.45; p<0.0001) and mean rate (0.13%; 95% CI 0.11% to 0.15%; p<0.0001) of CAA publications increased yearly. Analysis of copublication networks over 5-year periods from 1990 to 2014, revealed a great increase in the total number of connected investigators publishing on CAA (coefficient 16.74; 95% CI 14 to 19.49; p<0.0001) as well as the interactions between them (coefficient 73.53; 95% CI 52.03 to 89.03; p<0.0001). Further analysis of the network characteristics showed that in the past 15 years, copublication networks became not only larger, but also more connected and coherent. Content analysis identified 16 major CAA research themes and their differential evolution in the past 15 years, with the following main trends: (A) limited focus on vascular cognitive impairment; (B) a shift in emphasis towards neuroimaging, cerebral microbleeds and diagnostic aspects and away from pathological aspects; and (3) a reduced emphasis on basic biology apart from an increased focus on mouse models and perivascular drainage. Our study reveals the rapidly developing nature of the CAA research landscape, providing a novel quantitative and objective basis for identifying unmet needs and new directions. Our findings support the idea of a collaborative culture in the field, encouraging international research initiatives.
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Affiliation(s)
- Andreas Charidimou
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Zoe Fox
- UCL and the Education Unit, Biomedical Research Centre, UCL Institute of Neurology, London, UK
| | - David J Werring
- Stroke Research Group, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Min Song
- Department of Library and Information Science, Yonsei University, Seoul, Korea
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Charidimou A, Boulouis G, Haley K, Auriel E, van Etten ES, Fotiadis P, Reijmer Y, Ayres A, Vashkevich A, Dipucchio ZY, Schwab KM, Martinez-Ramirez S, Rosand J, Viswanathan A, Greenberg SM, Gurol ME. White matter hyperintensity patterns in cerebral amyloid angiopathy and hypertensive arteriopathy. Neurology 2016; 86:505-11. [PMID: 26747886 PMCID: PMC4753727 DOI: 10.1212/wnl.0000000000002362] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/12/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify different white matter hyperintensity (WMH) patterns between 2 hemorrhage-prone cerebral small vessel diseases (SVD): cerebral amyloid angiopathy (CAA) and hypertensive arteriopathy (HA). METHODS Consecutive patients with SVD-related intracerebral hemorrhage (ICH) from a single-center prospective cohort were analyzed. Four predefined subcortical WMH patterns were compared between the CAA and HA groups. These WMH patterns were (1) multiple subcortical spots; (2) peri-basal ganglia (BG); (3) large posterior subcortical patches; and (4) anterior subcortical patches. Their associations with other imaging (cerebral microbleeds [CMBs], enlarged perivascular spaces [EPVS]) and clinical markers of SVD were investigated using multivariable logistic regression. RESULTS The cohort included 319 patients with CAA and 137 patients with HA. Multiple subcortical spots prevalence was higher in the CAA compared to the HA group (29.8% vs 16.8%; p = 0.004). Peri-BG WMH pattern was more common in the HA- vs the CAA-ICH group (19% vs 7.8%; p = 0.001). In multivariable logistic regression, presence of multiple subcortical spots was associated with lobar CMBs (odds ratio [OR] 1.23; 95% confidence interval [CI] 1.01-1.50, p = 0.039) and high degree of centrum semiovale EPVS (OR 2.43; 95% CI 1.56-3.80, p < 0.0001). By contrast, age (OR 1.05; 95% CI 1.02-1.09, p = 0.002), deep CMBs (OR 2.46; 95% CI 1.44-4.20, p = 0.001), total WMH volume (OR 1.02; 95% CI 1.01-1.04, p = 0.002), and high BG EPVS degree (OR 8.81; 95% CI 3.37-23.02, p < 0.0001) were predictors of peri-BG WMH pattern. CONCLUSION Different patterns of subcortical leukoaraiosis visually identified on MRI might provide insights into the dominant underlying microangiopathy type as well as mechanisms of tissue injury in patients with ICH.
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Affiliation(s)
- Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Kellen Haley
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Eitan Auriel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Ellis S van Etten
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Panagiotis Fotiadis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Yael Reijmer
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Alison Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Anastasia Vashkevich
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Zora Y Dipucchio
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Kristin M Schwab
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Sergi Martinez-Ramirez
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA
| | - M Edip Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center (A.C., G.B., K.H., E.A., E.S.v.E., P.F., Y.R., A.A., A. Vashkevich, Z.Y.D., K.M.S., S.M.-R., J.R., A. Viswanathan, S.M.G., M.E.G.), and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital (J.R.), Harvard Medical School, Boston, MA.
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Statin Therapy and the Development of Cerebral Amyloid Angiopathy--A Rodent in Vivo Approach. Int J Mol Sci 2016; 17:ijms17010126. [PMID: 26797603 PMCID: PMC4730367 DOI: 10.3390/ijms17010126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 12/24/2022] Open
Abstract
Background: Cerebral amyloid angiopathy (CAA) is characterized by vascular deposition of amyloid β (Aβ) with a higher incidence of cerebral microbleeds (cMBs) and spontaneous hemorrhage. Since statins are known for their benefit in vascular disease we tested for the effect on CAA. Methods: APP23-transgenic mice received atorvastatin-supplemented food starting at the age of eight months (n = 13), 12 months (n = 7), and 16 months (n = 6), respectively. Controls (n = 16) received standard food only. At 24 months of age cMBs were determined with T2*-weighted 9.4T magnetic resonance imaging and graded by size. Results: Control mice displayed an average of 35 ± 18.5 cMBs (mean ± standard deviation), compared to 29.3 ± 9.8 in mice with eight months (p = 0.49), 24.9 ± 21.3 with 12 months (p = 0.26), and 27.8 ± 15.4 with 16 months of atorvastatin treatment (p = 0.27). In combined analysis treated mice showed lower absolute numbers (27.4 ± 15.6, p = 0.16) compared to controls and also after adjustment for cMB size (p = 0.13). Conclusion: Despite to a non-significant trend towards fewer cMBs our results failed to provide evidence for beneficial effects of long-term atorvastatin treatment in the APP23-transgenic mouse model of CAA. A higher risk for bleeding complications was not observed.
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95
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Abstract
Cerebral amyloid angiopathy- related inflammation (CAA-ri) is an aggressive disease subtype of CAA with characteristic clinical and radiological findings. CAA-ri is an important diagnosis to reach in clinical practice, as patients typically respond to prompt immunosuppressive treatment. A definitive diagnosis of CAA-ri still requires a brain biopsy, and hence developing non-invasive diagnostic criteria and biomarkers for this syndrome are key priorities in the field. CAA-ri has gained additional interest for its notable similarities to amyloid-related imaging abnormalities, a complication of immunotherapy treatments in Alzheimer's disease patients. In this commentary, the current state of biomarkers research for CAA-ri and recently suggested diagnostic criteria are put into context.
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96
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Abstract
Vascular cognitive impairment (VCI) is the diagnostic term used to describe a heterogeneous group of sporadic and hereditary diseases of the large and small blood vessels. Subcortical small vessel disease (SVD) leads to lacunar infarcts and progressive damage to the white matter. Patients with progressive damage to the white matter, referred to as Binswanger's disease (BD), constitute a spectrum from pure vascular disease to a mixture with neurodegenerative changes. Binswanger's disease patients are a relatively homogeneous subgroup with hypoxic hypoperfusion, lacunar infarcts, and inflammation that act synergistically to disrupt the blood-brain barrier (BBB) and break down myelin. Identification of this subgroup can be facilitated by multimodal disease markers obtained from clinical, cerebrospinal fluid, neuropsychological, and imaging studies. This consensus statement identifies a potential set of biomarkers based on underlying pathologic changes that could facilitate diagnosis and aid patient selection for future collaborative treatment trials.
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97
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Reijmer YD, van Veluw SJ, Greenberg SM. Ischemic brain injury in cerebral amyloid angiopathy. J Cereb Blood Flow Metab 2016; 36:40-54. [PMID: 25944592 PMCID: PMC4758563 DOI: 10.1038/jcbfm.2015.88] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/24/2015] [Accepted: 03/26/2015] [Indexed: 12/16/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is a common form of cerebral small vessel disease and an important risk factor for intracerebral hemorrhage and cognitive impairment. While the majority of research has focused on the hemorrhagic manifestation of CAA, its ischemic manifestations appear to have substantial clinical relevance as well. Findings from imaging and pathologic studies indicate that ischemic lesions are common in CAA, including white-matter hyperintensities, microinfarcts, and microstructural tissue abnormalities as detected with diffusion tensor imaging. Furthermore, imaging markers of ischemic disease show a robust association with cognition, independent of age, hemorrhagic lesions, and traditional vascular risk factors. Widespread ischemic tissue injury may affect cognition by disrupting white-matter connectivity, thereby hampering communication between brain regions. Challenges are to identify imaging markers that are able to capture widespread microvascular lesion burden in vivo and to further unravel the etiology of ischemic tissue injury by linking structural magnetic resonance imaging (MRI) abnormalities to their underlying pathophysiology and histopathology. A better understanding of the underlying mechanisms of ischemic brain injury in CAA will be a key step toward new interventions to improve long-term cognitive outcomes for patients with CAA.
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Affiliation(s)
- Yael D Reijmer
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanne J van Veluw
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven M Greenberg
- Department of Neurology, Hemorrhagic Stroke Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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98
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Mainly subarachnoid amyloid angiopathy with pseudotumoral course. Clin Neurol Neurosurg 2015; 141:89-91. [PMID: 26773595 DOI: 10.1016/j.clineuro.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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99
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Banerjee G, Wilson D, Jäger HR, Werring DJ. Novel imaging techniques in cerebral small vessel diseases and vascular cognitive impairment. Biochim Biophys Acta Mol Basis Dis 2015; 1862:926-38. [PMID: 26687324 DOI: 10.1016/j.bbadis.2015.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
Dementia is a global growing concern, affecting over 35 million people with a global economic impact of over $604 billion US. With an ageing population the number of people affected is expected double over the next two decades. Vascular cognitive impairment can be caused by various types of cerebrovascular disease, including cortical and subcortical infarcts, and the more diffuse white matter injury due to cerebral small vessel disease. Although this type of cognitive impairment is usually considered the second most common form of dementia after Alzheimer's disease, there is increasing recognition of the vascular contribution to neurodegeneration, with both pathologies frequently coexisting. The aim of this review is to highlight the recent advances in the understanding of vascular cognitive impairment, with a focus on small vessel diseases of the brain. We discuss recently identified small vessel imaging markers that have been associated with cognitive impairment, namely cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and microinfarcts. We will also consider quantitative techniques including diffusion tensor imaging, magnetic resonance perfusion imaging with arterial spin labelling, functional magnetic resonance imaging and positron emission tomography. As well as potentially shedding light on the mechanism by which cerebral small vessel diseases cause dementia, these novel imaging biomarkers are also of increasing relevance given their ability to guide diagnosis and reflect disease progression, which may in the future be useful for therapeutic interventions. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
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100
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Wilson D, Werring DJ. Establishing the "meaning" of microbleeds: Clinical context or lobar microbleed burden? Alzheimers Dement 2015; 12:85-6. [PMID: 26515762 DOI: 10.1016/j.jalz.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Duncan Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, London, UK.
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