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Montandon ML, Haller S, Scheffler M, Giannakopoulos P, Herrmann FR, Gold G, Kövari E. Medial temporal lobe volume is associated with neuronal loss but not with hippocampal microinfarcts despite their high frequency in aging brains. Neurobiol Aging 2020; 95:9-14. [PMID: 32739558 DOI: 10.1016/j.neurobiolaging.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
Medial temporal lobe (MTL) atrophy is an important marker for the clinical diagnosis of Alzheimer's disease at its prodromal stages. Several brain lesions have been associated with MTL atrophy including hippocampal sclerosis, neurodegenerative neuronal loss, and vascular pathology. To better explore the relationship between MTL volume on MRI and age-related degenerative and microvascular hippocampal pathology, we compared MTL volume on postmortem whole brain MRI and stereological estimates of the total number of neurons, cortical microinfarcts (CMIs), and neurofibrillary tangles (NFTs) in a consecutive autopsy series of 21 older individuals (11 females and 10 males, mean age 83.3 ± 5.8; range: 74-93 years, 7 demented and 14 nondemented). Our results revealed a very high percentage of cases with hippocampal CMIs (52%), particularly in the CA1 field. MTL volume was closely related to neuronal loss in both the CA1 area of the hippocampus (p = 0.0109) and the entorhinal cortex (p = 0.0272). MTL volume was not related to total CMI volume or to the total number of NFTs in our sample. In conclusion, hippocampal CMIs are very common in old age. MTL volume is determined essentially by the number of neurons in the hippocampus and does not appear to be related to the presence of NFTs or CMIs in this region.
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Affiliation(s)
- Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland; Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland
| | - Sven Haller
- CIRD Centre d'Imagerie Rive Droite, Geneva, Switzerland; Department of Surgical Sciences, Radiology, Uppsala University, Sweden
| | - Max Scheffler
- Department of Radiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland; Division of Institutional Measures, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland
| | - Gabriel Gold
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thônex, Switzerland
| | - Enikö Kövari
- Department of Psychiatry, Geneva University Hospitals and University of Geneva, Chêne-Bourg, Switzerland.
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Abstract
OBJECTIVES Many survivors of sepsis suffer long-term cognitive impairment, but the mechanisms of this association remain unknown. The objective of this study was to determine whether sepsis is associated with cerebral microinfarcts on brain autopsy. DESIGN Retrospective cohort study. SETTING AND SUBJECTS Five-hundred twenty-nine participants of the Adult Changes in Thought, a population-based prospective cohort study of older adults carried out in Kaiser Permanente Washington greater than or equal to 65 years old without dementia at study entry and who underwent brain autopsy. MEASUREMENTS AND MAIN RESULTS Late-life sepsis hospitalization was identified using administrative data. We identified 89 individuals with greater than or equal to 1 sepsis hospitalization during study participation, 80 of whom survived hospitalization and died a median of 169 days after discharge. Thirty percent of participants with one or more sepsis hospitalization had greater than two microinfarcts, compared with 19% participants without (χ p = 0.02); 20% of those with sepsis hospitalization had greater than two microinfarcts in the cerebral cortex, compared with 10% of those without (χ p = 0.01). The adjusted relative risk of greater than two microinfarcts was 1.61 (95% CI, 1.01-2.57; p = 0.04); the relative risk for having greater than two microinfarcts in the cerebral cortex was 2.12 (95% CI, 1.12-4.02; p = 0.02). There was no difference in Braak stage for neurofibrillary tangles or consortium to establish a registry for Alzheimer's disease score for neuritic plaques between, but Lewy bodies were less significantly common in those with sepsis. CONCLUSIONS Sepsis was specifically associated with moderate to severe vascular brain injury as assessed by microvascular infarcts. This association was stronger for microinfarcts within the cerebral cortex, with those who experienced severe sepsis hospitalization being more than twice as likely to have evidence of moderate to severe cerebral cortical injury in adjusted analyses. Further study to identify mechanisms for the association of sepsis and microinfarcts is needed.
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Shindo A, Ishikawa H, Ii Y, Niwa A, Tomimoto H. Clinical Features and Experimental Models of Cerebral Small Vessel Disease. Front Aging Neurosci 2020; 12:109. [PMID: 32431603 PMCID: PMC7214616 DOI: 10.3389/fnagi.2020.00109] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/30/2020] [Indexed: 12/24/2022] Open
Abstract
Cerebral small vessel disease (SVD) refers to a group of disease conditions affecting the cerebral small vessels, which include the small arteries, arterioles, capillaries, and postcapillary venules in the brain. SVD is the primary cause of vascular cognitive impairment and gait disturbances in aged people. There are several types of SVD, though arteriolosclerosis, which is mainly associated with hypertension, aging, and diabetes mellitus, and cerebral amyloid angiopathy (CAA) comprise most SVD cases. The pathology of arteriolosclerosis-induced SVD is characterized by fibrinoid necrosis and lipohyalinosis, while CAA-associated SVD is characterized by progressive deposition of amyloid beta (Aβ) protein in the cerebral vessels. Brain magnetic resonance imaging (MRI) has been used for examination of SVD lesions; typical lesions are characterized by white matter hyperintensity, lacunar infarcts, enlargement of perivascular spaces (EPVS), microbleeds, cortical superficial siderosis (cSS), and cortical microinfarcts. The microvascular changes that occur in the small vessels are difficult to identify clearly; however, these consequent image findings can represent the SVD. There are two main strategies for prevention and treatment of SVD, i.e., pharmacotherapy and lifestyle modification. In this review, we discuss clinical features of SVD, experimental models replicating SVD, and treatments to further understand the pathological and clinical features of SVD.
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Affiliation(s)
- Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
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54
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He F, Sullender CT, Zhu H, Williamson MR, Li X, Zhao Z, Jones TA, Xie C, Dunn AK, Luan L. Multimodal mapping of neural activity and cerebral blood flow reveals long-lasting neurovascular dissociations after small-scale strokes. SCIENCE ADVANCES 2020; 6:eaba1933. [PMID: 32494746 PMCID: PMC7244270 DOI: 10.1126/sciadv.aba1933] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/10/2020] [Indexed: 06/02/2023]
Abstract
Neurovascular coupling, the close spatial and temporal relationship between neural activity and hemodynamics, is disrupted in pathological brain states. To understand the altered neurovascular relationship in brain disorders, longitudinal, simultaneous mapping of neural activity and hemodynamics is critical yet challenging to achieve. Here, we use a multimodal neural platform in a mouse model of stroke and realize long-term, spatially resolved tracking of intracortical neural activity and cerebral blood flow in the same brain regions. We observe a pronounced neurovascular dissociation that occurs immediately after small-scale strokes, becomes the most severe a few days after, lasts into chronic periods, and varies with the level of ischemia. Neuronal deficits extend spatiotemporally, whereas restoration of cerebral blood flow occurs sooner and reaches a higher relative value. Our findings reveal the neurovascular impact of ministrokes and inform the limitation of neuroimaging techniques that infer neural activity from hemodynamic responses.
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Affiliation(s)
- Fei He
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Neuroengineering Initiative, Rice University, 6500 Main Street, Houston, TX 77005, USA
| | - Colin T. Sullender
- Department of Biomedical Engineering, The University of Texas at Austin, 107 E. Dean Keeton Street, 1 University Station, C0800, Austin, TX 78712, USA
| | - Hanlin Zhu
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Michael R. Williamson
- Institute for Neuroscience, The University of Texas at Austin, 1 University Station, Stop C7000, Austin, TX 78712, USA
| | - Xue Li
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Zhengtuo Zhao
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Neuroengineering Initiative, Rice University, 6500 Main Street, Houston, TX 77005, USA
| | - Theresa A. Jones
- Department of Psychology, The University of Texas at Austin, 108 E. Dean Keeton Street, Stop A8000, SEA 6.106, Austin, TX 78712, USA
| | - Chong Xie
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Neuroengineering Initiative, Rice University, 6500 Main Street, Houston, TX 77005, USA
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
| | - Andrew K. Dunn
- Department of Biomedical Engineering, The University of Texas at Austin, 107 E. Dean Keeton Street, 1 University Station, C0800, Austin, TX 78712, USA
| | - Lan Luan
- Department of Electrical and Computer Engineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
- Neuroengineering Initiative, Rice University, 6500 Main Street, Houston, TX 77005, USA
- Department of Bioengineering, Rice University, 6100 Main Street, Houston, TX 77005, USA
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55
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Yilmazer-Hanke D, Mayer T, Müller HP, Neugebauer H, Abaei A, Scheuerle A, Weis J, Forsberg KME, Althaus K, Meier J, Ludolph AC, Del Tredici K, Braak H, Kassubek J, Rasche V. Histological correlates of postmortem ultra-high-resolution single-section MRI in cortical cerebral microinfarcts. Acta Neuropathol Commun 2020; 8:33. [PMID: 32169123 PMCID: PMC7071593 DOI: 10.1186/s40478-020-00900-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023] Open
Abstract
The identification of cerebral microinfarctions with magnetic resonance imaging (MRI) and histological methods remains challenging in aging and dementia. Here, we matched pathological changes in the microvasculature of cortical cerebral microinfarcts to MRI signals using single 100 μm-thick histological sections scanned with ultra-high-resolution 11.7 T MRI. Histologically, microinfarcts were located in superficial or deep cortical layers or transcortically, compatible with the pattern of layer-specific arteriolar blood supply of the cerebral cortex. Contrary to acute microinfarcts, at chronic stages the core region of microinfarcts showed pallor with extracellular accumulation of lipofuscin and depletion of neurons, a dense meshwork of collagen 4-positive microvessels with numerous string vessels, CD68-positive macrophages and glial fibrillary acidic protein (GFAP)-positive astrocytes. In MRI scans, cortical microinfarcts at chronic stages, called chronic cortical microinfarcts here, gave hypointense signals in T1-weighted and hyperintense signals in T2-weighted images when thinning of the tissue and cavitation and/or prominent iron accumulation were present. Iron accumulation in chronic microinfarcts, histologically verified with Prussian blue staining, also produced strong hypointense T2*-weighted signals. In summary, the microinfarct core was occupied by a dense microvascular meshwork with string vessels, which was invaded by macrophages and astroglia and contained various degrees of iron accumulation. While postmortem ultra-high-resolution single-section imaging improved MRI-histological matching and the structural characterization of chronic cortical cerebral microinfarcts, miniscule microinfarcts without thinning or iron accumulation could not be detected with certainty in the MRI scans. Moreover, string vessels at the infarct margin indicate disturbances in the microcirculation in and around microinfarcts, which might be exploitable in the diagnostics of cortical cerebral microinfarcts with MRI in vivo.
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Yassi N, Hilal S, Xia Y, Lim YY, Watson R, Kuijf H, Fowler C, Yates P, Maruff P, Martins R, Ames D, Chen C, Rowe CC, Villemagne VL, Salvado O, Desmond PM, Masters CL. Influence of Comorbidity of Cerebrovascular Disease and Amyloid-β on Alzheimer’s Disease. J Alzheimers Dis 2020; 73:897-907. [DOI: 10.3233/jad-191028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Saima Hilal
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ying Xia
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Yen Ying Lim
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Rosie Watson
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Hugo Kuijf
- Image Sciences Institute, University Medical Center, Utrecht, Utrecht, Netherlands
| | - Christopher Fowler
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Paul Yates
- Department of Aged Care Services, Austin Health, Heidelberg, Australia
- Department of Medicine, Austin Hospital, University of Melbourne, Heidelberg, Australia
| | | | - Ralph Martins
- Centre of Excellence for Alzheimer’s Disease Research and Care, Edith Cowan University, Perth, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
- National Ageing Research Institute, Parkville, Australia
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore
| | - Christopher C. Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Victor L. Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia
| | - Olivier Salvado
- Data61, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Patricia M. Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Colin L. Masters
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
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57
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Huang Q, Liu Y, Liao W, Yang S, Shen L, Tang T, Feng J, Tuo J, Liu L, Tan X, He W. Disruption of Regional Brain Activity and Functional Connectivity in Patients with Asymptomatic Vulnerable Carotid Plaque. Neurosci Lett 2020; 716:134634. [PMID: 31751668 DOI: 10.1016/j.neulet.2019.134634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Studies have shown that moderate to severe stenosis of the carotid was associated with abnormal neural activity and functional connectivity (FC). However, whether there is a change of neuronal activity in individuals with asymptomatic vulnerable carotid plaque but mild stenosis (VCP) remains unknown. METHODS From December 2015 to December 2017, a total of 31 patients with VCP and 31 no carotid plaque (NCP) controls were performed multi-modal state functional magnetic resonance imaging and investigated the regional brain activity and FC. Two basic algorithms of rs-fMRI, arterial spin labeling, and inflammatory biomarkers were comprehensively evaluated. The time series of aberrant ReHo and FC were also extracted and correlated with other clinical imaging features. RESULTS As compared with NCP group, decreased regional brain activity was found mainly in left middle occipital gyrus (MOG) in the VCP group, but there was no significant difference in cerebral blood flow between the two groups. With the left MOG as seed, decreased FC was found between left MOG and right MOG and frontoparietal network in VCP group. Carotid intima-media thickness but not inflammatory biomarkers including high sensitivity c-reactive protein and interleukin-6 was significantly correlated with aberrant ReHo and FC in left MOG and right MOG. CONCLUSIONS regional brain activity and FC may serve as early imaging markers for vascular-related brain dysfunctions and clinical indicators for early intervention of both atherosclerotic cerebral infarction and vascular cognitive impairments.
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Affiliation(s)
- Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China; Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China; Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Weihua Liao
- Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China; Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Shuai Yang
- Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China; Department of Radiology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Lu Shen
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Tao Tang
- Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China; Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China
| | - Jia Tuo
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Lihui Liu
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China
| | - Xinglin Tan
- Department of Neurology, Nanhai Hospital, Southern Medical University, 28 Liguan Road, Foshan, Guangdong, 528244, PR China.
| | - Wei He
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China; Clinical Research Center for CerebrovascularDiseaseof Hunan Province, Central South University, Changsha, Hunan, 410008, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, PR China.
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58
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Hilal S, Tan CS, van Veluw SJ, Xu X, Vrooman H, Tan BY, Venketasubramanian N, Biessels GJ, Chen C. Cortical cerebral microinfarcts predict cognitive decline in memory clinic patients. J Cereb Blood Flow Metab 2020; 40:44-53. [PMID: 30890075 PMCID: PMC6928564 DOI: 10.1177/0271678x19835565] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cortical cerebral microinfarcts (CMIs) - a novel MRI marker of cerebral vascular pathology have been linked with dementia and impaired cognition in cross-sectional studies. However, it is unknown if cortical CMIs are an indicator of further cognitive decline. We sought to examine whether baseline cortical CMIs predict cognitive decline in a prospective memory-clinic setting. A total of 313 patients with baseline 3T MRI scans and at least two neuropsychological assessments obtained a minimum of one year apart were recruited. Cortical CMIs were graded on baseline MRI according to a validated protocol. The Montreal Cognitive Assessment (MoCA) and a detailed neuropsychological battery were used to assess cognition. Patients with increased cortical CMIs showed greater decline in MoCA and global cognition per year. Patients with > 2 cortical CMIs decline on average by 2 scores on MoCA and 0.5 on global cognition at year two which corresponds to 109.8% and 184.5% greater decline when compared to those without CMIs. Furthermore, cortical CMIs at baseline were associated with accelerated decline in memory and language domains. Similar associations were observed when analysis was restricted to demented patients. Cortical CMIs together with other cerebrovascular disease markers can be used to design clinical trials in vascular cognitive impairment.
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Affiliation(s)
- Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore.,Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Susanne J van Veluw
- Department of Neurology, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore
| | - Henri Vrooman
- Departments of Radiology and Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Geert J Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
| | - Christopher Chen
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore.,Department of Psychological Medicine, National University Hospital, Singapore
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59
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Quintana DD, Garcia JA, Anantula Y, Rellick SL, Engler-Chiurazzi EB, Sarkar SN, Brown CM, Simpkins JW. Amyloid-β Causes Mitochondrial Dysfunction via a Ca2+-Driven Upregulation of Oxidative Phosphorylation and Superoxide Production in Cerebrovascular Endothelial Cells. J Alzheimers Dis 2020; 75:119-138. [PMID: 32250296 PMCID: PMC7418488 DOI: 10.3233/jad-190964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cerebrovascular pathology is pervasive in Alzheimer's disease (AD), yet it is unknown whether cerebrovascular dysfunction contributes to the progression or etiology of AD. In human subjects and in animal models of AD, cerebral hypoperfusion and hypometabolism are reported to manifest during the early stages of the disease and persist for its duration. Amyloid-β is known to cause cellular injury in both neurons and endothelial cells by inducing the production of reactive oxygen species and disrupting intracellular Ca2+ homeostasis. We present a mechanism for mitochondrial degeneration caused by the production of mitochondrial superoxide, which is driven by increased mitochondrial Ca2+ uptake. We found that persistent superoxide production injures mitochondria and disrupts electron transport in cerebrovascular endothelial cells. These observations provide a mechanism for the mitochondrial deficits that contribute to cerebrovascular dysfunction in patients with AD.
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Affiliation(s)
- Dominic D. Quintana
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Jorge A. Garcia
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Yamini Anantula
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Stephanie L. Rellick
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Elizabeth B. Engler-Chiurazzi
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Saumyendra N. Sarkar
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Candice M. Brown
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - James W. Simpkins
- Department of Neuroscience, Center of Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
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60
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Chen H, Huang L, Yang D, Ye Q, Guo M, Qin R, Luo C, Li M, Ye L, Zhang B, Xu Y. Nodal Global Efficiency in Front-Parietal Lobe Mediated Periventricular White Matter Hyperintensity (PWMH)-Related Cognitive Impairment. Front Aging Neurosci 2019; 11:347. [PMID: 31920627 PMCID: PMC6914700 DOI: 10.3389/fnagi.2019.00347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/28/2019] [Indexed: 12/24/2022] Open
Abstract
White matter hyperintensity (WMH) is widely observed in the elderly population and serves as a key indicator of cognitive impairment (CI). However, the underlying mechanism remains to be elucidated. Herein, we investigated the topological patterns of resting state functional networks in WMH subjects and the relationship between the topological measures and CI. A graph theory-based analysis was employed in the resting-state functional magnetic resonance scans of 112 subjects (38 WMH subjects with cognitive impairment without dementia (CIND), 36 WMH subjects with normal cognition and 38 healthy controls (HCs), and we found that WMH-CIND subjects displayed decreased global efficiency at the levels of the whole brain, specific subnetworks [fronto-parietal network (FPN) and cingulo-opercular network (CON)] and certain nodes located in the FPN and CON, as well as decreased local efficiency in subnetworks. Our results demonstrated that nodal global efficiency in frontal and parietal regions mediated the impairment of information processing speed related to periventricular WMH (PWMH). Additionally, we performed support vector machine (SVM) analysis and found that altered functional efficiency can identify WMH-CIND subjects with high accuracy, sensitivity and specificity. These findings suggest impaired functional networks in WMH-CIND individuals and that decreased functional efficiency may be a feature of CI in WMH subjects.
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Affiliation(s)
- Haifeng Chen
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Lili Huang
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Dan Yang
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Qing Ye
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Mengdi Guo
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Caimei Luo
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Mengchun Li
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Lei Ye
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yun Xu
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China.,Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China.,Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, China.,Nanjing Neuropsychiatry Clinic Medical Center, Nanjing, China
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Takasugi J, Miwa K, Watanabe Y, Okazaki S, Todo K, Sasaki T, Sakaguchi M, Mochizuki H. Cortical Cerebral Microinfarcts on 3T Magnetic Resonance Imaging in Patients With Carotid Artery Stenosis. Stroke 2019; 50:639-644. [PMID: 30744544 DOI: 10.1161/strokeaha.118.023781] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Carotid artery stenosis is common in the elderly and contributes to cognitive impairment and dementia. Cortical cerebral microinfarcts (CMIs) play an important role in vascular cognitive impairment and dementia. We aimed to investigate the association between CMIs on 3T magnetic resonance imaging and clinical and radiological features, including plaque morphology, and cognitive function in patients with carotid stenosis. Methods- Eighty-nine patients with >30% carotid stenosis on ultrasound were prospectively enrolled, and underwent brain and carotid artery magnetic resonance imaging. CMIs were rated according to predetermined criteria based on 3D-double inversion recovery and fluid-attenuated inversion recovery images. Results- CMIs were identified in 26 patients (29%; median number 0, range 0-9). Poisson regression models adjusted for age and sex revealed that CMIs were associated with intraplaque hemorrhage (rate ratio, 1.95; 95% CI, 1.26-3.18), lacunar infarcts (rate ratio, 1.54; 95% CI, 1.00-2.44), and cortical infarcts (rate ratio, 3.22; 95% CI, 2.20-5.00). These associations were also observed in asymptomatic patients (n=64). Of 81 patients with unilateral carotid stenosis, the prevalence and number of CMIs were significantly higher in the hemisphere ipsilateral to the carotid stenosis than in the contralateral hemisphere ( P=0.005 and P<0.001, respectively). The presence of CMIs was associated with poor cognitive function. Conclusions- Our results indicate that vulnerable carotid plaque increases the risk of CMIs and subsequent cognitive impairment. Carotid atherosclerosis could be a potential therapeutic target for cognitive impairment.
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Affiliation(s)
- Junji Takasugi
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Kaori Miwa
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (K.W.)
| | - Yoshiyuki Watanabe
- Department of Diagnostic and Interventional Radiology (Y.W.), Osaka University Graduate School of Medicine, Japan
| | - Shuhei Okazaki
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Kenichi Todo
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Tsutomu Sasaki
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Manabu Sakaguchi
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
| | - Hideki Mochizuki
- From the Department of Neurology (J.T., K.M., S.O., K.T., T.S., M.S., H.M.), Osaka University Graduate School of Medicine, Japan
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Azeem F, Durrani R, Zerna C, Smith EE. Silent brain infarctions and cognition decline: systematic review and meta-analysis. J Neurol 2019; 267:502-512. [PMID: 31691021 DOI: 10.1007/s00415-019-09534-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Silent brain infarction (SBI) may be associated with cognitive decline in the general population. We systematically reviewed prior literature on: (1) SBI and cognition cross-sectionally; (2) baseline SBI and future cognitive decline and risk for cognitive disorders including dementia, and (3) incident SBI and the emergence of cognitive decline or cognitive disorders. METHODS The MEDLINE and EMBASE databases were searched for relevant studies. Data were independently extracted by two reviewers. Quality was assessed using the Newcastle Ottawa Scale. Data were pooled using a random effects model when more than two comparable estimates were found. RESULTS Thirty relevant studies were identified: 17 had a cross-sectional design, 10 evaluated the association of baseline SBI with future cognitive decline, and 5 evaluated the association of incident SBI with cognitive decline. Most cross-sectional studies reported lower cognitive performance in persons with SBI. The pooled risk for incident dementia in persons with SBI was 1.48 (95% CI 1.12-1.97), but there was significant heterogeneity (p = 0.009); removing one outlier eliminated the heterogeneity (p = 0.53), giving a lower but still significant estimate (hazard ratio 1.27, 95% CI 1.06-1.51). The pooled risk for incident MCI was not increased in persons with SBI (hazard ratio 0.83, 95% CI 0.40 to 1.72), but there was significant heterogeneity (p < 0.001). The appearance of new SBI was associated with steeper rate of cognitive decline and the appearance of dementia. CONCLUSIONS SBI are associated with worse cognition and increased risk for dementia. More standardization of cognitive assessment methods would facilitate future cross-study comparisons.
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Affiliation(s)
- Feeha Azeem
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Romella Durrani
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Charlotte Zerna
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Hotchkiss Brain Institute, Calgary, AB, Canada.,Calgary Stroke Program, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Eric E Smith
- Neurology, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. .,Hotchkiss Brain Institute, Calgary, AB, Canada. .,Calgary Stroke Program, Calgary, AB, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Xiong L, van Veluw SJ, Bounemia N, Charidimou A, Pasi M, Boulouis G, Reijmer YD, Giese AK, Davidsdottir S, Fotiadis P, Valenti R, Riley G, Schwab K, Gurol EM, Biffi A, Greenberg SM, Viswanathan A. Cerebral Cortical Microinfarcts on Magnetic Resonance Imaging and Their Association With Cognition in Cerebral Amyloid Angiopathy. Stroke 2019; 49:2330-2336. [PMID: 30355109 DOI: 10.1161/strokeaha.118.022280] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- We aimed to explore the association between presence of cerebral cortical microinfarcts (CMIs) on magnetic resonance imaging and other small-vessel disease neuroimaging biomarkers in cerebral amyloid angiopathy (CAA) and to analyze the role of CMIs on individual cognitive domains and dementia conversion. Methods- Participants were recruited from an ongoing longitudinal research cohort of eligible CAA patients between March 2006 and October 2016. A total of 102 cases were included in the analysis that assessed the relationship of cortical CMIs to CAA neuroimaging markers. Ninety-five subjects had neuropsychological tests conducted within 1 month of magnetic resonance imaging scanning. Seventy-five nondemented CAA patients had cognitive evaluation data available during follow-up. Results- Among 102 patients enrolled, 40 patients had CMIs (39%) on magnetic resonance imaging. CMIs were uniformly distributed throughout the cortex without regional predilection ( P=0.971). The presence of CMIs was associated with lower total brain volume (odds ratio, 0.85; 95% CI, 0.74-0.98; P=0.025) and presence of cortical superficial siderosis (odds ratio, 2.66; 95% CI, 1.10-6.39; P=0.029). In 95 subjects with neuropsychological tests, presence of CMIs was associated with impaired executive function (β, -0.23; 95% CI, -0.44 to -0.02; P=0.036) and processing speed (β, -0.24; 95% CI, -0.45 to -0.04; P=0.020). Patients with CMIs had a higher cumulative dementia incidence compared with patients without CMIs ( P=0.043), whereas only baseline total brain volume (hazard ratio, 0.76; 95% CI, 0.62-0.92; P=0.006) independently predicted dementia conversion. Conclusions- Magnetic resonance imaging-detected CMIs in CAA correlated with greater overall disease burden. The presence of CMIs was associated with worse cognitive performance, whereas only total brain atrophy independently predicted dementia conversion.
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Affiliation(s)
- Li Xiong
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Susanne J van Veluw
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Narimene Bounemia
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Marco Pasi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Gregoire Boulouis
- Centre Hospitalier Sainte-Anne, Université Paris Descartes, France (G.B.)
| | - Yael D Reijmer
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (Y.D.R.)
| | - Anne-Katrin Giese
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Sigurros Davidsdottir
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (S.D.)
| | - Panagiotis Fotiadis
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Italy (R.V.)
| | - Grace Riley
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Kristin Schwab
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Edip M Gurol
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Alessandro Biffi
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
| | - Anand Viswanathan
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (L.X., S.J.v.V., N.B., A.C., M.P., A.-K.G., P.F., G.R., K.S., E.M.G., A.B., S.M.G., A.V.)
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Ter Telgte A, van Leijsen EMC, Wiegertjes K, Klijn CJM, Tuladhar AM, de Leeuw FE. Cerebral small vessel disease: from a focal to a global perspective. Nat Rev Neurol 2019; 14:387-398. [PMID: 29802354 DOI: 10.1038/s41582-018-0014-y] [Citation(s) in RCA: 290] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cerebral small vessel disease (SVD) is commonly observed on neuroimaging among elderly individuals and is recognized as a major vascular contributor to dementia, cognitive decline, gait impairment, mood disturbance and stroke. However, clinical symptoms are often highly inconsistent in nature and severity among patients with similar degrees of SVD on brain imaging. Here, we provide a new framework based on new advances in structural and functional neuroimaging that aims to explain the remarkable clinical variation in SVD. First, we discuss the heterogeneous pathology present in SVD lesions despite an identical appearance on imaging and the perilesional and remote effects of these lesions. We review effects of SVD on structural and functional connectivity in the brain, and we discuss how network disruption by SVD can lead to clinical deficits. We address reserve and compensatory mechanisms in SVD and discuss the part played by other age-related pathologies. Finally, we conclude that SVD should be considered a global rather than a focal disease, as the classically recognized focal lesions affect remote brain structures and structural and functional network connections. The large variability in clinical symptoms among patients with SVD can probably be understood by taking into account the heterogeneity of SVD lesions, the effects of SVD beyond the focal lesions, the contribution of neurodegenerative pathologies other than SVD, and the interaction with reserve mechanisms and compensatory mechanisms.
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Esther M C van Leijsen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, Netherlands.
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van den Brink H, Zwiers A, Switzer AR, Charlton A, McCreary CR, Goodyear BG, Frayne R, Biessels GJ, Smith EE. Cortical Microinfarcts on 3T Magnetic Resonance Imaging in Cerebral Amyloid Angiopathy. Stroke 2019; 49:1899-1905. [PMID: 29986931 DOI: 10.1161/strokeaha.118.020810] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cerebral microinfarcts are small ischemic lesions that are found in cerebral amyloid angiopathy (CAA) patients at autopsy. The current study aimed to detect cortical microinfarcts (CMI) on in vivo 3 Tesla (3T) magnetic resonance imaging (MRI) in CAA patients, to study the progression of CMI over a 1-year period, and to correlate CMI with markers of CAA-related vascular brain injury and cognitive functioning. Methods- Thirty-five CAA patients (mean age, 74.2±7.6 years), 13 Alzheimer disease (AD) patients (67.0±5.8 years), and 26 healthy controls (67.2±9.5 years) participated in the study. All participants underwent a standardized clinical and neuropsychological assessment as well as 3T MRI. CMI were rated according to standardized criteria. Results- CMI were present in significantly more CAA patients (57.1%; median number: 1, range 1-9) than in Alzheimer disease (7.7%) or in healthy controls (11.5%; P<0.001). Incident CMI were observed after a 1-year follow-up. CMI did not correlate with any other MRI marker of CAA nor with cognitive function. Conclusions- In vivo CMI are a frequent finding on 3T MRI in CAA patients, and incident CMI are observable after 1-year follow-up. CMI can be regarded as a new MRI marker of CAA, potentially distinct from other well-established markers. Future larger cohort studies with longitudinal follow-up are needed to elucidate the relationship between CMI and possible causes and clinical outcomes in CAA.
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Affiliation(s)
- Hilde van den Brink
- From the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands (H.v.d.B., G.J.B.)
| | - Angela Zwiers
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Aaron R Switzer
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Anna Charlton
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.)
| | - Cheryl R McCreary
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, AB, Canada (B.G.G., R.F.)
| | - Richard Frayne
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, AB, Canada (B.G.G., R.F.)
| | - Geert Jan Biessels
- From the Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands (H.v.d.B., G.J.B.)
| | - Eric E Smith
- Department of Clinical Neurosciences (A.Z., A.R.S., A.C., B.G.G., C.R.M., E.E.S., R.F.).,Department of Radiology (B.G.G., C.R.M., E.E.S., R.F.), University of Calgary, AB, Canada
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Balbi M, Vanni MP, Vega MJ, Silasi G, Sekino Y, Boyd JD, LeDue JM, Murphy TH. Longitudinal monitoring of mesoscopic cortical activity in a mouse model of microinfarcts reveals dissociations with behavioral and motor function. J Cereb Blood Flow Metab 2019; 39:1486-1500. [PMID: 29521138 PMCID: PMC6681536 DOI: 10.1177/0271678x18763428] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
Abstract
Small vessel disease is characterized by sporadic obstruction of small vessels leading to neuronal cell death. These microinfarcts often escape detection by conventional magnetic resonance imaging and are identified only upon postmortem examination. Our work explores a brain-wide microinfarct model in awake head-fixed mice, where occlusions of small penetrating arterioles are reproduced by endovascular injection of fluorescent microspheres. Mesoscopic functional connectivity was mapped longitudinally in awake GCaMP6 mice using genetically encoded calcium indicators for transcranial wide-field calcium imaging. Microsphere occlusions were quantified and changes in cerebral blood flow were measured with laser speckle imaging. The neurodeficit score in microinfarct mice was significantly higher than in sham, indicating impairment in motor function. The novel object recognition test showed a reduction in the discrimination index in microinfarct mice compared to sham. Graph-theoretic analysis of functional connectivity did not reveal significant differences in functional connectivity between sham and microinfarct mice. While behavioral tasks revealed impairments following microinfarct induction, the absence of measurable functional alterations in cortical activity has a less straightforward interpretation. The behavioral alterations produced by this model are consistent with alterations observed in human patients suffering from microinfarcts and support the validity of microsphere injection as a microinfarct model.
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Affiliation(s)
- Matilde Balbi
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Matthieu P Vanni
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Max J Vega
- Department of Psychology, Motivated
Cognition Lab, University of British Columbia, Vancouver, British Columbia,
Canada
| | - Gergely Silasi
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Yuki Sekino
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Jamie D Boyd
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
| | - Jeffrey M LeDue
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
- Djavad Mowafaghian Center for Brain
Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy H Murphy
- Department of Psychiatry, Kinsmen
Laboratory of Neurological Research, University of British Columbia, Vancouver,
British Columbia, Canada
- Djavad Mowafaghian Center for Brain
Health, University of British Columbia, Vancouver, British Columbia, Canada
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67
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Das AS, Regenhardt RW, Feske SK, Gurol ME. Treatment Approaches to Lacunar Stroke. J Stroke Cerebrovasc Dis 2019; 28:2055-2078. [PMID: 31151838 PMCID: PMC7456600 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/12/2022] Open
Abstract
Lacunar strokes are appropriately named for their ability to cavitate and form ponds or "little lakes" (Latin: lacune -ae meaning pond or pit is a diminutive form of lacus meaning lake). They account for a substantial proportion of both symptomatic and asymptomatic ischemic strokes. In recent years, there have been several advances in the management of large vessel occlusions. New therapies such as non-vitamin K antagonist oral anticoagulants and left atrial appendage closure have recently been developed to improve stroke prevention in atrial fibrillation; however, the treatment of small vessel disease-related strokes lags frustratingly behind. Since Fisher characterized the lacunar syndromes and associated infarcts in the late 1960s, there have been no therapies specifically targeting lacunar stroke. Unfortunately, many therapeutic agents used for the treatment of ischemic stroke in general offer only a modest benefit in reducing recurrent stroke while adding to the risk of intracerebral hemorrhage and systemic bleeding. Escalation of antithrombotic treatments beyond standard single antiplatelet agents has not been effective in long-term lacunar stroke prevention efforts, unequivocally increasing intracerebral hemorrhage risk without providing a significant benefit. In this review, we critically review the available treatments for lacunar stroke based on evidence from clinical trials. For several of the major drugs, we summarize the adverse effects in the context of this unique patient population. We also discuss the role of neuroprotective therapies and neural repair strategies as they may relate to recovery from lacunar stroke.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Sagnier S, Okubo G, Catheline G, Munsch F, Bigourdan A, Debruxelles S, Poli M, Olindo S, Renou P, Rouanet F, Dousset V, Tourdias T, Sibon I. Chronic Cortical Cerebral Microinfarcts Slow Down Cognitive Recovery After Acute Ischemic Stroke. Stroke 2019; 50:1430-1436. [DOI: 10.1161/strokeaha.118.024672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sharmila Sagnier
- From the UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., I.S.)
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Gosuke Okubo
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France (G.O., A.B., V.D., T.T.)
| | - Gwenaëlle Catheline
- From the UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., I.S.)
| | - Fanny Munsch
- CHU de Bordeaux, Neuroimagerie diagnostique et thérapeutique, France (F.M., V.D., T.T.)
| | - Antoine Bigourdan
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France (G.O., A.B., V.D., T.T.)
| | - Sabrina Debruxelles
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Mathilde Poli
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Stéphane Olindo
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Pauline Renou
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - François Rouanet
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
| | - Vincent Dousset
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France (G.O., A.B., V.D., T.T.)
- CHU de Bordeaux, Neuroimagerie diagnostique et thérapeutique, France (F.M., V.D., T.T.)
| | - Thomas Tourdias
- INSERM-U1215, Neurocentre Magendie, Bordeaux, France (G.O., A.B., V.D., T.T.)
- CHU de Bordeaux, Neuroimagerie diagnostique et thérapeutique, France (F.M., V.D., T.T.)
| | - Igor Sibon
- From the UMR 5287 CNRS, Université de Bordeaux, EPHE PSL Research University, France (S.S., G.C., I.S.)
- CHU de Bordeaux, Unité Neuro-vasculaire, France (S.S., S.D., M.P., S.O., P.R., F.R., I.S.)
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Regenhardt RW, Das AS, Ohtomo R, Lo EH, Ayata C, Gurol ME. Pathophysiology of Lacunar Stroke: History's Mysteries and Modern Interpretations. J Stroke Cerebrovasc Dis 2019; 28:2079-2097. [PMID: 31151839 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/13/2019] [Accepted: 05/04/2019] [Indexed: 01/13/2023] Open
Abstract
Since the term "lacune" was adopted in the 1800s to describe infarctions from cerebral small vessels, their underlying pathophysiological basis remained obscure until the 1960s when Charles Miller Fisher performed several autopsy studies of stroke patients. He observed that the vessels displayed segmental arteriolar disorganization that was associated with vessel enlargement, hemorrhage, and fibrinoid deposition. He coined the term "lipohyalinosis" to describe the microvascular mechanism that engenders small subcortical infarcts in the absence of a compelling embolic source. Since Fisher's early descriptions of lipohyalinosis and lacunar stroke (LS), there have been many advancements in the understanding of this disease process. Herein, we review lipohyalinosis as it relates to modern concepts of cerebral small vessel disease (cSVD). We discuss clinical classifications of LS as well as radiographic definitions based on modern neuroimaging techniques. We provide a broad and comprehensive overview of LS pathophysiology both at the vessel and parenchymal levels. We also comment on the role of biomarkers, the possibility of systemic disease processes, and advancements in the genetics of cSVD. Lastly, we assess preclinical models that can aid in studying LS disease pathogenesis. Enhanced understanding of this highly prevalent disease will allow for the identification of novel therapeutic targets capable of mitigating disease sequelae.
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Affiliation(s)
- Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryo Ohtomo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eng H Lo
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cenk Ayata
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mahmut Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Ii Y, Maeda M, Ishikawa H, Ito A, Matsuo K, Umino M, Shindo A, Kida H, Satoh M, Niwa A, Taniguchi A, Tomimoto H. Cortical microinfarcts in patients with multiple lobar microbleeds on 3 T MRI. J Neurol 2019; 266:1887-1896. [DOI: 10.1007/s00415-019-09350-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
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Fulop GA, Tarantini S, Yabluchanskiy A, Molnar A, Prodan CI, Kiss T, Csipo T, Lipecz A, Balasubramanian P, Farkas E, Toth P, Sorond F, Csiszar A, Ungvari Z. Role of age-related alterations of the cerebral venous circulation in the pathogenesis of vascular cognitive impairment. Am J Physiol Heart Circ Physiol 2019; 316:H1124-H1140. [PMID: 30848677 PMCID: PMC6580383 DOI: 10.1152/ajpheart.00776.2018] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023]
Abstract
There has been an increasing appreciation of the role of vascular contributions to cognitive impairment and dementia (VCID) associated with old age. Strong preclinical and translational evidence links age-related dysfunction and structural alterations of the cerebral arteries, arterioles, and capillaries to the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. The low-pressure, low-velocity, and large-volume venous circulation of the brain also plays critical roles in the maintenance of homeostasis in the central nervous system. Despite its physiological importance, the role of age-related alterations of the brain venous circulation in the pathogenesis of vascular cognitive impairment and dementia is much less understood. This overview discusses the role of cerebral veins in the pathogenesis of VCID. Pathophysiological consequences of age-related dysregulation of the cerebral venous circulation are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages of venous origin, altered production of cerebrospinal fluid, impaired function of the glymphatics system, dysregulation of cerebral blood flow, and ischemic neuronal dysfunction and damage. Understanding the age-related functional and phenotypic alterations of the cerebral venous circulation is critical for developing new preventive, diagnostic, and therapeutic approaches to preserve brain health in older individuals.
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Affiliation(s)
- Gabor A Fulop
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andrea Molnar
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Calin I Prodan
- Veterans Affairs Medical Center , Oklahoma City, Oklahoma
- Department of Neurology, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Agnes Lipecz
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Eszter Farkas
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Peter Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Cerebrovascular Laboratory, Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School , Pecs , Hungary
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University , Chicago, Illinois
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
- Semmelweis University, Department of Pulmonology , Budapest , Hungary
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Das AS, Regenhardt RW, Vernooij MW, Blacker D, Charidimou A, Viswanathan A. Asymptomatic Cerebral Small Vessel Disease: Insights from Population-Based Studies. J Stroke 2019; 21:121-138. [PMID: 30991799 PMCID: PMC6549070 DOI: 10.5853/jos.2018.03608] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/28/2019] [Indexed: 12/28/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common group of neurological conditions that confer a significant burden of morbidity and mortality worldwide. In most cases, CSVD is only recognized in its advanced stages once its symptomatic sequelae develop. However, its significance in asymptomatic healthy populations remains poorly defined. In population-based studies of presumed healthy elderly individuals, CSVD neuroimaging markers including white matter hyperintensities, lacunes, cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and cerebral microinfarcts are frequently detected. While the presence of these imaging markers may reflect unique mechanisms at play, there are likely shared pathways underlying CSVD. Herein, we aim to assess the etiology and significance of these individual biomarkers by focusing in asymptomatic populations at an epidemiological level. By primarily examining population-based studies, we explore the risk factors that are involved in the formation and progression of these biomarkers. Through a critical semi-systematic review, we aim to characterize “asymptomatic” CSVD, review screening modalities, and draw associations from observational studies in clinical populations. Lastly, we highlight areas of research (including therapeutic approaches) in which further investigation is needed to better understand asymptomatic CSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Deborah Blacker
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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74
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Yusuke S, Norio H, Tomoko M, Shunichi M, Koichi U, Takayuki S, Haruyuki W, Toshihiro O, Akio O, Yoshito T. Voxel-based morphometry analysis of double inversion-recovery magnetic resonance imaging for detecting microscopic lesions: a simulation study. Radiol Phys Technol 2019; 12:149-155. [PMID: 30796738 DOI: 10.1007/s12194-019-00501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
Double inversion-recovery (DIR) imaging has the potential to improve the detection of subcortical lesions through the use of voxel-based morphometry (VBM) analysis. The aim of this study was to clarify the characteristics of detectable lesions by performing a VBM analysis on DIR images of simulated lesions. Twenty healthy volunteers underwent magnetic resonance imaging using a head three-dimensional DIR sequence. The images were processed using SPM12; then, the selected images with simulated lesions were analyzed via VBM. The VBM results were evaluated using free-response receiver-operating characteristic curves and a receiver-operating characteristic analysis. The sensitivity was 100% (5/5), with 5.6 false-positive objects per case, in simulated lesions with a contrast of 0.6 and a size of 2.4 mm. The sensitivity was 80% (4/5), with 5.4 false-positive objects per case, in simulated lesions with a contrast of 0.5 and a size of 2.4 mm. The mean area under the curve value was increased from 0.783 to 0.883 using VBM, with a statistically significant difference (p < 0.01). The VBM analysis of the DIR images using SPM alone showed the potential to detect subcortical microscopic lesions. Early detection of Alzheimer's disease may be possible by adapting VBM in the clinical setting.
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Affiliation(s)
- Sato Yusuke
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki, Maebashi, Gunma, 371-0052, Japan.
| | - Hayashi Norio
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Maruyama Tomoko
- Department of Radiological Technology, Graduate School of Radiological Technology, Gunma Prefectural College of Health Sciences, 323-1 Kamioki, Maebashi, Gunma, 371-0052, Japan
| | | | - Ujita Koichi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Suto Takayuki
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Watanabe Haruyuki
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Ogura Toshihiro
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Ogura Akio
- Department of Radiological Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
| | - Tsushima Yoshito
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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75
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Jonkman LE, Kenkhuis B, Geurts JJG, van de Berg WDJ. Post-Mortem MRI and Histopathology in Neurologic Disease: A Translational Approach. Neurosci Bull 2019; 35:229-243. [PMID: 30790214 DOI: 10.1007/s12264-019-00342-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023] Open
Abstract
In this review, combined post-mortem brain magnetic resonance imaging (MRI) and histology studies are highlighted, illustrating the relevance of translational approaches to define novel MRI signatures of neuropathological lesions in neuroinflammatory and neurodegenerative disorders. Initial studies combining post-mortem MRI and histology have validated various MRI sequences, assessing their sensitivity and specificity as diagnostic biomarkers in neurologic disease. More recent studies have focused on defining new radiological (bio)markers and implementing them in the clinical (research) setting. By combining neurological and neuroanatomical expertise with radiological development and pathological validation, a cycle emerges that allows for the discovery of novel MRI biomarkers to be implemented in vivo. Examples of this cycle are presented for multiple sclerosis, Alzheimer's disease, Parkinson's disease, and traumatic brain injury. Some applications have been shown to be successful, while others require further validation. In conclusion, there is much to explore with post-mortem MRI and histology studies, which can eventually be of high relevance for clinical practice.
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Affiliation(s)
- Laura E Jonkman
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Boyd Kenkhuis
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
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Farhat NS, Theiss R, Santini T, Ibrahim TS, Aizenstein HJ. Neuroimaging of Small Vessel Disease in Late-Life Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:95-115. [PMID: 31705491 PMCID: PMC6939470 DOI: 10.1007/978-981-32-9721-0_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cerebral small vessel disease is associated with late-life depression, cognitive impairment, executive dysfunction, distress, and loss of life for older adults. Late-life depression is becoming a substantial public health burden, and a considerable number of older adults presenting to primary care have significant clinical depression. Even though white matter hyperintensities are linked with small vessel disease, white matter hyperintensities are nonspecific to small vessel disease and can co-occur with other brain diseases. Advanced neuroimaging techniques at the ultrahigh field magnetic resonance imaging are enabling improved characterization, identification of cerebral small vessel disease and are elucidating some of the mechanisms that associate small vessel disease with late-life depression.
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Affiliation(s)
- Nadim S Farhat
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Theiss
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tales Santini
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tamer S Ibrahim
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Howard J Aizenstein
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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77
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Grajauskas LA, Siu W, Medvedev G, Guo H, D’Arcy RC, Song X. MRI-based evaluation of structural degeneration in the ageing brain: Pathophysiology and assessment. Ageing Res Rev 2019; 49:67-82. [PMID: 30472216 DOI: 10.1016/j.arr.2018.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 11/08/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022]
Abstract
Advances in MRI technology have significantly contributed to our ability to understand the process of brain ageing, allowing us to track and assess changes that occur during normal ageing and neurological conditions. This paper focuses on reviewing structural changes of the ageing brain that are commonly seen using MRI, summarizing the pathophysiology, prevalence, and neuroanatomical distribution of changes including atrophy, lacunes, white matter lesions, and dilated perivascular spaces. We also review the clinically accessible methodology for assessing these MRI-based changes, covering visual rating scales, as well computer-aided and fully automated methods. Subsequently, we consider novel assessment methods designed to evaluate changes across the whole brain, and finally discuss new directions in this field of research.
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Risacher SL, Saykin AJ. Neuroimaging in aging and neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:191-227. [PMID: 31753134 DOI: 10.1016/b978-0-12-804766-8.00012-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroimaging biomarkers for neurologic diseases are important tools, both for understanding pathology associated with cognitive and clinical symptoms and for differential diagnosis. This chapter explores neuroimaging measures, including structural and functional measures from magnetic resonance imaging (MRI) and molecular measures primarily from positron emission tomography (PET), in healthy aging adults and in a number of neurologic diseases. The spectrum covers neuroimaging measures from normal aging to a variety of dementias: late-onset Alzheimer's disease [AD; including mild cognitive impairment (MCI)], familial and nonfamilial early-onset AD, atypical AD syndromes, posterior cortical atrophy (PCA), logopenic aphasia (lvPPA), cerebral amyloid angiopathy (CAA), vascular dementia (VaD), sporadic and familial behavioral-variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive nonfluent aphasia (PNFA), frontotemporal dementia with motor neuron disease (FTD-MND), frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS), corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), Parkinson's disease (PD) with and without dementia, and multiple systems atrophy (MSA). We also include a discussion of the appropriate use criteria (AUC) for amyloid imaging and conclude with a discussion of differential diagnosis of neurologic dementia disorders in the context of neuroimaging.
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Affiliation(s)
- Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States.
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Braak H, Feldengut S, Kassubek J, Yilmazer-Hanke D, Del Tredici K. Two histological methods for recognition and study of cortical microinfarcts in thick sections. Eur J Histochem 2018; 62. [PMID: 30572697 PMCID: PMC6334235 DOI: 10.4081/ejh.2018.2989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022] Open
Abstract
Cortical microinfarcts are the most widespread form of brain infarction but frequently remain undetected by standard neuroimaging protocols. Moreover, microinfarcts are only partially detectable in hematoxylin- eosin-stained (H&E) 4-10 μm paraffin sections at routine neuropathological examination. In this short report, we provide two staining protocols for visualizing cortical microinfarcts in 100-300 μm sections. For low-power microscopy, the first protocol combines aldehyde fuchsine staining for detection of lipofuscin granules and macrophages with Darrow red counterstaining for Nissl material. The second protocol combines collagen IV immunohistochemistry with aldehyde fuchsine/Darrow red or with erythrosin-phosphotungstic acid-aniline blue staining for detailed study of the capillary network. In the first protocol, microinfarcts are recognizable as radially- oriented funnel-like accumulations of aldehyde fuchsine-positive macrophages. The second protocol recognizes microinfarcts and alterations of the capillary network, at whose center accumulations of dead neurons and aldehyde fuchsine-positive macrophages cluster. In addition, the second protocol permits visualization of abnormalities within the capillary network associated with more recent microinfarcts. Both protocols can be useful for comparing MRI datasets with cortical microinfarcts in corresponding whole brain sections of 100-300 μm thickness.
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Affiliation(s)
- Heiko Braak
- University of Ulm, Center for Biomedical Research, Department of Neurology.
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80
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Chen X, He X, Luo S, Feng Y, Liang F, Shi T, Huang R, Pei Z, Li Z. Vagus Nerve Stimulation Attenuates Cerebral Microinfarct and Colitis-induced Cerebral Microinfarct Aggravation in Mice. Front Neurol 2018; 9:798. [PMID: 30319530 PMCID: PMC6168656 DOI: 10.3389/fneur.2018.00798] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022] Open
Abstract
Cerebral cortical microinfarct (CMI) is common in patients with dementia and cognitive decline. Emerging studies reported that intestinal dysfunction influenced the outcome of ischemic stroke and that vagus nerve stimulation (VNS) protected against ischemic stroke. However, the effects of intestinal dysfunction and VNS on CMI are not clear. Therefore, we examined the influence of colitis and VNS on CMI and the mechanisms of VNS attenuating CMI in mice with colitis. CMI was induced using a two-photon laser. Colitis was induced using oral dextran sodium sulfate (DSS). The cervical vagus nerve was stimulated using a constant current. In vivo blood-brain barrier (BBB) permeability was evaluated using two-photon imaging. Infarct volume, microglial and astrocyte activation, oxidative stress and proinflammatory cytokine levels were assessed using immunofluorescent and immunohistochemical staining. The BBB permeability, infarct volume, activation of microglia and astrocytes and oxidative stress increased significantly in mice with colitis and CMI compared to those in mice with CMI. However, these processes were reduced in CMI mice when VNS was performed. Brain lesions in mice with colitis and CMI were significantly ameliorated when VNS was performed during the acute phase of colitis. Our study demonstrated that VNS alleviated CMI and this neuroprotection was associated with the suppression of BBB permeability, neuroinflammation and oxidative stress. Also, our results indicated that VNS reduced colitis-induced microstroke aggravation.
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Affiliation(s)
- Xiaofeng Chen
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiaofei He
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shijian Luo
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yukun Feng
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Fengyin Liang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Taotao Shi
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Ruxun Huang
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhong Pei
- Department of Neurology, National Key Clinical Department and Key Discipline of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhendong Li
- Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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81
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Ghaznawi R, de Bresser J, van der Graaf Y, Zwartbol MH, Witkamp TD, Geerlings MI, Hendrikse J. Detection and characterization of small infarcts in the caudate nucleus on 7 Tesla MRI: The SMART-MR study. J Cereb Blood Flow Metab 2018; 38:1609-1617. [PMID: 28436255 PMCID: PMC6120126 DOI: 10.1177/0271678x17705974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Small infarcts are among the key imaging features of cerebral small vessel disease (CSVD), but remain largely undetected on conventional MRI. We aimed to evaluate (1) imaging criteria for the detection of small infarcts in the caudate nucleus on 7T MRI, (2) intra- and inter-rater agreement, (3) frequency and (4) detection rate on 7T versus 1.5T MRI. In 90 patients (68 ± 8 years) with a history of vascular disease from the SMART-MR study, we defined 7T imaging criteria for cavitated and non-cavitated small infarcts in the caudate nucleus. In a separate set of 23 patients from the SMART study, intra-rater and inter-rater agreement was excellent for presence, number, and individual locations (Kappa's, ICCs, and Dice similarity coefficients ranged from 0.85 to 1.00). In the 90 patients, 21 infarcts (20 cavitated) in 12 patients were detected on 7T (13%) compared to 7 infarcts in 6 patients on 1.5T (7%). In conclusion, we established reproducible imaging criteria for the detection of small infarcts in the caudate nucleus on 7T MRI and showed that 7T MRI allows for a higher detection rate than conventional 1.5T MRI. These imaging criteria can be used in future studies to provide new insights into the pathophysiology of CSVD.
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Affiliation(s)
- Rashid Ghaznawi
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands.,2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jeroen de Bresser
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Yolanda van der Graaf
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Maarten Ht Zwartbol
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Theo D Witkamp
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
| | - Mirjam I Geerlings
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Jeroen Hendrikse
- 1 Department of Radiology, University Medical Center Utrecht, the Netherlands
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82
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Ferro DA, van Veluw SJ, Koek HL, Exalto LG, Biessels GJ. Cortical Cerebral Microinfarcts on 3 Tesla MRI in Patients with Vascular Cognitive Impairment. J Alzheimers Dis 2018; 60:1443-1450. [PMID: 29036822 DOI: 10.3233/jad-170481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cerebral microinfarcts (CMIs) are small ischemic lesions that are a common neuropathological finding in patients with stroke or dementia. CMIs in the cortex can now be detected in vivo on 3 Tesla MRI. OBJECTIVE To determine the occurrence of CMIs and associated clinical features in patients with possible vascular cognitive impairment (VCI). METHOD 182 memory-clinic patients (mean age 71.4±10.6, 55% male) with vascular injury on brain MRI (i.e., possible VCI) underwent a standardized work-up including 3 Tesla MRI and cognitive assessment. A control group consisted of 70 cognitively normal subjects (mean age 70.6±4.7, 60% male). Cortical CMIs and other neuroimaging markers of vascular brain injury were rated according to established criteria. RESULT Occurrence of CMIs was higher (20%) in patients compared to controls (10%). Among patients, the presence of CMIs was associated with male sex, history of stroke, infarcts, and white matter hyperintensities. CMI presence was also associated with a diagnosis of vascular dementia and reduced performance in multiple cognitive domains. CONCLUSION CMIs on 3 Tesla MRI are common in patients with possible VCI and co-occur with imaging markers of small and large vessel disease, likely reflecting a heterogeneous etiology. CMIs are associated with worse cognitive performance, independent of other markers of vascular brain injury.
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Affiliation(s)
- Doeschka A Ferro
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Susanne J van Veluw
- Department of Neurology, J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lieza G Exalto
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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83
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Ishikawa H, Ii Y, Niwa A, Shindo A, Ito A, Matsuura K, Sasaki R, Uno K, Maeda M, Tomimoto H. Comparison of Premortem Magnetic Resonance Imaging and Postmortem Autopsy Findings of a Cortical Microinfarct. J Stroke Cerebrovasc Dis 2018; 27:2623-2626. [PMID: 29970322 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022] Open
Abstract
An 85-year-old woman diagnosed with amyotrophic lateral sclerosis died of pneumonia and was autopsied. Magnetic resonance imaging (MRI) performed 16 days before death revealed an intracortical high-intensity lesion in her right temporal cortex on three-dimensional (3D)-double inversion recovery (DIR) and 3D-fluid-attenuated inversion recovery (FLAIR) images. Histopathological examination indicated a cortical microinfarct (CMI) juxtaposed to cerebral amyloid angiopathy. Recently, in vivo detection of CMIs using 3D-DIR and 3D-FLAIR on 3-tesla MRI has been reported, and postmortem MRI study confirmed the presence of CMIs. This is the first case study to compare CMI findings detected upon premortem MRI to the CMI itself discovered upon postmortem neuropathological examination.
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Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ai Ito
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ryogen Sasaki
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; Department of Neurology, National Mie Hospital, Tsu, Mie, Japan
| | - Kenichiro Uno
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; Department of Neurology, Matsusaka Central General Hospital, Matsusaka, Mie, Japan
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Kapasi A, Leurgans SE, James BD, Boyle PA, Arvanitakis Z, Nag S, Bennett DA, Buchman AS, Schneider JA. Watershed microinfarct pathology and cognition in older persons. Neurobiol Aging 2018; 70:10-17. [PMID: 29935416 DOI: 10.1016/j.neurobiolaging.2018.05.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/27/2022]
Abstract
Brain microinfarcts are common in aging and are associated with cognitive impairment. Anterior and posterior watershed border zones lie at the territories of the anterior, middle, and posterior cerebral arteries, and are more vulnerable to hypoperfusion than brain regions outside the watershed areas. However, little is known about microinfarcts in these regions and how they relate to cognition in aging. Participants from the Rush Memory and Aging Project, a community-based clinical-pathologic study of aging, underwent detailed annual cognitive evaluations. We examined 356 consecutive autopsy cases (mean age-at-death, 91 years [SD = 6.16]; 28% men) for microinfarcts from 3 watershed brain regions (2 anterior and 1 posterior) and 8 brain regions outside the watershed regions. Linear regression models were used to examine the association of cortical watershed microinfarcts with cognition, including global cognition and 5 cognitive domains. Microinfarcts in any region were present in 133 (37%) participants, of which 50 had microinfarcts in watershed regions. Persons with multiple microinfarcts in cortical watershed regions had lower global cognition (estimate = -0.56, standard error (SE) = 0.26, p = 0.03) and lower cognitive function in the specific domains of working memory (estimate = -0.58, SE = 0.27, p = 0.03) and visuospatial abilities (estimate = -0.57, SE = 0.27, p = 0.03), even after controlling for microinfarcts in other brain regions, demographics, and age-related pathologies. Neither the presence nor multiplicity of microinfarcts in brain regions outside the cortical watershed regions were related to global cognition or any of the 5 cognitive domains. These findings suggest that multiple microinfarcts in watershed regions contribute to age-related cognitive impairment.
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Affiliation(s)
- Alifiya Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA.
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patricia A Boyle
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sukriti Nag
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Pathology (Neuropathology), Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Miyata M, Kakeda S, Yoneda T, Ide S, Watanabe K, Moriya J, Korogi Y. Signal Change of Acute Cortical and Juxtacortical Microinfarction on Follow-Up MRI. AJNR Am J Neuroradiol 2018; 39:834-840. [PMID: 29599171 DOI: 10.3174/ajnr.a5606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Although the clinical importance of cortical microinfarcts has become well-recognized recently, the evolution of cortical microinfarcts on MR imaging is not fully understood. The aim of this study was to examine the temporal changes in acute cortical microinfarcts using susceptibility-weighted imaging and conventional MR imaging. MATERIALS AND METHODS Patients with acute infarcts located in the cortical and/or juxtacortical region measuring ≤10 mm in axial diameter based on diffusion-weighted imaging who had a follow-up 3T MR imaging were retrospectively included in the study. All lesions did not show hypointensity on initial T2*WI. For cortical and/or juxtacortical microinfarcts detected on initial DWI, 2 neuroradiologists evaluated the follow-up MR imaging (T2WI, FLAIR, T2*WI, and SWI) and assessed lesion signal intensities and locations (cortical microinfarcts or microinfarcts with juxtacortical white matter involvement). RESULTS On initial DWI, 2 radiologists observed 180 cortical and/or juxtacortical microinfarcts in 35 MR imaging examinations in 25 patients; on follow-up, the neuroradiologists identified 29 cortical microinfarcts (16%) on T2WI, 9 (5%) on FLAIR, 4 (2%) on T2*, and 97 (54%) on SWI. All cortical microinfarcts detected with any follow-up MR imaging showed hyperintensity on T2WI/FLAIR and/or hypointensity on T2*WI and SWI. CONCLUSIONS SWI revealed conversion (paramagnetic susceptibility changes) of acute cortical microinfarcts, suggesting that a substantial number of cortical microinfarcts may contain hemorrhagic components.
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Affiliation(s)
- M Miyata
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - S Kakeda
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - T Yoneda
- Department of Medical Physics in Advanced Biomedical Sciences (T.Y.), Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Ide
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - K Watanabe
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - J Moriya
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Y Korogi
- From the Department of Radiology (M.M., S.K., S.I., K.W., J.M., Y.K.), School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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86
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Present and Future of Ultra-High Field MRI in Neurodegenerative Disorders. Curr Neurol Neurosci Rep 2018; 18:31. [DOI: 10.1007/s11910-018-0841-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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87
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Niwa A, Ii Y, Shindo A, Matsuo K, Ishikawa H, Taniguchi A, Takase S, Maeda M, Sakuma H, Akatsu H, Hashizume Y, Tomimoto H. Comparative Analysis of Cortical Microinfarcts and Microbleeds using 3.0-Tesla Postmortem Magnetic Resonance Images and Histopathology. J Alzheimers Dis 2018; 59:951-959. [PMID: 28697558 PMCID: PMC5545920 DOI: 10.3233/jad-161242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Microvascular lesions including cortical microinfarctions (CMIs) and cerebral lobar microbleeds (CMBs) are usually caused by cerebral amyloid angiopathy (CAA) in the elderly and are correlated with cognitive decline. However, their radiological-histopathological coincidence has not been revealed systematically with widely used 3-Tesla (3T) magnetic resonance imaging (MRI). The purpose of the present study is to delineate the histopathological background corresponding to MR images of these lesions. We examined formalin-fixed 10-mm thick coronal brain blocks from 10 CAA patients (five were also diagnosed with Alzheimer's disease, three with dementia with Lewy bodies, and two with CAA only) with dementia and six non CAA patients with neurodegenerative disease. Using 3T MRI, both 3D-fluid attenuated inversion recovery (FLAIR) and 3D-double inversion recovery (DIR) were examined to identify CMIs, and T2* and susceptibility-weighted images (SWI) were examined to identify CMBs. These blocks were subsequently examined histologically and immunohistochemically. In CAA patients, 48 CMIs and 6 lobar CMBs were invariably observed in close proximity to degenerated Aβ-positive blood vessels. Moreover, 16 CMIs (33%) of 48 were detected with postmortem MRI, but none were seen when the lesion size was smaller than 1 mm. In contrast, only 1 undeniable CMI was founded with MRI and histopathology in 6 non CAA patients. Small, cortical high-intensity lesions seen on 3D-FLAIR and 3D-DIR images likely represent CMIs, and low-intensity lesions in T2* and SWI correspond to CMBs with in vivo MRI. Furthermore, a close association between amyloid-laden vessels and these microvascular lesions indicated the contribution of CAA to their pathogenesis.
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Affiliation(s)
- Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Ko Matsuo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Masayuki Maeda
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hiroyasu Akatsu
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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Geraldes R, Ciccarelli O, Barkhof F, De Stefano N, Enzinger C, Filippi M, Hofer M, Paul F, Preziosa P, Rovira A, DeLuca GC, Kappos L, Yousry T, Fazekas F, Frederiksen J, Gasperini C, Sastre-Garriga J, Evangelou N, Palace J. The current role of MRI in differentiating multiple sclerosis from its imaging mimics. Nat Rev Neurol 2018. [DOI: 10.1038/nrneurol.2018.14] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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89
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Hartmann DA, Hyacinth HI, Liao FF, Shih AY. Does pathology of small venules contribute to cerebral microinfarcts and dementia? J Neurochem 2018; 144:517-526. [PMID: 28950410 PMCID: PMC5869083 DOI: 10.1111/jnc.14228] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 09/08/2017] [Accepted: 09/18/2017] [Indexed: 12/28/2022]
Abstract
Microinfarcts are small, but strikingly common, ischemic brain lesions in the aging human brain. There is mounting evidence that microinfarcts contribute to vascular cognitive impairment and dementia, but the origins of microinfarcts are unclear. Understanding the vascular pathologies that cause microinfarcts may yield strategies to prevent their occurrence and reduce their deleterious effects on brain function. Current thinking suggests that cortical microinfarcts arise from the occlusion of penetrating arterioles, which are responsible for delivering oxygenated blood to small volumes of tissue. Unexpectedly, pre-clinical studies have shown that the occlusion of penetrating venules, which drain deoxygenated blood from cortex, lead to microinfarcts that appear identical to those resulting from arteriole occlusion. Here we discuss the idea that cerebral venule pathology could be an overlooked source for brain microinfarcts in humans. This article is part of the Special Issue "Vascular Dementia". Cover Image for this Issue: doi: 10.1111/jnc.14167.
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Affiliation(s)
- David A. Hartmann
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Hyacinth I. Hyacinth
- Aflac Cancer and Blood Disorder Center, Children’s Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, USA
| | - Francesca-Fang Liao
- Department of Pharmacology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andy Y. Shih
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
- Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
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90
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Shih AY, Hyacinth HI, Hartmann DA, van Veluw SJ. Rodent Models of Cerebral Microinfarct and Microhemorrhage. Stroke 2018; 49:803-810. [PMID: 29459393 DOI: 10.1161/strokeaha.117.016995] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Andy Y Shih
- From the Department of Neuroscience (A.Y.S., D.A.H.) and Center for Biomedical Imaging (A.Y.S.), Medical University of South Carolina, Charleston, SC; Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, GA (H.I.H.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.v.V.).
| | - Hyacinth I Hyacinth
- From the Department of Neuroscience (A.Y.S., D.A.H.) and Center for Biomedical Imaging (A.Y.S.), Medical University of South Carolina, Charleston, SC; Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, GA (H.I.H.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.v.V.)
| | - David A Hartmann
- From the Department of Neuroscience (A.Y.S., D.A.H.) and Center for Biomedical Imaging (A.Y.S.), Medical University of South Carolina, Charleston, SC; Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, GA (H.I.H.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.v.V.)
| | - Susanne J van Veluw
- From the Department of Neuroscience (A.Y.S., D.A.H.) and Center for Biomedical Imaging (A.Y.S.), Medical University of South Carolina, Charleston, SC; Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta and Emory University Department of Pediatrics, GA (H.I.H.); and Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.v.V.)
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91
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Abstract
The term vascular cognitive impairment (VCI) was introduced around the start of the new millennium and refers to the contribution of vascular pathology to any severity of cognitive impairment, ranging from subjective cognitive decline and mild cognitive impairment to dementia. Although vascular pathology is common in elderly individuals with cognitive decline, pure vascular dementia (that is, dementia caused solely by vascular pathology) is uncommon. Indeed, most patients with vascular dementia also have other types of pathology, the most common of which is Alzheimer disease (specifically, the diffuse accumulation of amyloid-β plaques and neurofibrillary tangles composed of tau). At present, the main treatment for VCI is prevention by treating vascular diseases and other risk factors for VCI, such as hypertension and diabetes mellitus. Despite the current paucity of disease-modifying pharmacological treatments, we foresee that eventually, we might be able to target specific brain diseases to prevent cognitive decline and dementia.
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92
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Singh PK, Kawasaki M, Berk-Rauch HE, Nishida G, Yamasaki T, Foley MA, Norris EH, Strickland S, Aso K, Ahn HJ. Aminopyrimidine Class Aggregation Inhibitor Effectively Blocks Aβ-Fibrinogen Interaction and Aβ-Induced Contact System Activation. Biochemistry 2018; 57:1399-1409. [PMID: 29394041 DOI: 10.1021/acs.biochem.7b01214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Accumulating evidence suggests that fibrinogen, a key protein in the coagulation cascade, plays an important role in circulatory dysfunction in Alzheimer's disease (AD). Previous work has shown that the interaction between fibrinogen and β-amyloid (Aβ), a hallmark pathological protein in AD, induces plasmin-resistant abnormal blood clots, delays fibrinolysis, increases inflammation, and aggravates cognitive function in mouse models of AD. Since Aβ oligomers have a much stronger affinity for fibrinogen than Aβ monomers, we tested whether amyloid aggregation inhibitors could block the Aβ-fibrinogen interaction and found that some Aβ aggregation inhibitors showed moderate inhibitory efficacy against this interaction. We then modified a hit compound so that it not only showed a strong inhibitory efficacy toward the Aβ-fibrinogen interaction but also retained its potency toward the Aβ42 aggregation inhibition process. Furthermore, our best hit compound, TDI-2760, modulated Aβ42-induced contact system activation, a pathological condition observed in some AD patients, in addition to inhibiting the Aβ-fibrinogen interaction and Aβ aggregation. Thus, TDI-2760 has the potential to lessen vascular abnormalities as well as Aβ aggregation-driven pathology in AD.
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Affiliation(s)
- Pradeep K Singh
- Patricia and John Rosenwald Laboratory of Neurobiology and Genetics, The Rockefeller University , New York, New York 10065, United States
| | - Masanori Kawasaki
- Tri-Institutional Therapeutics Discovery Institute , New York, New York 10021, United States
| | - Hanna E Berk-Rauch
- Patricia and John Rosenwald Laboratory of Neurobiology and Genetics, The Rockefeller University , New York, New York 10065, United States
| | - Goushi Nishida
- Tri-Institutional Therapeutics Discovery Institute , New York, New York 10021, United States
| | - Takeshi Yamasaki
- Tri-Institutional Therapeutics Discovery Institute , New York, New York 10021, United States
| | - Michael A Foley
- Tri-Institutional Therapeutics Discovery Institute , New York, New York 10021, United States
| | - Erin H Norris
- Patricia and John Rosenwald Laboratory of Neurobiology and Genetics, The Rockefeller University , New York, New York 10065, United States
| | - Sidney Strickland
- Patricia and John Rosenwald Laboratory of Neurobiology and Genetics, The Rockefeller University , New York, New York 10065, United States
| | - Kazuyoshi Aso
- Tri-Institutional Therapeutics Discovery Institute , New York, New York 10021, United States
| | - Hyung Jin Ahn
- Patricia and John Rosenwald Laboratory of Neurobiology and Genetics, The Rockefeller University , New York, New York 10065, United States
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93
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Ueda Y, Satoh M, Tabei KI, Kida H, Ii Y, Asahi M, Maeda M, Sakuma H, Tomimoto H. Neuropsychological Features of Microbleeds and Cortical Microinfarct Detected by High Resolution Magnetic Resonance Imaging. J Alzheimers Dis 2018; 53:315-25. [PMID: 27163803 DOI: 10.3233/jad-151008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lobar microbleeds (MBs) and cortical microinfarct (CMI) are caused by cerebral amyloid angiopathy in the elderly and increase in number in Alzheimer's disease. OBJECTIVE The aim of this study is to elucidate the effects of lobar MBs and CMIs on cognitive function. METHODS The subjects were outpatients who visited the memory clinic of Mie University Hospital. Among 120 subjects, 109 patients fulfilled the inclusion criteria. We quantitatively estimated MBs and CMIs using double inversion recovery and 3D FLAIR images of 3T MRI. Neuropsychological assessments included intellectual, memory, constructional, and frontal lobe function. RESULTS Of the 109 patients, MBs and CMIs were observed in 68 (62%) and 17 (16%) subjects, respectively. Of the 68 patients with MBs, lobar MBs were found in 28, deep MBs in 8 and mixed MBs in 31. In each age group, the number of MBs increased in patients with CMI (CMI+ group) than those without CMI (CMI- group), and MBs and CMIs additively decreased MMSE scores. In psychological screens, the MBs+ group with more than 10 MBs showed significantly lower scores of category- and letter-WF than MB- group. The CMI+ group showed significantly worse scores than CMI- group in Japanese Raven's coloured progressive matrices, Trail Making Test-A, category- and letter-word fluency and copy and drawing of figures. CONCLUSION Lobar MBs and CMIs in the elderly frequently coexisted with each other and additively contributed to cognitive impairment, which is mainly predisposed to frontal lobe function.
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Affiliation(s)
- Yukito Ueda
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan.,Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masaru Asahi
- Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Masayuki Maeda
- Department of Radiology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Graduate School of Medicine, Mie University, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics, Graduate School of Medicine, Mie University, Mie, Japan.,Department of Neurology, Graduate School of Medicine, Mie University, Mie, Japan
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94
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Kaczmarz S, Griese V, Preibisch C, Kallmayer M, Helle M, Wustrow I, Petersen ET, Eckstein HH, Zimmer C, Sorg C, Göttler J. Increased variability of watershed areas in patients with high-grade carotid stenosis. Neuroradiology 2018; 60:311-323. [PMID: 29299616 DOI: 10.1007/s00234-017-1970-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Watershed areas (WSAs) of the brain are most susceptible to acute hypoperfusion due to their peripheral location between vascular territories. Additionally, chronic WSA-related vascular processes underlie cognitive decline especially in patients with cerebral hemodynamic compromise. Despite of high relevance for both clinical diagnostics and research, individual in vivo WSA definition is fairly limited to date. Thus, this study proposes a standardized segmentation approach to delineate individual WSAs by use of time-to-peak (TTP) maps and investigates spatial variability of individual WSAs. METHODS We defined individual watershed masks based on relative TTP increases in 30 healthy elderly persons and 28 patients with unilateral, high-grade carotid stenosis, being at risk for watershed-related hemodynamic impairment. Determined WSA location was confirmed by an arterial transit time atlas and individual super-selective arterial spin labeling. We compared spatial variability of WSA probability maps between groups and assessed TTP differences between hemispheres in individual and group-average watershed locations. RESULTS Patients showed significantly higher spatial variability of WSAs than healthy controls. Perfusion on the side of the stenosis was delayed within individual watershed masks as compared to a watershed template derived from controls, being independent from the grade of the stenosis and collateralization status of the circle of Willis. CONCLUSION Results demonstrate feasibility of individual WSA delineation by TTP maps in healthy elderly and carotid stenosis patients. Data indicate necessity of individual segmentation approaches especially in patients with hemodynamic compromise to detect critical regions of impaired hemodynamics.
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Affiliation(s)
- Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Vanessa Griese
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- Clinic for Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Helle
- Research Laboratories, Philips GmbH Innovative Technologies, Hamburg, Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Esben Thade Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
- Center for Magnetic Resonance, Department of Electrical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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95
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Abstract
This chapter provides a brief overview of studies that combine postmortem magnetic resonance imaging (MRI) and histopathology. We touch upon the logistics of setting up a protocol that limits unwanted postmortem delays and explain how combining postmortem MRI and histopathology can elucidate the histologic substrate of signal changes that appear on MRI. This is demonstrated by exemplary studies in multiple sclerosis, and includes various histopathologic techniques and a wide range of conventional and advanced MRI sequences at various field strengths. We cover topics such as how to visualize white-matter pathology and repair with conventional and advanced MRI sequences, describe the history of visualizing pathology of the gray matter (with newly developed MRI and immunohistopathology techniques), and how advanced methods have aided research in other neurologic diseases. We conclude with several suggestions for future development, such as bridging the gap between postmortem and in vivo research and the importance of collecting non-neurological control tissue.
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Affiliation(s)
- Laura E Jonkman
- Department of Anatomy and Neurosciences, VU Medical Center, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, VU Medical Center, Amsterdam, The Netherlands.
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96
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Kalaria RN. The pathology and pathophysiology of vascular dementia. Neuropharmacology 2017; 134:226-239. [PMID: 29273521 DOI: 10.1016/j.neuropharm.2017.12.030] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023]
Abstract
Vascular dementia (VaD) is widely recognised as the second most common type of dementia. Consensus and accurate diagnosis of clinically suspected VaD relies on wide-ranging clinical, neuropsychological and neuroimaging measures in life but more importantly pathological confirmation. Factors defining subtypes of VaD include the nature and extent of vascular pathologies, degree of involvement of extra and intracranial vessels and the anatomical location of tissue changes as well as time after the initial vascular event. Atherosclerotic and cardioembolic diseases combined appear the most common subtypes of vascular brain injury. In recent years, cerebral small vessel disease (SVD) has gained prominence worldwide as an important substrate of cognitive impairment. SVD is characterised by arteriolosclerosis, lacunar infarcts and cortical and subcortical microinfarcts and diffuse white matter changes, which involve myelin loss and axonal abnormalities. Global brain atrophy and focal degeneration of the cerebrum including medial temporal lobe atrophy are also features of VaD similar to Alzheimer's disease. Hereditary arteriopathies have provided insights into the mechanisms of dementia particularly how arteriolosclerosis, a major contributor of SVD promotes cognitive impairment. Recently developed and validated neuropathology guidelines indicated that the best predictors of vascular cognitive impairment were small or lacunar infarcts, microinfarcts, perivascular space dilation, myelin loss, arteriolosclerosis and leptomeningeal cerebral amyloid angiopathy. While these substrates do not suggest high specificity, VaD is likely defined by key neuronal and dendro-synaptic changes resulting in executive dysfunction and related cognitive deficits. Greater understanding of the molecular pathology is needed to clearly define microvascular disease and vascular substrates of dementia. This article is part of the Special Issue entitled 'Cerebral Ischemia'.
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Affiliation(s)
- Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle Upon Tyne NE4 5PL, United Kingdom.
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97
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Barrett EJ, Liu Z, Khamaisi M, King GL, Klein R, Klein BEK, Hughes TM, Craft S, Freedman BI, Bowden DW, Vinik AI, Casellini CM. Diabetic Microvascular Disease: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2017; 102:4343-4410. [PMID: 29126250 PMCID: PMC5718697 DOI: 10.1210/jc.2017-01922] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 01/18/2023]
Abstract
Both type 1 and type 2 diabetes adversely affect the microvasculature in multiple organs. Our understanding of the genesis of this injury and of potential interventions to prevent, limit, or reverse injury/dysfunction is continuously evolving. This statement reviews biochemical/cellular pathways involved in facilitating and abrogating microvascular injury. The statement summarizes the types of injury/dysfunction that occur in the three classical diabetes microvascular target tissues, the eye, the kidney, and the peripheral nervous system; the statement also reviews information on the effects of diabetes and insulin resistance on the microvasculature of skin, brain, adipose tissue, and cardiac and skeletal muscle. Despite extensive and intensive research, it is disappointing that microvascular complications of diabetes continue to compromise the quantity and quality of life for patients with diabetes. Hopefully, by understanding and building on current research findings, we will discover new approaches for prevention and treatment that will be effective for future generations.
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Affiliation(s)
- Eugene J. Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Zhenqi Liu
- Division of Endocrinology, Department of Medicine, University of Virginia, Charlottesville, Virginia 22908
| | - Mogher Khamaisi
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - George L. King
- Section of Vascular Cell Biology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Barbara E. K. Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705
| | - Timothy M. Hughes
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Suzanne Craft
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Barry I. Freedman
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Donald W. Bowden
- Divisions of Nephrology and Endocrinology, Department of Internal Medicine, Centers for Diabetes Research, and Center for Human Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Aaron I. Vinik
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
| | - Carolina M. Casellini
- EVMS Strelitz Diabetes Center, Eastern Virginia Medical Center, Norfolk, Virginia 23510
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98
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Summers PM, Hartmann DA, Hui ES, Nie X, Deardorff RL, McKinnon ET, Helpern JA, Jensen JH, Shih AY. Functional deficits induced by cortical microinfarcts. J Cereb Blood Flow Metab 2017; 37:3599-3614. [PMID: 28090802 PMCID: PMC5669342 DOI: 10.1177/0271678x16685573] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical studies have revealed a strong link between increased burden of cerebral microinfarcts and risk for cognitive impairment. Since the sum of tissue damage incurred by microinfarcts is a miniscule percentage of total brain volume, we hypothesized that microinfarcts disrupt brain function beyond the injury site visible to histological or radiological examination. We tested this idea using a mouse model of microinfarcts, where single penetrating vessels that supply mouse cortex were occluded by targeted photothrombosis. We found that in vivo structural and diffusion MRI reliably reported the acute microinfarct core, based on spatial co-registrations with post-mortem stains of neuronal viability. Consistent with our hypothesis, c-Fos assays for neuronal activity and in vivo imaging of single vessel hemodynamics both reported functional deficits in viable peri-lesional tissues beyond the microinfarct core. We estimated that the volume of tissue with functional deficit in cortex was at least 12-fold greater than the volume of the microinfarct core. Impaired hemodynamic responses in peri-lesional tissues persisted at least 14 days, and were attributed to lasting deficits in neuronal circuitry or neurovascular coupling. These data show how individually miniscule microinfarcts could contribute to broader brain dysfunction during vascular cognitive impairment and dementia.
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Affiliation(s)
- Philipp M Summers
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - David A Hartmann
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edward S Hui
- 2 Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Xingju Nie
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Rachael L Deardorff
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Emilie T McKinnon
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph A Helpern
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.,3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- 3 Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Andy Y Shih
- 1 Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.,4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
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99
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Azarpazhooh MR, Avan A, Cipriano LE, Munoz DG, Sposato LA, Hachinski V. Concomitant vascular and neurodegenerative pathologies double the risk of dementia. Alzheimers Dement 2017; 14:148-156. [PMID: 28974416 DOI: 10.1016/j.jalz.2017.07.755] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/12/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The relative contributions of vascular and degenerative pathology to dementia are unknown. We aim to quantify the proportion of dementia explained by potentially preventable vascular lesions. METHODS We systematically searched for population-based cohorts before February 2017 reporting clinicopathological data for individuals with and without dementia. We calculated the summary proportion and absolute risk of dementia comparing subjects with and without the pathology. RESULTS We identified 10 studies comprising 2856 subjects. Vascular-type pathology and mixed pathology are respectively two and three times more likely in demented patients. The summary proportion of dementia is 77%-86% in subjects with mixed degenerative and vascular pathology and 45% in subjects with pure Alzheimer-type pathology. DISCUSSION Patients with mixed pathologies have nearly twice the incremental risk of dementia compared with patients with only Alzheimer-type lesions. Consequently, many cases of dementia could be prevented or delayed by targeting the vascular component.
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Affiliation(s)
- Mahmoud Reza Azarpazhooh
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Abolfazl Avan
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lauren E Cipriano
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Ivey Business School, Western University, London, Ontario, Canada
| | - David G Munoz
- Department of Pathology and Laboratory Medicine, University of Toronto & Department of Laboratory Medicine, and Keenan Research Centre for Biomedical Research, The Li Ka Shing Knowledge Institute, St Michael's Hospital Toronto, Ontario, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Stroke, Dementia and Heart Disease Laboratory, Western University, London, Ontario, Canada; Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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100
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van Veluw SJ, Shih AY, Smith EE, Chen C, Schneider JA, Wardlaw JM, Greenberg SM, Biessels GJ. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740. [PMID: 28716371 PMCID: PMC5861500 DOI: 10.1016/s1474-4422(17)30196-5] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/17/2017] [Accepted: 06/01/2017] [Indexed: 02/07/2023]
Abstract
Cerebral microinfarcts are small lesions that are presumed to be ischaemic. Despite the small size of these lesions, affected individuals can have hundreds to thousands of cerebral microinfarcts, which cause measurable disruption to structural brain connections, and are associated with dementia that is independent of Alzheimer's disease pathology or larger infarcts (ie, lacunar infarcts, and large cortical and non-lacunar subcortical infarcts). Substantial progress has been made with regard to understanding risk factors and functional consequences of cerebral microinfarcts, partly driven by new in-vivo detection methods and the development of animal models that closely mimic multiple aspects of cerebral microinfarcts in human beings. Evidence from these advances suggests that cerebral microinfarcts can be manifestations of both small vessel and large vessel disease, that cerebral microinfarcts are independently associated with cognitive impairment, and that these lesions are likely to cause damage to brain structure and function that extends beyond their actual lesion boundaries. Criteria for the identification of cerebral microinfarcts with in-vivo MRI are provided to support further studies of the association between these lesions and cerebrovascular disease and dementia.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andy Y Shih
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Eric E Smith
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Chen
- Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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