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Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res 2017; 120:573-591. [PMID: 28154105 DOI: 10.1161/circresaha.116.308426] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/28/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.
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Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.).
| | - Didier Leys
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.)
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Abstract
BACKGROUND The National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) 5-minute neuropsychology protocol consists of only verbal tasks, and is proposed as a brief screening method for vascular cognitive impairment. We evaluated its feasibility within two weeks after stroke and ability to predict the development of post-stroke dementia (PSD) at 3 months after stroke. METHOD We prospectively enrolled subjects with ischemic stroke within seven days of symptom onset who were consecutively admitted to 12 university hospitals. Neuropsychological assessments using the NINDS-CSN 5-minute and 60-minute neuropsychology protocols were administered within two weeks and at 3 months after stroke onset, respectively. PSD was diagnosed with reference to the American Heart Association/American Stroke Association statement, requiring deficits in at least two cognitive domains. RESULTS Of 620 patients, 512 (82.6%) were feasible for the NINDS-CSN 5-minute protocol within two weeks after stroke. The incidence of PSD was 16.2% in 308 subjects who had completed follow-up at 3 months after stroke onset. The total score of the NINDS-CSN 5-minute protocol differed significantly between those with and without PSD (4.0 ± 2.7, 7.4 ± 2.7, respectively; p < 0.01). A cut-off value of 6/7 showed reasonable discriminative power (sensitivity 0.82, specificity 0.67, AUC 0.74). The NINDS-CSN 5-minute protocol score was a significant predictor for PSD (adjusted odds ratio 6.32, 95% CI 2.65-15.05). DISCUSSION The NINDS-CSN 5-minute protocol is feasible to evaluate cognitive functions in patients with acute ischemic stroke. It might be a useful screening method for early identification of high-risk groups for PSD.
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Abstract
Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.
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Affiliation(s)
- Helena C Chui
- Department of Neurology, University of Southern California, 1540 Alcazar Street, CHP215, Los Angeles, CA 90033, USA.
| | - Liliana Ramirez Gomez
- Department of Neurology, University of California San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA
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Abstract
Incident stroke has long been recognized to cause dementia shortly after the event. Patients who survive stroke without early-onset poststroke dementia (PSD) are at a high risk of developing dementia months to years after the initial stroke incident, which has generated enthusiasm for exploring treatments to prevent delayed-onset PSD in survivors of stroke. However, results from clinical trials completed in the past 10-15 years have been disappointing. In light of these results, the present Review revisits the mechanisms of both early-onset and delayed-onset PSD and proposes preventive strategies and directions for future clinical trials. Early-onset PSD results from a complex interplay between stroke lesion features and brain resilience, whereas delayed-onset PSD is associated mainly with the presence of severe sporadic small vessel disease (SVD), and to a lesser extent with Alzheimer disease pathology or recurrent stroke. As well as preventing stroke and delivering acute stroke treatments to reduce initial brain damage, measures to increase brain resilience could also reduce the risk of developing dementia if an incident stroke occurs. Future efforts to prevent delayed-onset PSD should focus on the study of sporadic SVD and on evaluating whether other strategies, in addition to conventional secondary stroke prevention, are effective in dementia prevention in this high-risk group.
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Kooi Ong L, Rohan Walker F, Nilsson M. Is Stroke a Neurodegenerative Condition? A Critical Review of Secondary Neurodegeneration and Amyloid-beta Accumulation after Stroke. AIMS MEDICAL SCIENCE 2017. [DOI: 10.3934/medsci.2017.1.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Sachdev PS, Lo JW, Crawford JD, Mellon L, Hickey A, Williams D, Bordet R, Mendyk AM, Gelé P, Deplanque D, Bae HJ, Lim JS, Brodtmann A, Werden E, Cumming T, Köhler S, Verhey FRJ, Dong YH, Tan HH, Chen C, Xin X, Kalaria RN, Allan LM, Akinyemi RO, Ogunniyi A, Klimkowicz-Mrowiec A, Dichgans M, Wollenweber FA, Zietemann V, Hoffmann M, Desmond DW, Linden T, Blomstrand C, Fagerberg B, Skoog I, Godefroy O, Barbay M, Roussel M, Lee BC, Yu KH, Wardlaw J, Makin SJ, Doubal FN, Chappell FM, Srikanth VK, Thrift AG, Donnan GA, Kandiah N, Chander RJ, Lin X, Cordonnier C, Moulin S, Rossi C, Sabayan B, Stott DJ, Jukema JW, Melkas S, Jokinen H, Erkinjuntti T, Mok VCT, Wong A, Lam BYK, Leys D, Hénon H, Bombois S, Lipnicki DM, Kochan NA. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 7:11-23. [PMID: 28138511 PMCID: PMC5257024 DOI: 10.1016/j.dadm.2016.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The Stroke and Cognition consortium (STROKOG) aims to facilitate a better understanding of the determinants of vascular contributions to cognitive disorders and help improve the diagnosis and treatment of vascular cognitive disorders (VCD). METHODS Longitudinal studies with ≥75 participants who had suffered or were at risk of stroke or TIA and which evaluated cognitive function were invited to join STROKOG. The consortium will facilitate projects investigating rates and patterns of cognitive decline, risk factors for VCD, and biomarkers of vascular dementia. RESULTS Currently, STROKOG includes 25 (21 published) studies, with 12,092 participants from five continents. The duration of follow-up ranges from 3 months to 21 years. DISCUSSION Although data harmonization will be a key challenge, STROKOG is in a unique position to reuse and combine international cohort data and fully explore patient level characteristics and outcomes. STROKOG could potentially transform our understanding of VCD and have a worldwide impact on promoting better vascular cognitive outcomes.
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Affiliation(s)
- Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Stroke and Geriatric Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Régis Bordet
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Anne-Marie Mendyk
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Patrick Gelé
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Dominique Deplanque
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Amy Brodtmann
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Emilio Werden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Toby Cumming
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Yan-Hong Dong
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Hui Tan
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xu Xin
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raj N Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Vera Zietemann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Hoffmann
- Cognitive Neurology and Stroke Programs, University of Central Florida, Orlando VA Medical Center, Orlando, Florida, USA
| | | | - Thomas Linden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Mélanie Barbay
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen J Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Amanda G Thrift
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Geoffrey A Donnan
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Xuling Lin
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Solene Moulin
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Costanza Rossi
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - David J Stott
- Academic Section of Geriatrics, University of Glasgow, Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Susanna Melkas
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Hanna Jokinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Timo Erkinjuntti
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Didier Leys
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Hilde Hénon
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Stéphanie Bombois
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
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Wong A, Lau AYL, Yang J, Wang Z, Liu W, Lam BYK, Au L, Shi L, Wang D, Chu WCW, Xiong YY, Lo ESK, Law LSN, Leung TWH, Lam LCW, Chan AYY, Soo YOY, Leung EYL, Wong LKS, Mok VCT. Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid. PLoS One 2016; 11:e0162846. [PMID: 27632159 PMCID: PMC5025073 DOI: 10.1371/journal.pone.0162846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters. Methods Hospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3–6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer’s Disease (AD) pathology. Results 50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention. Conclusion Frequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, 510260, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Eugene S. K. Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine S. N. Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Y. L. Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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Wollenweber FA, Därr S, Müller C, Duering M, Buerger K, Zietemann V, Malik R, Brendel M, Ertl-Wagner B, Bartenstein P, Rominger A, Dichgans M. Prevalence of Amyloid Positron Emission Tomographic Positivity in Poststroke Mild Cognitive Impairment. Stroke 2016; 47:2645-8. [PMID: 27539301 DOI: 10.1161/strokeaha.116.013778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Mild cognitive impairment (MCI) is common after stroke and associated with poor outcome. However, the mechanisms underlying poststroke MCI (PS-MCI) are insufficiently understood. We performed amyloid-β positron emission tomography (PET) in a prospective cohort of stroke survivors to determine the role of amyloid pathology in PS-MCI. METHODS We studied 178 consecutive patients enrolled into the prospective DEDEMAS study (Determinants of Dementia After Stroke). Follow-up visits 6 months post stroke included detailed cognitive testing, standardized magnetic resonance imaging, and amyloid-β imaging using flutemetamol ((18)F) PET. MCI was defined by the modified Petersen criteria. Amyloid-positivity was assessed visually and quantitatively. Fifty-six (31%) patients agreed to undergo PET imaging. RESULTS Thirty-eight (68%) patients who consented to PET imaging had PS-MCI. Visual assessment revealed amyloid PET positivity in 2 (5%) of the 38 PS-MCI patients and in 2 (11%) of the 18 cognitively healthy stroke survivors. There was no correlation between flutemetamol ((18)F) standardized uptake value ratios and cognitive scores in the 56 patients. PS-MCI patients had significant cognitive impairments on executive function (P<0.01) and memory tests (P<0.01) when compared with cognitively healthy stroke survivors (P<0.01). CONCLUSIONS The prevalence of amyloid-pathology in patients with PS-MCI is not increased when compared with cognitively healthy stroke survivors and to recent estimates for cognitively healthy elderly subjects. Factors other than amyloid-pathology likely contribute to the development of PS-MCI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01334749.
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Affiliation(s)
- Frank Arne Wollenweber
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Sonja Därr
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Claudia Müller
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Marco Duering
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Katharina Buerger
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Vera Zietemann
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Rainer Malik
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Matthias Brendel
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Birgit Ertl-Wagner
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Peter Bartenstein
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Axel Rominger
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research (F.A.W., C.M., M. Duering, K.B., V.Z., R.M., M. Dichgans), Department of Nuclear Medicine (S.D., M.B., P.B., A.R.), and Institute of Clinical Radiology (B.E.-W.), Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany; and German Center for Neurodegenerative Diseases (DZNE) (M. Dichgans) and Munich Cluster for Systems Neurology (SyNergy) (P.B., A.R., M. Dichgans), Germany.
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Chen X, Du YM, Xu F, Liu D, Wang YL. Propofol Prevents Hippocampal Neuronal Loss and Memory Impairment in Cerebral Ischemia Injury Through Promoting PTEN Degradation. J Mol Neurosci 2016; 60:63-70. [DOI: 10.1007/s12031-016-0791-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/28/2016] [Indexed: 01/07/2023]
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Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta Mol Basis Dis 2016; 1862:915-25. [PMID: 26806700 PMCID: PMC4827373 DOI: 10.1016/j.bbadis.2016.01.015] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 12/13/2022]
Abstract
The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. Ischaemic injury is common among long-term stroke survivors About 25% stroke survivors develop dementia with a much greater proportion developing cognitive impairment Risk factors of dementia after stroke include older age, vascular comorbidities, prior stroke and pre-stroke impairment Current imaging and pathological studies suggest 70% of dementia after stroke is vascular dementia Severe white matter changes and medial temporal lobe atrophy as sequelae after ischaemic injury are substrates of dementia Controlling vascular risk factors and prevention strategies related to lifestyle factors would reduce dementia after stroke
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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; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
| | - Rufus Akinyemi
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Masafumi Ihara
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom; Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Kulesh AA, Shestakov VV. Post-stroke cognitive impairment and the possibility of treatment with cellex. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:38-42. [DOI: 10.17116/jnevro20161165138-42] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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