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Sommer R, Yu L, Schneider JA, Bennett DA, Buchman AS, Lim ASP. Disrupted Rest-Activity Rhythms and Cerebral Small Vessel Disease Pathology in Older Adults. Stroke 2021; 52:2427-2431. [PMID: 33902300 PMCID: PMC8790726 DOI: 10.1161/strokeaha.120.030870] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenesis of cerebral small vessel disease remains incompletely understood. The relationship between circadian rhythm disturbances and histopathologic measures of cerebral small vessel disease has not been studied. We hypothesized that disrupted circadian rest-activity rhythms would be associated with a higher burden of cerebral small vessel disease pathology. METHODS We studied 561 community-dwelling older adults (mean age at death, 91.2, 27.4% male) from the Rush Memory and Aging Project. We used actigraphy to quantify several measures of 24-hour rest-activity rhythmicity, including interdaily stability, intradaily variability, and amplitude, and used ordinal logistic regression models to relate these measures to the severity of cerebral arteriolosclerosis, atherosclerosis, macroinfarcts, and microinfarcts, assessed at autopsy. RESULTS Lower interdaily stability was associated with a higher burden of arteriolosclerosis, higher intradaily variability was associated with a higher burden of atherosclerosis and subcortical infarcts, and lower amplitude was associated with a higher burden of arteriosclerosis, atherosclerosis and subcortical macroinfarcts. Moreover, the associations between interdaily stability and arteriolosclerosis and intradaily variability and subcortical infarcts were independent of cardiovascular risk factors, sleep fragmentation, and medical comorbidities. CONCLUSIONS Disrupted rest-activity rhythms are associated with a greater burden of cerebral small vessel disease in older adults.
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Affiliation(s)
- Rosa Sommer
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.S., A.S.P.L.)
| | - Lei Yu
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Julie A Schneider
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
- Department of Pathology (J.A.S.), Rush University, Chicago, IL
| | - David A Bennett
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Aron S Buchman
- Rush Alzheimer Disease Center (L.Y., J.A.S., D.A.B., A.S.B.), Rush University, Chicago, IL
| | - Andrew S P Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (R.S., A.S.P.L.)
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Imaging neurovascular, endothelial and structural integrity in preparation to treat small vessel diseases. The INVESTIGATE-SVDs study protocol. Part of the SVDs@Target project. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100020. [PMID: 36324725 PMCID: PMC9616332 DOI: 10.1016/j.cccb.2021.100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/25/2021] [Accepted: 06/20/2021] [Indexed: 12/30/2022]
Abstract
Background Sporadic cerebral small vessel disease (SVD) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) share clinical and neuroimaging features and possibly vascular dysfunction(s). However few studies have included both conditions, assessed more than one vascular dysfunction simultaneously, or included more than one centre. The INVESTIGATE-SVDs study will assess several cerebrovascular dysfunctions with MRI in participants with sporadic SVD or CADASIL at three European centres. Methods We will recruit participants with sporadic SVDs (ischaemic stroke or vascular cognitive impairment) and CADASIL in Edinburgh, Maastricht and Munich. We will perform detailed clinical and neuropsychological phenotyping of the participants, and neuroimaging including structural MRI, cerebrovascular reactivity MRI (CVR: using carbon dioxide challenge), phase contrast MRI (arterial, venous and CSF flow and pulsatility), dynamic contrast-enhanced MRI (blood brain barrier (BBB) leakage) and multishell diffusion imaging. Participants will measure their blood pressure (BP) and its variability over seven days using a telemetric device. Discussion INVESTIGATE-SVDs will assess the relationships of BBB integrity, CVR, pulsatility and CSF flow in sporadic SVD and CADASIL using a multisite, multimodal MRI protocol. We aim to establish associations between these measures of vascular function, risk factors particularly BP and its variability, and brain parenchymal lesions in these two SVD phenotypes. Additionally we will test feasibility of complex multisite MRI, provide reliable intermediary outcome measures and sample size estimates for future trials.
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Key Words
- BBB, blood brain barrier
- BOLD, blood oxygen level dependent
- BP, blood pressure
- BPv, blood pressure variability
- Blood-brain barrier permeability
- CADASIL
- CADASIL, cerebral autosomal dominant arteriopathy with leukoencephalopathy and subcortical infarcts
- CBF, cerebral blood flow
- CERAD+, consortium to establish a disease registry for Alzheimer's disease plus battery
- CO2, carbon dioxide
- CSF, cerebrospinal fluid
- CVR, cerebrovascular reactivity
- Cerebral small vessel disease
- Cerebrovascular reactivity
- DCE, dynamic contrast enhanced
- EtCO2, end-tidal carbon dioxide
- GM, grey matter
- MMSE, mini-mental state examination
- MRI
- MoCA, Montreal cognitive exam
- NIHSS, national institute for health stroke scale
- PI, pulsatility index
- PVS, perivascular space
- RSSI, recent small subcortical infarct
- SVDs, small vessel diseases
- WM, white matter
- WMH, white matter hyperintensity
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Liu W, Huang X, Liu X, Wang L, Chen Z, Ortega D, Chen L, Sun J, Hatsukami TS, Yuan C, Li H, Yang J. Urinary sodium and potassium excretion and cerebrovascular health: a multimodal imaging study. Eur J Nutr 2021; 60:4555-4563. [PMID: 34146142 DOI: 10.1007/s00394-021-02612-1] [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: 12/06/2020] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Dietary sodium and potassium intake are associated with stroke, but the potential mechanisms are unclear. We aimed to study the association between sodium and potassium intake and subclinical cerebrovascular health in hypertensive older males using multimodal magnetic resonance imaging. METHODS A total of 189 hypertensive male subjects without previous cardiovascular or cerebrovascular disease were included. Daily urinary sodium and potassium excretion were estimated from a fasting spot urine sample using a formula approach. A dedicated cerebrovascular health imaging protocol including vessel wall imaging, angiography, arterial spin labeling imaging and T2-weighted fluid-attenuated inversion recovery imaging was performed to study intracranial atherosclerosis, vascular rarefaction (defined as fewer discernible vessels on angiography), brain perfusion and small vessel disease, respectively. RESULTS The mean age was 64.9 (± 7.2) years. The average daily urinary and potassium excretion was 4.7 (± 1.4) g/L and 2.1 (± 0.5) g/L, respectively. Increased urinary sodium excretion was associated with decreased cerebral blood flow and elevated urinary potassium excretion was associated with reduced prevalence of intracranial plaque. The associations remained significant after adjusting for covariates, even including blood pressure control. Quadratic regression analysis indicated a marginally significant U-shaped association between urinary sodium intake and white matter hyperintensity, which lost significance in fully adjusted models. No significant association of urinary sodium and potassium excretion with other cerebrovascular health measures was noted. CONCLUSION We concluded that in hypertensive older males without overt cardiovascular disease, increased sodium intake and reduced potassium intake are associated with impaired subclinical cerebrovascular health.
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Affiliation(s)
- Wenjin Liu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Xiaoqin Huang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# Zhongshan North Road, Nanjing, Jiangsu, China
| | - Xuebing Liu
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan, Nanjing, Jiangsu, China
| | - Lulu Wang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# Zhongshan North Road, Nanjing, Jiangsu, China
| | - Zhensen Chen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dakota Ortega
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Li Chen
- Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Thomas S Hatsukami
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Haige Li
- Department of Radiology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan, Nanjing, Jiangsu, China.
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, 262# Zhongshan North Road, Nanjing, Jiangsu, China.
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Humphreys CA, Smith C, Wardlaw JM. Correlations in post-mortem imaging-histopathology studies of sporadic human cerebral small vessel disease: A systematic review. Neuropathol Appl Neurobiol 2021; 47:910-930. [PMID: 34037264 DOI: 10.1111/nan.12737] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/30/2022]
Abstract
AIMS Sporadic human cerebral small vessel disease (SVD) commonly causes stroke and dementia but its pathogenesis is poorly understood. There are recognised neuroimaging and histopathological features. However, relatively few studies have examined the relationship between the radiological and pathological correlates of SVD; better correlation would promote greater insight into the underlying biological changes. METHODS We performed a systematic review to collate and appraise the information derived from studies that correlated histological with neuroimaging-defined SVD lesions. We searched for studies describing post-mortem imaging and histological tissue examination in adults, extracted data from published studies, categorised the information and compiled this narrative. RESULTS We identified 38 relevant studies, including at least 1146 subjects, 342 of these with SVD: 29 studies focussed on neuroradiological white matter lesions (WML), six on microinfarcts and three on dilated perivascular spaces (PVS) and lacunes. The histopathology terminology was diverse with few robust definitions. Reporting and methodology varied widely between studies, precluding formal meta-analysis. PVS and 'oedema' were frequent findings in WML, being described in at least 94 and 18 radiological WML, respectively, in addition to myelin pallor. Histopathological changes extended beyond the radiological lesion margins in at least 33 radiological WML. At least 43 radiological lesions not seen pathologically and at least 178 histological lesions were not identified on imaging. CONCLUSIONS Histopathological assessment of human SVD is hindered by inconsistent methodological approaches and unstandardised definitions. The data from this systematic review will help to develop standardised definitions to promote consistency in human SVD research.
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Affiliation(s)
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh, UK.,Row Fogo Centre for Research into Ageing and the Brain, Edinburgh, UK
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Guevarra AC, Ng SC, Saffari SE, Wong BYX, Chander RJ, Ng KP, Kandiah N. Age Moderates Associations of Hypertension, White Matter Hyperintensities, and Cognition. J Alzheimers Dis 2021; 75:1351-1360. [PMID: 32417773 DOI: 10.3233/jad-191260] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypertension and white matter hyperintensities (WMH) are mutually associated risk factors for cognitive impairment. However, age may modify the associations between hypertension and WMH, and their links to cognitive impairment. OBJECTIVE We evaluated the interaction between age and hypertension on WMH, and the age-stratified associations of hypertension and WMH with cognition. METHODS Key measures include systolic blood pressure (SBP), WMH (modified Fazekas visual ratings of cranial MRI), and the Montreal Cognitive Assessment (MoCA). Participants (N = 488) with prodromal and mild dementia were age-stratified (≤49, 50-59, 60-69,≥70), and considered hypertensive if their SBP≥140 mmHg. The interaction between age strata and hypertension on WMH, and age-stratified associations of hypertension and WMH with cognition, were evaluated using multiple linear regression analyses. Analyses controlled for other risk factors for WMH and cognitive impairment. RESULTS Age moderated the association between SBP and WMH. Hypertension was associated with higher WMH only in those aged 60-69, and WMH trends across age bands differed between those with and without hypertension. Finally, WMH and SBP≥140 were independently associated with lower MoCA scores within the 50-59 age band, while WMH alone was associated with poorer MoCA scores in the≥70 age band. CONCLUSION In adults with prodromal or mild dementia, hypertension was associated with WMH specifically in the 60-69 age strata. Associations between hypertension and WMH with poorer cognition also differed across age bands. Future studies will be needed to investigate whether blood pressure management to slow cognitive decline by targeting WMH may be age dependent.
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Affiliation(s)
| | - Sheng Chun Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Russell Jude Chander
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine - Imperial College London, Nanyang Technological University, Singapore
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Liu J, Ke X, Lai Q. Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities. Acta Radiol 2021; 62:515-523. [PMID: 32551801 DOI: 10.1177/0284185120932386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter. PURPOSE To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals. MATERIAL AND METHODS A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV). RESULTS Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities. CONCLUSION Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.
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Affiliation(s)
- Jiyang Liu
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Xiaoting Ke
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Qingquan Lai
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
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Huynh K, Piguet O, Kwok J, Dobson-Stone C, Halliday GM, Hodges JR, Landin-Romero R. Clinical and Biological Correlates of White Matter Hyperintensities in Patients With Behavioral-Variant Frontotemporal Dementia and Alzheimer Disease. Neurology 2021; 96:e1743-e1754. [PMID: 33597290 DOI: 10.1212/wnl.0000000000011638] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/18/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To test the hypothesis that white matter hyperintensities (WMH) in behavioral-variant frontotemporal dementia (bvFTD) and Alzheimer disease (AD) are associated with disease variables such as disease severity, cortical atrophy, and cognition, we conducted a cross-sectional brain MRI study with volumetric and voxel-wise analyses. METHODS A total of 129 patients (64 bvFTD, 65 AD) and 66 controls underwent high-resolution brain MRI and clinical and neuropsychological examination. Genetic screening was conducted in 124 cases (54 bvFTD, 44 AD, 26 controls) and postmortem pathology was available in 18 cases (13 bvFTD, 5 AD). WMH were extracted using an automated segmentation algorithm and analyses of total volumes and spatial distribution were conducted. Group differences in total WMH volume and associations with vascular risk and disease severity were examined. Syndrome-specific voxel-wise associations between WMH, cortical atrophy, and performance across different cognitive domains were assessed. RESULTS Total WMH volumes were larger in patients with bvFTD than patients with AD and controls. In bvFTD, WMH volumes were associated with disease severity but not vascular risk. Patients with bvFTD and patients with AD showed distinct spatial patterns of WMH that mirrored characteristic patterns of cortical atrophy. Regional WMH load correlated with worse cognitive performance in discrete cognitive domains. WMH-related cognitive impairments were shared between syndromes, with additional associations found in bvFTD. CONCLUSION Increased WMH are common in patients with bvFTD and patients with AD. Our findings suggest that WMH are partly independent of vascular pathology and associated with the neurodegenerative process. WMH occur in processes independent of and related to cortical atrophy. Furthermore, increased WMH in different regions contributes to cognitive deficits.
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Affiliation(s)
- Katharine Huynh
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - John Kwok
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Carol Dobson-Stone
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Glenda M Halliday
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - John R Hodges
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia
| | - Ramón Landin-Romero
- From the School of Psychology (K.H., O.P., R.L.-R.), Brain and Mind Centre (K.H., O.P., J.K., C.D.-S., G.M.H., J.R.H., R.L.-R.), Central Clinical School (J.K., C.D.-S., G.M.H., J.R.H.), The University of Sydney; and the School of Medical Sciences (J.K., C.D.-S., G.M.H., J.R.H.), University of New South Wales, Sydney, Australia.
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Geraldes R, Esiri MM, Perera R, Yee SA, Jenkins D, Palace J, DeLuca GC. Vascular disease and multiple sclerosis: a post-mortem study exploring their relationships. Brain 2021; 143:2998-3012. [PMID: 32875311 DOI: 10.1093/brain/awaa255] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/17/2020] [Accepted: 06/29/2020] [Indexed: 12/18/2022] Open
Abstract
Vascular comorbidities have a deleterious impact on multiple sclerosis clinical outcomes but it is unclear whether this is mediated by an excess of extracranial vascular disease (i.e. atherosclerosis) and/or of cerebral small vessel disease or worse multiple sclerosis pathology. To address these questions, a study using a unique post-mortem cohort wherein whole body autopsy reports and brain tissue were available for interrogation was established. Whole body autopsy reports were used to develop a global score of systemic vascular disease that included aorta and coronary artery atheroma, cardiac hypertensive disease, myocardial infarction and ischaemic stroke. The score was applied to 85 multiple sclerosis cases (46 females, age range 39 to 84 years, median 62.0 years) and 68 control cases. Post-mortem brain material from a subset of the multiple sclerosis (n = 42; age range 39-84 years, median 61.5 years) and control (n = 39) cases was selected for detailed neuropathological study. For each case, formalin-fixed paraffin-embedded tissue from the frontal and occipital white matter, basal ganglia and pons was used to obtain a global cerebral small vessel disease score that captured the presence and/or severity of arteriolosclerosis, periarteriolar space dilatation, haemosiderin leakage, microinfarcts, and microbleeds. The extent of multiple sclerosis-related pathology (focal demyelination and inflammation) was characterized in the multiple sclerosis cases. Regression models were used to investigate the influence of disease status on systemic vascular disease and cerebral small vessel disease scores and, in the multiple sclerosis group, the relationship between multiple sclerosis-related pathology and both vascular scores. We show that: (i) systemic cardiovascular burden, and specifically atherosclerosis, is lower and cerebral small vessel disease is higher in multiple sclerosis cases that die at younger ages compared with control subjects; (ii) the association between systemic vascular disease and cerebral small vessel disease is stronger in patients with multiple sclerosis compared with control subjects; and (iii) periarteriolar changes, including periarteriolar space dilatation, haemosiderin deposition and inflammation, are key features of multiple sclerosis pathology outside the classic demyelinating lesion. Our data argue against a common primary trigger for atherosclerosis and multiple sclerosis but suggest that an excess burden of cerebral small vessel disease in multiple sclerosis may explain the link between vascular comorbidity and accelerated irreversibility disability.
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Affiliation(s)
- Ruth Geraldes
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Margaret M Esiri
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | - Sydney A Yee
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Damian Jenkins
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurology, University of Oxford, Oxford, UK
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Alateeq K, Walsh EI, Cherbuin N. Higher Blood Pressure is Associated with Greater White Matter Lesions and Brain Atrophy: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:637. [PMID: 33562359 PMCID: PMC7915964 DOI: 10.3390/jcm10040637] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To summarise and quantify the evidence on the association between Blood pressure (BP), white matter lesions (WMLs), and brain volumes. METHOD Electronic databases PubMed, Scopus, and Clarivate were searched in February 2020 using an established methodology and pre-determined search terms. Studies were eligible for inclusion if they reported on the association between BP and WMLs or brain volume in cognitively healthy individuals, while adjusting for age and intra-cranial volume. RESULTS Searches yielded 7509 articles, of which 52 (26 longitudinal and 33 cross-sectional), were eligible and had a combined sample size of 343,794 individuals. Analyses found that 93.7% of studies reported that higher BP was associated with poorer cerebral health (higher WMLs and lower brain volumes). Meta-analysis of compatible results indicated a dose-dependent relationship with every one standard deviation increase in systolic BP (SBP) above 120 mmHg being associated with a 11.2% (95% CI 2.3, 19.9, p = 0.0128) increase in WMLs and -0.13% (95% CI -0.25, -0.023, p = 0.0183) smaller hippocampal volume. CONCLUSION The association between BP and brain volumes appears across the full range of BP measurements and is not limited to hypertensive individuals. Higher BP in community-residing individuals is associated with poorer cerebral health.
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Affiliation(s)
- Khawlah Alateeq
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, ACT 2601, Australia; (E.I.W.); (N.C.)
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Huang ZX, Fang J, Zhou CH, Zeng J, Yang D, Liu Z. CD34 + cells and endothelial progenitor cell subpopulations are associated with cerebral small vessel disease burden. Biomark Med 2021; 15:191-200. [PMID: 33496611 DOI: 10.2217/bmm-2020-0350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Endothelial dysfunction is considered to be involved in the pathogenesis of cerebral small vessel disease (CSVD). Endothelial progenitor cells are associated with endothelial dysfunction. The present study was designed to investigate the correlation between the populations of circulating CD34-positive cells and endothelial progenitor cells and CSVD burden. Methodology & results: A total of 364 patients with confirmed diagnosis of CSVD were included in this prospective study. Multiple ordinal logistic regression analyses showed that subjects with higher CSVD burden had significantly decreased circulating CD34+ cell level (odds ratio [OR], 0.42; p = 0.034) and significantly increased levels of circulating CD34+CD133+CD309+ and CD34+CD133+ cells (OR 1.07, p = 0.031; OR 1.03, p = 0.001, respectively), compared with patients with lower CSVD burden. Conclusion: The findings suggest that the levels of circulating CD34+ cells, CD34+CD133+CD309+ cells and CD34+CD133+ cells may be used as potential biomarkers to monitor the disease progression of CSVD.
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Affiliation(s)
- Zhi-Xin Huang
- Stroke Center & Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
- Department of Neurology, the Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Medicine, Center for Precision Medicine & Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Jin Fang
- Department of Radiology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Chang-Hua Zhou
- Department of Hematology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Jie Zeng
- Center for Clinical Epidemiology & Methodology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China
| | - Dong Yang
- Guangzhou AID Cloud Technology, Guangzhou, Guangdong, China
| | - Zhenguo Liu
- Department of Medicine, Center for Precision Medicine & Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
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Associated factors of white matter hyperintensity volume: a machine-learning approach. Sci Rep 2021; 11:2325. [PMID: 33504924 PMCID: PMC7840689 DOI: 10.1038/s41598-021-81883-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
To identify the most important parameters associated with cerebral white matter hyperintensities (WMH), in consideration of potential collinearity, we used a data-driven machine-learning approach. We analysed two independent cohorts (KORA and SHIP). WMH volumes were derived from cMRI-images (FLAIR). 90 (KORA) and 34 (SHIP) potential determinants of WMH including measures of diabetes, blood-pressure, medication-intake, sociodemographics, life-style factors, somatic/depressive-symptoms and sleep were collected. Elastic net regression was used to identify relevant predictor covariates associated with WMH volume. The ten most frequently selected variables in KORA were subsequently examined for robustness in SHIP. The final KORA sample consisted of 370 participants (58% male; age 55.7 ± 9.1 years), the SHIP sample comprised 854 participants (38% male; age 53.9 ± 9.3 years). The most often selected and highly replicable parameters associated with WMH volume were in descending order age, hypertension, components of the social environment (i.e. widowed, living alone) and prediabetes. A systematic machine-learning based analysis of two independent, population-based cohorts showed, that besides age and hypertension, prediabetes and components of the social environment might play important roles in the development of WMH. Our results enable personal risk assessment for the development of WMH and inform prevention strategies tailored to the individual patient.
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62
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Dai S, Piscicelli C, Lemaire C, Christiaens A, de Schotten MT, Hommel M, Krainik A, Detante O, Pérennou D. Recovery of balance and gait after stroke is deteriorated by confluent white matter hyperintensities: Cohort study. Ann Phys Rehabil Med 2021; 65:101488. [PMID: 33450367 DOI: 10.1016/j.rehab.2021.101488] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND White matter hyperintensities (WMHs) are well known to affect post-stroke disability, mainly by cognitive impairment. Their impact on post-stroke balance and gait disorders is unclear. OBJECTIVES We aimed to test the hypothesis that WMHs would independently deteriorate post-stroke balance and gait recovery. METHODS This study was performed in 210 individuals of the cohort Determinants of Balance Recovery After Stroke (DOBRAS), consecutively enrolled after a first-ever hemisphere stroke. Clinical data were systematically collected on day 30±3 (D30) post-stroke and at discharge from the rehabilitation ward. WMHs were searched on MRI, graded with the Fazekas scale, and dichotomized as no/mild (absence/sparse) or moderate/severe (confluent). The primary endpoint was the recovery of the single limb stance, assessed with the Postural Assessment Scale for Stroke (PASS). The secondary endpoint was the recovery of independent gait, assessed with the modified Fugl-Meyer Gait Assessment (mFMA). The adjusted hazard ratios (aHRs) of achievements of these endpoints by level of WMHs were estimated by using Cox models, accounting for other relevant clinical and imaging factors. RESULTS Individuals with moderate/severe WMHs (n=86, 41%) had greater balance and gait disorders and were more often fallers than others (n=124, 59%). Overall, they had worse and slower recovery of single limb stance and independent gait (p<0.001). Moderate/severe WMHs was the most detrimental factor for recovery of balance (aHR 0.46, 95% confidence interval [CI] 0.32-0.68, p<0.001) and gait (0.51, 0.35-0.74, p<0.001), along with age, stroke severity, lesion volume and disrupted corticospinal tract. With cerebral infarct, endovascular treatments had an independent positive effect, both on the recovery of balance (aHR 1.65, 95% CI 1.13-2.4, p=0.009) and gait (1.78, 1.24-2.55, p=0.002). CONCLUSIONS WMHs magnify balance and gait disorders after stroke and worsen their recovery. They should be better accounted for in post-stroke rehabilitation, especially to help establish a prognosis of mobility. ClinicalTrials.gov registration: NCT03203109.
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Affiliation(s)
- Shenhao Dai
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Céline Piscicelli
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Camille Lemaire
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Adélie Christiaens
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, 75013 Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, 33000 Bordeaux, France; Inserm, U 1216, Grenoble, France
| | - Marc Hommel
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, AGEIS EA 7407, Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Alexandre Krainik
- Department of Neuroradiology, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, Inserm, CNRS, Grenoble Alpes University Hospital, IRMaGe, 38043 Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, 38043 Grenoble, France; Univ. Grenoble Alpes, Grenoble Institute of Neurosciences, 38042 Grenoble, France; Inserm, U 1216, Grenoble, France
| | - Dominic Pérennou
- Neurorehabilitation Department, Institute of Rehabilitation, Grenoble Alpes University Hospital, 38434 Echirolles, France; Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105, Univ. Grenoble Alpes, Grenoble, France; Inserm, U 1216, Grenoble, France.
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63
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van den Brink H, Weaver NA, Biessels GJ. A Case of Sporadic Cerebral Small Vessel Disease in an Identical Twin. Case Rep Neurol 2020; 12:416-421. [PMID: 33362520 PMCID: PMC7747080 DOI: 10.1159/000511027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Sporadic cerebral small vessel disease (cSVD) is primarily attributed to heritability and vascular risk factors. Still, our understanding of the causative factors in cSVD lesion burden in the brain is far from complete. This is exemplified by this case of identical twins with remarkably similar vascular risk profiles, where one twin had developed severe cSVD on neuroimaging with cognitive deficits, while the other twin had no cSVD. This case highlights the need to search for further causes of cSVD, also beyond genetic and conventional vascular risk factors. Identification of other potential risk factors or disease mechanisms should be a priority for cSVD research to improve our understanding, prevention and treatment of this common cause of vascular brain injury with major clinical consequences.
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Affiliation(s)
- Hilde van den Brink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Nick A Weaver
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
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64
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Quick S, Moss J, Rajani RM, Williams A. A Vessel for Change: Endothelial Dysfunction in Cerebral Small Vessel Disease. Trends Neurosci 2020; 44:289-305. [PMID: 33308877 DOI: 10.1016/j.tins.2020.11.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023]
Abstract
The blood vessels of the brain are lined with endothelial cells and it has been long known that these help to regulate blood flow to the brain. However, there is increasing evidence that these cells also interact with the surrounding brain tissue. These interactions change when the endothelial cells become dysfunctional and have an impact in diseases such as cerebral small vessel disease, the leading cause of vascular dementia. In this review, we focus on what endothelial dysfunction is, what causes it, how it leads to surrounding brain pathology, how researchers can investigate it with current models, and where this might lead in the future for dementia therapies.
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Affiliation(s)
- Sophie Quick
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Jonathan Moss
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK
| | - Rikesh M Rajani
- UK Dementia Research Institute at UCL, University College London, London, UK
| | - Anna Williams
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh EH16 4UU, UK.
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65
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Cox SR, Lyall DM, Ritchie SJ, Bastin ME, Harris MA, Buchanan CR, Fawns-Ritchie C, Barbu MC, de Nooij L, Reus LM, Alloza C, Shen X, Neilson E, Alderson HL, Hunter S, Liewald DC, Whalley HC, McIntosh AM, Lawrie SM, Pell JP, Tucker-Drob EM, Wardlaw JM, Gale CR, Deary IJ. Associations between vascular risk factors and brain MRI indices in UK Biobank. Eur Heart J 2020; 40:2290-2300. [PMID: 30854560 PMCID: PMC6642726 DOI: 10.1093/eurheartj/ehz100] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Several factors are known to increase risk for cerebrovascular disease and dementia, but there is limited evidence on associations between multiple vascular risk factors (VRFs) and detailed aspects of brain macrostructure and microstructure in large community-dwelling populations across middle and older age. Methods and results Associations between VRFs (smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index, and waist–hip ratio) and brain structural and diffusion MRI markers were examined in UK Biobank (N = 9722, age range 44–79 years). A larger number of VRFs was associated with greater brain atrophy, lower grey matter volume, and poorer white matter health. Effect sizes were small (brain structural R2 ≤1.8%). Higher aggregate vascular risk was related to multiple regional MRI hallmarks associated with dementia risk: lower frontal and temporal cortical volumes, lower subcortical volumes, higher white matter hyperintensity volumes, and poorer white matter microstructure in association and thalamic pathways. Smoking pack years, hypertension and diabetes showed the most consistent associations across all brain measures. Hypercholesterolaemia was not uniquely associated with any MRI marker. Conclusion Higher levels of VRFs were associated with poorer brain health across grey and white matter macrostructure and microstructure. Effects are mainly additive, converging upon frontal and temporal cortex, subcortical structures, and specific classes of white matter fibres. Though effect sizes were small, these results emphasize the vulnerability of brain health to vascular factors even in relatively healthy middle and older age, and the potential to partly ameliorate cognitive decline by addressing these malleable risk factors.
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Affiliation(s)
- Simon R Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Donald M Lyall
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Stuart J Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK
| | - Mathew A Harris
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Colin R Buchanan
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK
| | - Chloe Fawns-Ritchie
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Miruna C Barbu
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Laura de Nooij
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Lianne M Reus
- Alzheimer Centre Amsterdam, Department of Neurology, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Clara Alloza
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Xueyi Shen
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Emma Neilson
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | | | - Stuart Hunter
- NHS Lothian, Waverley Gate, 2-4 Waterloo Place, Edinburgh, UK
| | - David C Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
| | - Heather C Whalley
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Stephen M Lawrie
- Division of Psychiatry, The University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Morningside Park, Edinburgh, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, UK
| | - Elliot M Tucker-Drob
- Department of Psychology, University of Texas, 108 E Dean Keeton St, Austin, Texas, USA
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, 300 Bath St, Glasgow, UK.,Brain Research Imaging Centre, Neuroimaging Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Catharine R Gale
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, 7 George Square, Edinburgh, UK.,Department of Psychology, The University of Edinburgh, 7 George Square, Edinburgh, UK
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66
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Zhou LW, Panenka WJ, Al-Momen G, Gicas KM, Thornton AE, Jones AA, Woodward M, Heran MKS, Vertinsky AT, Su W, Barr AM, MacEwan GW, Lang DJ, Rauscher A, Honer WG, Field TS. Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing. Stroke 2020; 51:3271-3278. [PMID: 33019899 DOI: 10.1161/strokeaha.120.030446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing. METHODS Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance. RESULTS Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], P<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], P=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], P=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain. CONCLUSIONS The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
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Affiliation(s)
- Lily W Zhou
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William J Panenka
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Ghadeer Al-Momen
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Kristina M Gicas
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Allen E Thornton
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Andrea A Jones
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Melissa Woodward
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Manraj K S Heran
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - A Talia Vertinsky
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Wayne Su
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alasdair M Barr
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - G William MacEwan
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Donna J Lang
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alexander Rauscher
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William G Honer
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Thalia S Field
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
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Vancheri F, Longo G, Vancheri S, Henein M. Coronary Microvascular Dysfunction. J Clin Med 2020; 9:E2880. [PMID: 32899944 PMCID: PMC7563453 DOI: 10.3390/jcm9092880] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023] Open
Abstract
Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed "ischemia with non-obstructive coronary artery disease" (INOCA) and for a small proportion of "myocardial infarction with non-obstructive coronary artery disease" (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).
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Affiliation(s)
- Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy;
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden;
- Department of Fluid Mechanics, Brunel University, Middlesex, London UB8 3PH, UK
- Molecular and Nuclear Research Institute, St George’s University, London SW17 0RE, UK
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68
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Anderson VC, Tagge IJ, Li X, Quinn JF, Kaye JA, Bourdette DN, Spain RI, Riccelli LP, Sammi MK, Springer CS, Rooney WD. Observation of Reduced Homeostatic Metabolic Activity and/or Coupling in White Matter Aging. J Neuroimaging 2020; 30:658-665. [PMID: 32558031 PMCID: PMC7529981 DOI: 10.1111/jon.12744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Transvascular water exchange plays a key role in the functional integrity of the blood-brain barrier (BBB). In white matter (WM), a variety of imaging modalities have demonstrated age-related changes in structure and metabolism, but the extent to which water exchange is altered remains unclear. Here, we investigated the cumulative effects of healthy aging on WM capillary water exchange. METHODS A total of 38 healthy adults (aged 36-80 years) were studied using 7T dynamic contrast enhanced MRI. Blood volume fraction (vb ) and capillary water efflux rate constant (kpo ) were determined by fitting changes in the 1 H2 O longitudinal relaxation rate constant (R1 ) during contrast agent bolus passage to a two-compartment exchange model. WM volume was determined by morphometric analysis of structural images. RESULTS R1 values and WM volume showed similar trajectories of age-related decline. Among all subjects, vb and kpo averaged 1.7 (±0.5) mL/100 g of tissue and 2.1 (±1.1) s-1 , respectively. While vb showed minimal changes over the 40-year-age span of participants, kpo declined 0.06 s-1 (ca. 3%) per year (r = -.66; P < .0005), from near 4 s-1 at age 30 to ca. 2 s-1 at age 70. The association remained significant after controlling for WM volume. CONCLUSIONS Previous studies have shown that kpo tracks Na+ , K+ -ATPase activity-dependent water exchange at the BBB and likely reflects neurogliovascular unit (NGVU) coupled metabolic activity. The age-related decline in kpo observed here is consistent with compromised NGVU metabolism in older individuals and the dysregulated cellular bioenergetics that accompany normal brain aging.
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Affiliation(s)
- Valerie C Anderson
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Ian J Tagge
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Joseph F Quinn
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Jeffrey A Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Dennis N Bourdette
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Rebecca I Spain
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Louis P Riccelli
- Diagnostic Radiology, Oregon Health & Science University, Portland, OR
| | - Manoj K Sammi
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Charles S Springer
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
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69
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Elliott ML. MRI-based biomarkers of accelerated aging and dementia risk in midlife: how close are we? Ageing Res Rev 2020; 61:101075. [PMID: 32325150 DOI: 10.1016/j.arr.2020.101075] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/10/2020] [Accepted: 04/15/2020] [Indexed: 01/18/2023]
Abstract
The global population is aging, leading to an increasing burden of age-related neurodegenerative disease. Efforts to intervene against age-related dementias in older adults have generally proven ineffective. These failures suggest that a lifetime of brain aging may be difficult to reverse once widespread deterioration has occurred. To test interventions in younger populations, biomarkers of brain aging are needed that index subtle signs of accelerated brain deterioration that are part of the putative pathway to dementia. Here I review potential MRI-based biomarkers that could connect midlife brain aging to later life dementia. I survey the literature with three questions in mind, 1) Does the biomarker index age-related changes across the lifespan? 2) Does the biomarker index cognitive ability and cognitive decline? 3) Is the biomarker sensitive to known risk factors for dementia? I find that while there is preliminary support for some midlife MRI-based biomarkers for accelerated aging, the longitudinal research that would best answer these questions is still in its infancy and needs to be further developed. I conclude with suggestions for future research.
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Affiliation(s)
- Maxwell L Elliott
- Department of Psychology and Neuroscience, Duke University, 2020 West Main Street, Suite 030, Durham, NC, 27701, USA.
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70
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Seiler A, Brandhofe A, Gracien RM, Pfeilschifter W, Hattingen E, Deichmann R, Nöth U, Wagner M. Microstructural Alterations Analogous to Accelerated Aging of the Cerebral Cortex in Carotid Occlusive Disease. Clin Neuroradiol 2020; 31:709-720. [PMID: 32638029 PMCID: PMC8463359 DOI: 10.1007/s00062-020-00928-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
Purpose To investigate cortical thickness and cortical quantitative T2 values as imaging markers of microstructural tissue damage in patients with unilateral high-grade internal carotid artery occlusive disease (ICAOD). Methods A total of 22 patients with ≥70% stenosis (mean age 64.8 years) and 20 older healthy control subjects (mean age 70.8 years) underwent structural magnetic resonance imaging (MRI) and high-resolution quantitative (q)T2 mapping. Generalized linear mixed models (GLMM) controlling for age and white matter lesion volume were employed to investigate the effect of ICAOD on imaging parameters of cortical microstructural integrity in multivariate analyses. Results There was a significant main effect (p < 0.05) of the group (patients/controls) on both cortical thickness and cortical qT2 values with cortical thinning and increased cortical qT2 in patients compared to controls, irrespective of the hemisphere. The presence of upstream carotid stenosis had a significant main effect on cortical qT2 values (p = 0.01) leading to increased qT2 in the poststenotic hemisphere, which was not found for cortical thickness. The GLMM showed that in general cortical thickness was decreased and cortical qT2 values were increased with increasing age (p < 0.05). Conclusion Unilateral high-grade carotid occlusive disease is associated with widespread cortical thinning and prolongation of cortical qT2, presumably reflecting hypoperfusion-related microstructural cortical damage similar to accelerated aging of the cerebral cortex. Cortical thinning and increase of cortical qT2 seem to reflect different aspects and different pathophysiological states of cortical degeneration. Quantitative T2 mapping might be a sensitive imaging biomarker for early cortical microstructural damage.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. .,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany.
| | - Annemarie Brandhofe
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, Goethe University Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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Xin J, Huang X, Pan X, Lin L, Sun M, Liu C, Ye Q. Risk Factors for Aphasia in Cerebral Small Vessel Diseases. Curr Neurovasc Res 2020; 16:107-114. [PMID: 30827240 DOI: 10.2174/1567202616666190227202638] [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: 10/03/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lacunes and white matter hyperintensities (WMH) are two common findings seen on neuroimaging in patients with cerebral small vessel disease (cSVD). Clinically we observed that some patients with cSVD have aphasia through the language assessment scale. Our study aimed to explore the underlying risk factors for aphasia in cSVD patients. METHODS This study retrospectively analyzed 38 patients, with and without aphasia, aged 50 or over, Chinese Han population, diagnosed as cSVD with lacunes and/or WMH. We collected demographic characteristics and vascular risk factors. The severity of WMH was assessed by the age related white matter changes (ARWMC) rating scale. RESULTS Risk factors associated with aphasia were: lower education (p = 0.029), higher total cholesterol (TC) levels (p = 0.023), and higher low-density lipoprotein cholesterol (LDL-C) levels (p = 0.027). After controlling for age and sex, levels of TC (odds ratios, 1.96; 95% confidence interval, 1.06-3.62; p = 0.032) remained associated with aphasia independently. CONCLUSION High level of TC was significantly associated with a higher risk of aphasia in clinically silent cSVD patients. Early interventions including lipid-lowering treatment, cranial magnetic resonance imaging (MRI) and ARWMC rating scale should be performed. Further studies are needed to explore proper methods of prevention and treatment for aphasia in clinically silent cSVD patients, in addition to understanding the pathophysiological mechanism.
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Affiliation(s)
- Jiawei Xin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xuanyu Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Xiaodong Pan
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Lin Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Mingyao Sun
- Department of Geriatric Medicine, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Chen Liu
- Fujian Medical University, Fuzhou, Fujian, China
| | - Qinyong Ye
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Ni L, Zhou F, Qing Z, Zhang X, Li M, Zhu B, Zhang B, Xu Y. The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade. Front Aging Neurosci 2020; 12:163. [PMID: 32655391 PMCID: PMC7324557 DOI: 10.3389/fnagi.2020.00163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose The contribution of intracranial atherosclerotic stenosis (ICAS) to the development of white matter hyperintensities (WMHs) has not been fully elucidated. We aimed to retrospectively assess the relationship between WMH burden and unilateral ICAS by combined examination of lumen stenosis, plaque enhancement, and cerebral perfusion. Materials and methods A cross-sectional study of 41 patients with symptomatic unilateral ICAS (mean age 57 ± 10 years; 26 males) was conducted. Detailed clinical data, including vascular risk factors, were obtained. WMH volume was derived from 3D-fluid-attenuated inversion recovery (3D-FLAIR) and was assessed by using a validated semi-automated protocol. Lumen stenosis, plaque enhancement, and cerebral perfusion (assessed on time-to-peak parameter using the Alberta Stroke Program Early CT score (TTP-ASPECTS) scale) were evaluated. The WMH volumes of peri-ventricular (PWMH) and deep (DWMH) white matter were calculated separately and compared between hemispheres. Associations between WMH volume (inter-hemispheric volume difference, ipsilateral and contralateral to the ICAS site separately), unilateral ICAS imaging metrics, and vascular risk factors were assessed by using linear regression. Results The DWMH volume ipsilateral to the ICAS site (ipsilateral DWMH volume) was significantly greater than that of the contralateral site (P < 0.001), while the PWMH volume difference between hemispheres did not reach statistical significance. The inter-hemispheric DWMH volume difference was significantly associated with a higher plaque enhancement grade (β = 0.436, P = 0.005) and inversely associated with cerebral hypoperfusion (lower TTP-ASPECTS) (β = −0.613, P < 0.001). In the between-subject multivariable regression analysis, while older age (β = 0.323, P = 0.025), hypoperfusion (β = −0.394, P = 0.007), and hypertension (β = 0.378, P = 0.011) were independently associated with ipsilateral DWMH volume, plaque enhancement did not show an association with ipsilateral DWMH volume. The association between ipsilateral DWMH volume and lumen stenosis approached statistical significance (β = 0.274, P = 0.084). Conclusion The DWMH was attributed to chronic hypoperfusion secondary to atherosclerotic stenosis. The association between the asymmetry of deep white matter lesions and plaque enhancement might suggest that increased deep white matter lesions are those ischemic lesions, which are more prone to the development of stroke.
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Affiliation(s)
- Ling Ni
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fei Zhou
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhao Qing
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ming Li
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Zhu
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Nadkarni NK, Tudorascu D, Campbell E, Snitz BE, Cohen AD, Halligan E, Mathis CA, Aizenstein HJ, Klunk WE. Association Between Amyloid-β, Small-vessel Disease, and Neurodegeneration Biomarker Positivity, and Progression to Mild Cognitive Impairment in Cognitively Normal Individuals. J Gerontol A Biol Sci Med Sci 2020; 74:1753-1760. [PMID: 30957843 DOI: 10.1093/gerona/glz088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We estimated the prevalence and incidence of amyloid-β deposition (A), small-vessel disease (V), and neurodegeneration (N) biomarker positivity in community-dwelling cognitively normal individuals (CN). We determined the longitudinal association between the respective biomarker indices with progression to all-cause mild cognitive impairment (MCI) and its amnestic and nonamnestic subtypes. METHODS CN participants, recruited by advertising, underwent brain [C-11]Pittsburgh Compound-B (PiB)-positron emission tomography (PET), magnetic resonance imaging, and [F-18]fluoro-2-deoxy-glucose (FDG)-PET, and were designated as having high or low amyloid-β (A+/A-), greater or lower white matter hyperintensities burden (V+/V-) and diminished or normal cortical glucose metabolism (N+/N-). MCI was adjudicated using clinical assessments. We examined the association between A, V, and N biomarker positivity at study baseline and endpoint, with progression to MCI using linear regression, Cox proportional hazards and Kaplan-Meier analyses adjusted for age and APOE-ε4 carrier status. RESULTS In 98 CN individuals (average age 74 years, 65% female), A+, V+, and N+ prevalence was 26%, 33%, and 8%, respectively. At study endpoint (median: 5.5 years), an A+, but not a V+ or N+ scan, was associated with higher odds of all-cause MCI (Chi-square = 3.9, p = .048, odds ratio, 95% confidence interval = 2.6 [1.01-6.8]). Baseline A+, V+, or N+ were not associated with all-cause MCI, however, baseline A+ (p = .018) and A+N+ (p = .049), and endpoint A+N+ (p = .025) were associated with time to progression to amnestic, not nonamnestic, MCI. CONCLUSION Longitudinal assessments clarify the association between amyloid-β and progression to all-cause MCI in CN individuals. The association between biomarker positivity indices of amyloid-β and neurodegeneration, and amnestic MCI reflects the underlying pathology involved in the progression to prodromal Alzheimer's disease.
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Affiliation(s)
- Neelesh K Nadkarni
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania.,Department of Neurology, University of Pittsburgh, Pennsylvania
| | - Dana Tudorascu
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pennsylvania.,Department of Biostatistics, University of Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | | | - Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pennsylvania
| | - Annie D Cohen
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | - Edye Halligan
- Department of Psychiatry, University of Pittsburgh, Pennsylvania
| | | | | | - William E Klunk
- Department of Neurology, University of Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pennsylvania
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Clancy U, Garcia DJ, Stringer MS, Thrippleton MJ, Valdés-Hernández MC, Wiseman S, Hamilton OK, Chappell FM, Brown R, Blair GW, Hewins W, Sleight E, Ballerini L, Bastin ME, Maniega SM, MacGillivray T, Hetherington K, Hamid C, Arteaga C, Morgan AG, Manning C, Backhouse E, Hamilton I, Job D, Marshall I, Doubal FN, Wardlaw JM. Rationale and design of a longitudinal study of cerebral small vessel diseases, clinical and imaging outcomes in patients presenting with mild ischaemic stroke: Mild Stroke Study 3. Eur Stroke J 2020; 6:81-88. [PMID: 33817338 PMCID: PMC7995323 DOI: 10.1177/2396987320929617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral small vessel disease is a major cause of dementia and stroke, visible on brain magnetic resonance imaging. Recent data suggest that small vessel disease lesions may be dynamic, damage extends into normal-appearing brain and microvascular dysfunctions include abnormal blood–brain barrier leakage, vasoreactivity and pulsatility, but much remains unknown regarding underlying pathophysiology, symptoms, clinical features and risk factors of small vessel disease. Patients and Methods: The Mild Stroke Study 3 is a prospective observational cohort study to identify risk factors for and clinical implications of small vessel disease progression and regression among up to 300 adults with non-disabling stroke. We perform detailed serial clinical, cognitive, lifestyle, physiological, retinal and brain magnetic resonance imaging assessments over one year; we assess cerebrovascular reactivity, blood flow, pulsatility and blood–brain barrier leakage on magnetic resonance imaging at baseline; we follow up to four years by post and phone. The study is registered ISRCTN 12113543. Summary Factors which influence direction and rate of change of small vessel disease lesions are poorly understood. We investigate the role of small vessel dysfunction using advanced serial neuroimaging in a deeply phenotyped cohort to increase understanding of the natural history of small vessel disease, identify those at highest risk of early disease progression or regression and uncover novel targets for small vessel disease prevention and therapy.
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Affiliation(s)
- Una Clancy
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Stewart Wiseman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Olivia Kl Hamilton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon W Blair
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Will Hewins
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Emilie Sleight
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Tom MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Charlene Hamid
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alasdair G Morgan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cameron Manning
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ellen Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Iona Hamilton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Dominic Job
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ian Marshall
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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75
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Chen H, Pan Y, Zong L, Jing J, Meng X, Xu Y, Yan H, Zhao X, Liu L, Li H, Johnston SC, Wang Y, Wang Y. Cerebral small vessel disease or intracranial large vessel atherosclerosis may carry different risk for future strokes. Stroke Vasc Neurol 2020; 5:128-137. [PMID: 32606085 PMCID: PMC7337361 DOI: 10.1136/svn-2019-000305] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/26/2019] [Accepted: 12/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background The effect of cerebral small vessel disease (CSVD) and intracranial arterial stenosis (ICAS) on stroke outcomes remains unclear. Methods Data of 1045 patients with minor stroke or transient ischaemic attack (TIA) were obtained from 45 sites of the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. We assessed the associations of burdens of CSVD and ICAS with new strokes and bleeding events using multivariate Cox regression models and those with modified Rankin Scale (mRS) scores using ordinal logistic regression models. Results Among the 1045 patients, CSVD was present in 830 cases (79.4%) and ICAS in 460 (44.0%). Patients with >1 ICAS segment showed the highest risk of new strokes (HR 2.03, 95% CI 1.15 to 3.56, p=0.01). No association between CSVD and the occurrence of new strokes was found. The presence of severe CSVD (common OR (cOR) 2.01, 95% CI 1.40 to 2.89, p<0.001) and >1 ICAS segment (cOR 2.15, 95% CI 1.57 to 2.93, p<0.001) was associated with higher mRS scores. Severe CSVD (HR 10.70, 95% CI 1.16 to 99.04, p=0.04), but not ICAS, was associated with a higher risk of bleeding events. Six-point modified CSVD score improved the predictive power for bleeding events and disability. Interpretation CSVD is associated with more disability and bleeding events, and ICAS is associated with an increased risk of stroke and disability in patients with minor stroke and TIA at 3 months. CSVD and ICAS may represent different vascular pathologies and play distinct roles in stroke outcomes. Trial registration number NCT00979589
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Affiliation(s)
- Huimin Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Lixia Zong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yuyuan Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | | | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Advanced Innovation Center for Human Brain Projection, Capital Medical University, Beijing, China
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76
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Huang X, Wen MC, Ng SYE, Hartono S, Chia NSY, Choi X, Tay KY, Au WL, Chan LL, Tan EK, Tan LCS. Periventricular white matter hyperintensity burden and cognitive impairment in early Parkinson's disease. Eur J Neurol 2020; 27:959-966. [PMID: 32124496 DOI: 10.1111/ene.14192] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/20/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE This study quantified the total brain and periventricular white matter hyperintensity (WMH) burdens in patients with early Parkinson's disease (PD) and explored their associations with cardiovascular risk factors and cognitive performance. METHODS A total of 175 non-demented patients with early PD who had undergone baseline brain magnetic resonance imaging were included. Comprehensive neurocognitive testing was conducted to identify PD with mild cognitive impairment (PD-MCI) and to evaluate performances in individual cognitive domains. Cardiovascular risk was expressed as a modified Framingham 10-year cardiovascular risk score (mFRS). RESULTS A total of 53.7% of this early PD cohort fulfilled the diagnostic criteria for PD-MCI. An increase in mFRS was significantly associated with increases in the total brain WMH (P = 0.015) and periventricular WMH (P = 0.040) burden, independent of age and gender. The periventricular WMH burden was significantly associated with PD-MCI (P = 0.046) in early PD, independent of cardiovascular risk factors. Patients in the 5th quintile of periventricular WMH burden were 8.6 times more likely to have PD-MCI compared with patients in the 1st quintile of periventricular WMH burden (P = 0.004). However, total brain WMH burden was not associated with PD-MCI (P = 0.158). In individual cognitive domains, heavier periventricular WMH burden was associated with worse executive function and visuospatial function independent of cardiovascular risk factors. CONCLUSION Periventricular WMHs are a useful imaging biomarker for cognitive impairment in early PD. Cardiovascular risk factors, although associated with periventricular WMHs, were unable to fully explain the association between periventricular WMHs and cognitive impairment in early PD.
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Affiliation(s)
- X Huang
- Duke-NUS Medical School, Singapore, Singapore
| | - M-C Wen
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - S Y-E Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - S Hartono
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - N S-Y Chia
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - X Choi
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - K-Y Tay
- Duke-NUS Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - W-L Au
- Duke-NUS Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - L-L Chan
- Department of Radiology, Singapore General Hospital, Singapore, Singapore
| | - E-K Tan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
| | - L C-S Tan
- Duke-NUS Medical School, Singapore, Singapore.,Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Parkinson's Disease and Movement Disorders Centre, USA Parkinson Foundation International Center of Excellence, National Neuroscience Institute, Singapore, Singapore
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77
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The Whole Picture: From Isolated to Global MRI Measures of Neurovascular and Neurodegenerative Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 31894568 DOI: 10.1007/978-3-030-31904-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Structural magnetic resonance imaging (MRI) has been used to characterise the appearance of the brain in cerebral small vessel disease (SVD), ischaemic stroke, cognitive impairment, and dementia. SVD is a major cause of stroke and dementia; features of SVD include white matter hyperintensities (WMH) of presumed vascular origin, lacunes of presumed vascular origin, microbleeds, and perivascular spaces. Cognitive impairment and dementia have traditionally been stratified into subtypes of varying origin, e.g., vascular dementia versus dementia of the Alzheimer's type (Alzheimer's disease; AD). Vascular dementia is caused by reduced blood flow in the brain, often as a result of SVD, and AD is thought to have its genesis in the accumulation of tau and amyloid-beta leading to brain atrophy. But after early seminal studies in the 1990s found neurovascular disease features in around 30% of AD patients, it is becoming recognised that so-called "mixed pathologies" (of vascular and neurodegenerative origin) exist in many more patients diagnosed with stroke, only one type of dementia, or cognitive impairment. On the back of these discoveries, attempts have recently been made to quantify the full extent of degenerative and vascular disease in the brain in vivo on MRI. The hope being that these "global" methods may one day lead to better diagnoses of disease and provide more sensitive measurements to detect treatment effects in clinical trials. Indeed, the "Total MRI burden of cerebral small vessel disease", the "Brain Health Index" (BHI), and "MRI measure of degenerative and cerebrovascular pathology in Alzheimer disease" have all been shown to have stronger associations with clinical and cognitive phenotypes than individual brain MRI features. This chapter will review individual structural brain MRI features commonly seen in SVD, stroke, and dementia. The relationship between these features and differing clinical and cognitive phenotypes will be discussed along with developments in their measurement and quantification. The chapter will go on to review emerging methods for quantifying the collective burden of structural brain MRI findings and how these "whole picture" methods may lead to better diagnoses of neurovascular and neurodegenerative disorders.
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78
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Wyss A, Dawson J, Arba F, Wardlaw JM, Dickie DA. Combining Neurovascular and Neurodegenerative Magnetic Resonance Imaging Measures in Stroke. Stroke 2020; 50:1136-1139. [PMID: 31009345 DOI: 10.1161/strokeaha.118.024181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background and Purpose- Individual markers of cerebral small vessel disease and cerebral atrophy explain a small proportion of variance in vascular risk factors and cognitive function. Combining these markers into a single measure of neurovascular and neurodegenerative disease may be more powerful. We assessed this using data contained in the Virtual International Stroke Trials Archive - Prevention sub-archive. Methods- We extracted white matter hyperintensities (WMH) and cerebrospinal fluid (CSF) volumes from 317 people with ischemic stroke or transient ischemic attack who had baseline magnetic resonance imaging. We assessed progression of volumes in 208 people who had 2-year follow-up magnetic resonance imaging. WMH and CSF volumes were segmented from fluid attenuated inversion recovery and T1 images. The combined neurovascular and neurodegenerative measure was the sum of WMH and CSF volume normalized by intracranial volume. We assessed (1) the relationship between baseline vascular risk factors and imaging markers; and (2) the relationship between baseline imaging markers and Mini-Mental State Examination score at follow-up using multiple linear regression. We also assessed implications for sample size calculations using n=208 participants with follow-up magnetic resonance imaging. Results- Vascular risk factors accounted for 7%, 11%, and 12% of the variance in WMH, CSF, and combined volume, respectively (all P<0.001). The association between baseline combined volume and 6-month follow-up Mini-Mental State Examination (β=-0.442; SE, 0.07; P<0.0001) was 32% greater than WMH (β=-0.302; SE, 0.06; P<0.0001) and 12% greater than CSF (β=-0.391; SE, 0.07; P<0.0001) alone. The combined volume required between 207 and 3305 (20%) fewer patients per arm than WMH alone to detect reductions of 10% to 40% in volume progression over 2 years. Conclusions- A combined neurovascular and neurodegenerative magnetic resonance imaging measure including WMH and CSF volume was more closely related to vascular risk factors and cognitive function than either WMH or CSF volume alone. The combined volume may be a more sensitive measurement for clinical trials.
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Affiliation(s)
- Annick Wyss
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (A.W., J.D., D.A.D.).,Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland (A.W.)
| | - Jesse Dawson
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (A.W., J.D., D.A.D.)
| | - Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy (F.A.)
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.M.W.)
| | - David Alexander Dickie
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (A.W., J.D., D.A.D.)
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79
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Joutel A. Prospects for Diminishing the Impact of Nonamyloid Small-Vessel Diseases of the Brain. Annu Rev Pharmacol Toxicol 2020; 60:437-456. [PMID: 31425001 DOI: 10.1146/annurev-pharmtox-010818-021712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Small-vessel diseases (SVDs) of the brain are involved in about one-fourth of ischemic strokes and a vast majority of intracerebral hemorrhages and are responsible for nearly half of dementia cases in the elderly. SVDs are a heavy burden for society, a burden that is expected to increase further in the absence of significant therapeutic advances, given the aging population. Here, we provide a critical appraisal of currently available therapeutic approaches for nonamyloid sporadic SVDs that are largely based on targeting modifiable risk factors. We review what is known about the pathogenic mechanisms of vascular risk factor-related SVDs and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), the most frequent hereditary SVD, and elaborate on two mechanism-based therapeutic approaches worth exploring in sporadic SVD and CADASIL. We conclude by discussing opportunities and challenges that need to be tackled if efforts to achieve significant therapeutic advances for these diseases are to be successful.
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Affiliation(s)
- Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM UMR1266, Paris Descartes University, 75014 Paris, France; .,DHU NeuroVasc, Sorbonne Paris Cité, 75010 Paris, France.,Department of Pharmacology, College of Medicine, University of Vermont, Burlington, Vermont 05405, USA
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80
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Vigen T, Ihle‐Hansen H, Lyngbakken MN, Berge T, Thommessen B, Ihle‐Hansen H, Orstad EB, Enger S, Røsjø H, Tveit A, Rønning OM. Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index. J Neuroimaging 2019; 30:233-239. [DOI: 10.1111/jon.12684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Thea Vigen
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Håkon Ihle‐Hansen
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Magnus N Lyngbakken
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Trygve Berge
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Bente Thommessen
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
| | - Hege Ihle‐Hansen
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Eivind B Orstad
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Steve Enger
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Helge Røsjø
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Arnljot Tveit
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Medical Research Bærum Hospital, Vestre Viken Hospital Trust Drammen Norway
| | - Ole Morten Rønning
- Division of Medicine Akershus University Hospital Lørenskog Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Neurology Akershus University Hospital Lørenskog Norway
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81
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Appleton JP, Woodhouse LJ, Adami A, Becker JL, Berge E, Cala LA, Casado AM, Caso V, Christensen HK, Dineen RA, Gommans J, Koumellis P, Szatmari S, Sprigg N, Bath PM, Wardlaw JM. Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke. Neurology 2019; 94:e439-e452. [PMID: 31882527 PMCID: PMC7080284 DOI: 10.1212/wnl.0000000000008881] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/16/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To assess the association of baseline imaging markers of cerebral small vessel disease (SVD) and brain frailty with clinical outcome after acute stroke in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. METHODS ENOS randomized 4,011 patients with acute stroke (<48 hours of onset) to transdermal glyceryl trinitrate (GTN) or no GTN for 7 days. The primary outcome was functional outcome (modified Rankin Scale [mRS] score) at day 90. Cognition was assessed via telephone at day 90. Stroke syndrome was classified with the Oxfordshire Community Stroke Project classification. Brain imaging was adjudicated masked to clinical information and treatment and assessed SVD (leukoaraiosis, old lacunar infarcts/lacunes, atrophy) and brain frailty (leukoaraiosis, atrophy, old vascular lesions/infarcts). Analyses used ordinal logistic regression adjusted for prognostic variables. RESULTS In all participants and those with lacunar syndrome (LACS; 1,397, 34.8%), baseline CT imaging features of SVD and brain frailty were common and independently associated with unfavorable shifts in mRS score at day 90 (all participants: SVD score odds ratio [OR] 1.15, 95% confidence interval [CI] 1.07-1.24; brain frailty score OR 1.25, 95% CI 1.17-1.34; those with LACS: SVD score OR 1.30, 95% CI 1.15-1.47, brain frailty score OR 1.28, 95% CI 1.14-1.44). Brain frailty was associated with worse cognitive scores at 90 days in all participants and in those with LACS. CONCLUSIONS Baseline imaging features of SVD and brain frailty were common in lacunar stroke and all stroke, predicted worse prognosis after all acute stroke with a stronger effect in lacunar stroke, and may aid future clinical decision-making. IDENTIFIER ISRCTN99414122.
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Affiliation(s)
- Jason P Appleton
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Lisa J Woodhouse
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Alessandro Adami
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Jennifer L Becker
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Eivind Berge
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Lesley A Cala
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Ana M Casado
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Valeria Caso
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Hanne K Christensen
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Robert A Dineen
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - John Gommans
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Panos Koumellis
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Szabolcs Szatmari
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Nikola Sprigg
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
| | - Philip M Bath
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK.
| | - Joanna M Wardlaw
- From the Stroke Trials Unit (J.P.A., L.J.W., N.S., P.M.B.) and Radiological Sciences Research Group (R.A.D.), Division of Clinical Neurosciences, University of Nottingham; Stroke (J.P.A., N.S., P.M.B.), Nottingham University Hospitals NHS Trust, UK; Stroke Center (A.A.), IRCSS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy; Department of Medical Imaging (J.L.B.), College of Medicine, University of Arizona, Tucson; Department of Internal Medicine and Cardiology (E.B.), Oslo University Hospital, Norway; School of Medicine (L.A.C.), University of Western Australia, Crawley; Department of Neuroradiology (A.M.C.), Division of Clinical Neurosciences, Western General Hospital, Edinburgh, UK; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Neurology (H.K.C.), Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Medicine (J.G.), Hawke's Bay District Health Board, Hastings, New Zealand; Department of Neuroradiology (P.K.), Nottingham University Hospitals, Queen's Medical Centre, UK; Department of Neurology (S.S.), Clinical County Emergency Hospital, Targu Mures, Romania; and Division of Neuroimaging Sciences (J.M.W.), Centre for Clinical Brain Sciences, Dementia Research Institute, University of Edinburgh, UK
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Cardiovascular risks impact human brain N-acetylaspartate in regionally specific patterns. Proc Natl Acad Sci U S A 2019; 116:25243-25249. [PMID: 31754041 DOI: 10.1073/pnas.1907730116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular risk factors such as dyslipidemia and hypertension increase the risk for white matter pathology and cognitive decline. We hypothesize that white matter levels of N-acetylaspartate (NAA), a chemical involved in the metabolic pathway for myelin lipid synthesis, could serve as a biomarker that tracks the influence of cardiovascular risk factors on white matter prior to emergence of clinical changes. To test this, we measured levels of NAA across white matter and gray matter in the brain using echo planar spectroscopic imaging (EPSI) in 163 individuals and examined the relationship of regional NAA levels and cardiovascular risk factors as indexed by the Framingham Cardiovascular Risk Score (FCVRS). NAA was strongly and negatively correlated with FCVRS across the brain, but, after accounting for age and sex, the association was found primarily in white matter regions, with additional effects found in the thalamus, hippocampus, and cingulate gyrus. FCVRS was also negatively correlated with creatine levels, again primarily in white matter. The results suggest that cardiovascular risks are related to neurochemistry with a predominantly white matter pattern and some subcortical and cortical gray matter involvement. NAA mapping of the brain may provide early surveillance for the potential subclinical impact of cardiovascular and metabolic risk factors on the brain.
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Noz MP, Ter Telgte A, Wiegertjes K, Joosten LAB, Netea MG, de Leeuw FE, Riksen NP. Trained Immunity Characteristics Are Associated With Progressive Cerebral Small Vessel Disease. Stroke 2019; 49:2910-2917. [PMID: 30571420 DOI: 10.1161/strokeaha.118.023192] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose- Cerebral small vessel disease (cSVD) is the major vascular cause of cognitive decline and dementia. The pathogenesis of cSVD remains largely unknown, although several studies suggest a role for systemic inflammation. In certain pathophysiological situations, monocytes can reprogram toward a long-term proinflammatory phenotype, which has been termed trained immunity. We hypothesize that trained immunity contributes to the progression of cSVD. Methods- Individuals with mild-to-severe cSVD participated in the study. Severity of cSVD was determined by the white matter hyperintensities (WMH) volume (mL) on magnetic resonance imaging in 2006, 2015, and the progression between 2006 and 2015 (ΔWMH). Cytokine production was assessed after ex vivo stimulation of peripheral blood mononuclear cells and monocytes. Additionally, monocyte subsets were identified by flow cytometry. Results- Fifty-one subjects (70±6 years, 60% men, 5.1±6.4 mL ΔWMH) were included. Circulating hsIL (high-sensitivity interleukin)-6 correlated with cSVD ( P=0.005, rs=0.40). Cytokine production capacity by monocytes was associated with cSVD progression. Basal IL-8 and IL-17 production ( P=0.08, rs=0.25; P=0.03, rs=0.30) and IL-6 production after Pam3Cys stimulation in monocytes was associated with cSVD (n=35: P=0.008, rs=0.44). Conversely, interferon (IFN)-γ production in Candida albicans stimulated peripheral blood mononuclear cells was negatively correlated with cSVD ( P=0.009, rs=-0.36). Flow cytometry revealed a correlation of the intermediate monocyte subset with cSVD ( P=0.01, rs=0.36). Conclusions- Severity and progression of cSVD are not only correlated with systemic inflammation (hsIL-6) but also with trained immunity characteristics of circulating monocytes, in terms of an altered cytokine production capacity and a shift toward the proinflammatory intermediate monocyte subset.
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Affiliation(s)
- Marlies P Noz
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
| | - Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Leo A B Joosten
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
| | - Mihai G Netea
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands.,Department for Genomics and Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Germany (M.G.N.)
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour (A.t.T., K.W., F.-E.d.L.), Nijmegen, the Netherlands
| | - Niels P Riksen
- From the Department of Internal Medicine, Radboud University Medical Center Behaviour, (M.P.N., L.A.B.J., M.G.N., N.P.R.), Nijmegen, the Netherlands
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Reiche B, Moody A, Khademi A. Pathology-preserving intensity standardization framework for multi-institutional FLAIR MRI datasets. Magn Reson Imaging 2019; 62:59-69. [DOI: 10.1016/j.mri.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
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Vangberg TR, Eikenes L, Håberg AK. The effect of white matter hyperintensities on regional brain volumes and white matter microstructure, a population-based study in HUNT. Neuroimage 2019; 203:116158. [PMID: 31493533 DOI: 10.1016/j.neuroimage.2019.116158] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/03/2019] [Accepted: 09/02/2019] [Indexed: 12/19/2022] Open
Abstract
Even though age-related white matter hyperintensities (WMH) begin to emerge in middle age, their effect on brain micro- and macrostructure in this age group is not fully elucidated. We have examined how presence of WMH and load of WMH affect regional brain volumes and microstructure in a validated, representative general population sample of 873 individuals between 50 and 66 years. Presence of WMH was determined as Fazakas grade ≥1. WMH load was WMH volume from manual tracing of WMHs divided on intracranial volume. The impact of age appropriate WMH (Fazakas grade 1) on the brain was also investigated. Major novel findings were that even the age appropriate WMH group had widespread macro- and microstructural changes in gray and white matter, showing that the mere presence of WMH, not just WMH load is an important clinical indicator of brain health. With increasing WMH load, structural changes spread centrifugally. Further, we found three major patterns of FA and MD changes related to increasing WMH load, demonstrating a heterogeneous effect on white matter microstructure, where distinct patterns were found in the proximity of the lesions, in deep white matter and in white matter near the cortex. This study also raises several questions about the onset of WMH related pathology, in particular, whether some of the aberrant brain structural and microstructural findings are present before the emergence of WMH. We also found, similar to other studies, that WMH risk factors had low explanatory power for WMH, making it unclear which factors lead to WMH.
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Affiliation(s)
- Torgil Riise Vangberg
- Medical Imaging Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; PET Center, University Hospital North Norway, Tromsø, Norway
| | - Live Eikenes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Asta K Håberg
- Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Khademi A, Reiche B, DiGregorio J, Arezza G, Moody AR. Whole volume brain extraction for multi-centre, multi-disease FLAIR MRI datasets. Magn Reson Imaging 2019; 66:116-130. [PMID: 31472262 DOI: 10.1016/j.mri.2019.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/01/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022]
Abstract
Automatic segmentation of the brain from magnetic resonance images (MRI) is a fundamental step in many neuroimaging processing frameworks. There are mature technologies for this task for T1- and T2-weighted MRI; however, a widely-accepted brain extraction method for Fluid-Attenuated Inversion Recovery (FLAIR) MRI has yet to be established. FLAIR MRI are becoming increasingly important for the analysis of neurodegenerative diseases and tools developed for this sequence would have clinical value. To maximize translation opportunities and for large scale research studies, algorithms for brain extraction in FLAIR MRI should generalize to multi-centre (MC) data. To this end, this work proposes a fully automated, whole volume brain extraction methodology for MC FLAIR MRI datasets. The framework is built using a novel standardization framework which reduces acquisition artifacts, standardizes the intensities of tissues and normalizes the spatial coordinates of brain tissue across MC datasets. Using the standardized datasets, an intuitive set of features based on intensity, spatial location and gradients are extracted and classified using a random forest (RF) classifier to segment the brain tissue class. A series of experiments were conducted to optimize classifier parameters, and to determine segmentation accuracy for standardized and unstandardized (original) data, as a function of scanner vendor, feature type and disease type. The models are trained, tested and validated on 156 image volumes (∼8000 image slices) from two multi-centre, multi-disease datasets, acquired with varying imaging parameters from 30 centres and three scanner vendors. The image datasets, denoted as CAIN and ADNI for vascular and dementia disease, respectively, represent a diverse collection of MC data to test the generalization capabilities of the proposed design. Results demonstrate the importance of standardization for segmentation of MC data, as models trained on standardized data yielded a drastic improvement in brain extraction accuracy compared to the original, unstandardized data (CAIN: DSC = 91% and ADNI: DSC = 86% vs. CAIN: 78% and ADNI: 65%). It was also found that models created from one scanner vendor based on unstandardized data yielded poor segmentation results in data acquired from other scanner vendors, which was improved through standardization. These results demonstrate that to create consistency in segmentations from multi-institutional datasets it is paramount that MC variability be mitigated to improve stability and to ensure generalization of machine learning algorithms for MRI.
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Affiliation(s)
- April Khademi
- Image Analysis in Medicine Lab (IAMLAB), Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada.
| | | | - Justin DiGregorio
- Image Analysis in Medicine Lab (IAMLAB), Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Giordano Arezza
- Image Analysis in Medicine Lab (IAMLAB), Department of Electrical, Computer and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto M5S 1A1, Canada
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Aribisala BS, Riha RL, Valdes Hernandez M, Muñoz Maniega S, Cox S, Radakovic R, Taylor A, Pattie A, Corley J, Redmond P, Bastin ME, Starr J, Deary I, Wardlaw JM. Sleep and brain morphological changes in the eighth decade of life. Sleep Med 2019; 65:152-158. [PMID: 31706897 DOI: 10.1016/j.sleep.2019.07.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Sleep is important for brain health. We analysed associations between usual sleep habits and magnetic resonance imaging (MRI) markers of neurodegeneration (brain atrophy), vascular damage (white matter hyperintensities, WMH) and waste clearance (perivascular spaces, PVS) in older community-dwelling adults. METHOD We collected self-reported usual sleep duration, quality and medical histories from the Lothian Birth Cohort 1936 (LBC1936) age 76 years and performed brain MRI. We calculated sleep efficiency, measured WMH and brain volumes, quantified PVS, and assessed associations between sleep measures and brain markers in multivariate models adjusted for demographic and medical history variables. RESULTS In 457 subjects (53% males, mean age 76 ± 0.65 years), we found: brain and white matter loss with increased weekend daytime sleep (β = -0.114, P = 0.03; β = -0.122, P = 0.007 respectively), white matter loss with less efficient sleep (β = 0.132, P = 0.011) and PVS increased with interrupted sleep (OR 1.84 95% CI, P = 0.025). CONCLUSION Cross-sectional associations of sleep parameters with brain atrophy and more PVS suggest adverse relationships between usual sleep habits and brain health in older people that should be evaluated longitudinally.
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Affiliation(s)
- Benjamin S Aribisala
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK; Department of Computer Science, Lagos State University, Lagos, Nigeria
| | - Renata L Riha
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Sleep Medicine, Royal Infirmary of Edinburgh, NHS Lothian, UK
| | - Maria Valdes Hernandez
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - Susana Muñoz Maniega
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - Simon Cox
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ratko Radakovic
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK; Faculty of Health and Medical Sciences, University of East Anglia, Norwich, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Adele Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Janie Corley
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Paul Redmond
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK
| | - John Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Ian Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), UK; UK Dementia Research Institute, University of Edinburgh, UK.
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88
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Frösen J, Joutel A. Smooth muscle cells of intracranial vessels: from development to disease. Cardiovasc Res 2019; 114:501-512. [PMID: 29351598 DOI: 10.1093/cvr/cvy002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/12/2018] [Indexed: 02/02/2023] Open
Abstract
Cerebrovascular diseases that cause ischaemic or haemorrhagic stroke with subsequent loss of life or functional capacity due to damage of the brain tissue are among the leading causes of human suffering and economic burden inflicted by diseases in the developed world. Diseases affecting intracranial vessels are significant contributors to ischaemic and haemorrhagic strokes. Brain arteriovenous malformations, which are a collection of abnormal blood vessels connecting arteries to veins, are the most common cause of intracranial haemorrhage in children and young adults. Saccular intracranial aneurysms, which are pathological saccular dilations mainly occurring at bifurcations of the large intracranial arteries near the circle of Willis, are highly prevalent in the middle-aged population, causing significant anxiety and concern; their rupture, although rare, is a significant cause of intracranial haemorrhage in those past middle age that is associated with a very sinister prognosis. Cerebral small-vessel disease, which comprise all pathological processes affecting vessels <500 microns in diameter, account for the majority of intracerebral haemorrhages and ∼25% of ischaemic strokes and 45% of dementias in the elderly. In this review, we summarize the developmental, structural, and functional features of intracranial vessels. We then describe the role of smooth muscle cells in brain arteriovenous malformations, intracranial aneurysms, and small-vessel diseases, and discuss how the peculiar ontogeny, structure, and function of intracranial vessels are related to the development of these diseases.
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Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio 70029, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio 70029, Finland
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, 10 av de Verdun, Paris 75010, France.,DHU NeuroVasc, Sorbonne Paris Cité, Paris 75010, France
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89
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Mejía-Rentería H, Matias-Guiu JA, Lauri F, Yus M, Escaned J. Microcirculatory dysfunction in the heart and the brain. Minerva Cardioangiol 2019; 67:318-329. [DOI: 10.23736/s0026-4725.18.04701-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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90
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Dickie DA, Gardner K, Wagener A, Wyss A, Arba F, Wardlaw JM, Dawson J. Cortical thickness, white matter hyperintensities, and cognition after stroke. Int J Stroke 2019; 15:46-54. [PMID: 31088224 DOI: 10.1177/1747493019851291] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A thinner cerebral cortex is associated with higher white matter hyperintensity burden and cognitive impairment in community-dwelling and dementia cohorts. It is important to assess these associations in people with ischemic stroke because their cerebrovascular disease profiles are different to these cohorts. AIMS We aimed to determine whether cortical thickness was related to white matter hyperintensity burden and cognition after ischemic stroke. METHODS We measured cortical thickness using advanced normalization tools' "KellyKapowski" function in 244 patients with ischemic stroke or transient ischemic attack from the Virtual International Stroke Trials Archive. We measured white matter hyperintensity burden via quantitative volumes and Fazekas score. We extracted data on vascular risk factors at baseline and Mini Mental State Examination scores at one year. We assessed associations between imaging and clinical data using correlation and multiple linear regression. RESULTS Pairwise correlation showed that higher white matter hyperintensity Fazekas score was associated with a thinner cortex (rho = -0.284, P < 0.0001). White matter hyperintensities were generally distributed adjacent to and above the lateral ventricles. Voxel-wise analyses showed statistically significant negative associations between cortical thickness and white matter hyperintensities across fronto-temporal and inferior parietal cortical regions. Mean cortical thickness was positively related to Mini Mental State Examination in pair-wise correlation (r = 0.167, P = 0.0088) but there was no independent association after adjustment for age and white matter hyperintensities (beta = 0.016, P = 0.7874). CONCLUSIONS Cortical thickness was not an independent predictor of cognition after ischemic stroke. Further work is required to understand how white matter hyperintensities are associated with a thinner cortex in temporal regions but less so in more superior regions where white matter hyperintensities are generally found in people with stroke.
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Affiliation(s)
- David Alexander Dickie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kirstyn Gardner
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Annika Wagener
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.,Interdisciplinary Center for Neurosciences, Heidelberg University, Heidelberg, Germany
| | - Annick Wyss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK.,Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Royal Infirmary of Edinburgh, The University of Edinburgh, Edinburgh, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
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91
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Association between white matter lesions and cerebral glucose metabolism in patients with cognitive impairment. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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92
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Association between white matter lesions and the cerebral glucose metabolism in patients with cognitive impairment. Rev Esp Med Nucl Imagen Mol 2019; 38:160-166. [PMID: 31053556 DOI: 10.1016/j.remn.2018.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/21/2018] [Accepted: 12/08/2018] [Indexed: 11/23/2022]
Abstract
AIM White matter lesions (WMLs), detected as hyperintensities on T2-weighted MRI, represent small vessel disease in the brain and are considered a potential risk factor for memory and cognitive impairment. It has not been sufficiently evident that cognitive impairment in patients with Alzheimer's disease is caused by WMLs as well as β-amyloid (Aβ) pathology. The aim of this study was to evaluate relationship between WMLs and cerebral glucose metabolism in patients with cognitive impairment after adjustment of cerebral Aβ burden. MATERIALS AND METHODS Eighty-three subjects with cognitive performance ranging from normal to dementia, who underwent brain MRI and 18F-florbetaben positron emission tomography (PET) and 18F-fluorodeoxyglucose PET, were included in this cross-sectional study. The Fazekas scale was used to quantify WMLs on brain T2-weighted MRI. The cerebral Aβ burden and cerebral glucose metabolism were quantitatively estimated using volume-of-interest analysis. Differences in the regional cerebral glucose metabolism were evaluated between low-WML (Fazekas scale<2) and high-WML (Fazekas scale≥2) groups. Multiple linear regression analysis adjusted for age, sex and cerebral Aβ burden was performed to evaluate the relationship between the Fazekas scale score and cerebral glucose metabolism. RESULTS The regional cerebral glucose metabolism for the bilateral frontal, temporal, and parietal cortices, and limbic lobes in the high-WML group were significantly lower than those in the low-WML group. There were significant negative correlations between the Fazekas scale score and regional cerebral glucose metabolism in the bilateral frontal, bilateral temporal and left parietal cortices, and bilateral limbic lobes. Multiple linear regression analysis revealed that the Fazekas scale score was an independent determinant of the glucose metabolism in the bilateral frontal and temporal cortices and limbic lobes. CONCLUSIONS WMLs are associated with decreased cerebral glucose metabolism. Our findings suggest that small vessel disease, as well as Aβ pathology, may contribute to cognitive impairment in patients with Alzheimer's disease.
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93
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McGrory S, Ballerini L, Doubal FN, Staals J, Allerhand M, Valdes-Hernandez MDC, Wang X, MacGillivray T, Doney ASF, Dhillon B, Starr JM, Bastin ME, Trucco E, Deary IJ, Wardlaw JM. Retinal microvasculature and cerebral small vessel disease in the Lothian Birth Cohort 1936 and Mild Stroke Study. Sci Rep 2019; 9:6320. [PMID: 31004095 PMCID: PMC6474900 DOI: 10.1038/s41598-019-42534-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023] Open
Abstract
Research has suggested that the retinal vasculature may act as a surrogate marker for diseased cerebral vessels. Retinal vascular parameters were measured using Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE) software in two cohorts: (i) community-dwelling older subjects of the Lothian Birth Cohort 1936 (n = 603); and (ii) patients with recent minor ischaemic stroke of the Mild Stroke Study (n = 155). Imaging markers of small vessel disease (SVD) (white matter hyperintensities [WMH] on structural MRI, visual scores and volume; perivascular spaces; lacunes and microbleeds), and vascular risk measures were assessed in both cohorts. We assessed associations between retinal and brain measurements using structural equation modelling and regression analysis. In the Lothian Birth Cohort 1936 arteriolar fractal dimension accounted for 4% of the variance in WMH load. In the Mild Stroke Study lower arteriolar fractal dimension was associated with deep WMH scores (odds ratio [OR] 0.53; 95% CI, 0.32–0.87). No other retinal measure was associated with SVD. Reduced fractal dimension, a measure of vascular complexity, is related to SVD imaging features in older people. The results provide some support for the use of the retinal vasculature in the study of brain microvascular disease.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Lucia Ballerini
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mike Allerhand
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Xin Wang
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK
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94
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Staszewski J, Skrobowska E, Piusińska-Macoch R, Brodacki B, Stępień A. Cerebral and Extracerebral Vasoreactivity in Patients With Different Clinical Manifestations of Cerebral Small-Vessel Disease: Data From the Significance of Hemodynamic and Hemostatic Factors in the Course of Different Manifestations of Cerebral Small-Vessel Disease Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:975-987. [PMID: 30208231 DOI: 10.1002/jum.14782] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Endothelial dysfunction has been implicated in the pathogenesis of cerebral small-vessel disease (SVD). Little is known about the relationship between SVD and measures of endothelium-dependent vasodilatation and cerebral vasomotor reactivity. The aim of this study was to evaluate cerebral and extracerebral endothelial dysfunction in patients with different manifestations of SVD and to assess the relationship between endothelial dysfunction and radiologic markers of SVD. METHODS The vasomotor reactivity reserve (VMRr), breath-holding index (BHI) of the middle cerebral arteries, and brachial artery flow-mediated dilatation (FMD) were measured with ultrasound techniques in 90 patients (30 in each group) older than 60 years with extensive white matter lesions (Fazekas grade ≥ 2) with a history of lacunar stroke, vascular dementia, or parkinsonism and 30 individuals with normal magnetic resonance imaging findings (control group). All groups were matched for age, sex, hypertension, and diabetes. RESULTS The mean age ± SD (71.8 ± 3.4 versus 71.7 ± 3.4 years), sex distribution, and prevalence of the main vascular risk factors were similar in the SVD and control groups. The VMRr (56.6% ± 18.3% versus 77.1% ± 16.9%), BHI (0.8 ± 0.3 versus 1.1 ± 0.4), and FMD (5.8% ± 4 versus 12.1% ± 5.2%) were severely impaired in the SVD groups compared to the control group (P < .01). The vascular responses to all tests was similar in the SVD groups, but they were significantly decreased in patients with severe white matter lesions, marked brain atrophy, and enlarged perivascular spaces. CONCLUSIONS This study was the first that simultaneously evaluated cerebral and extracerebral vasodilator responses in a well-phenotyped cohort of patients with lacunar stroke, vascular dementia, or parkinsonism. The VMRr, BHI, and FMD were more severely impaired in patients with SVD, regardless of its clinical manifestation, than in control participants. All measures were significantly lower in patients with severe white-matter lesions, brain atrophy, or enlarged perivascular spaces.
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Affiliation(s)
| | - Ewa Skrobowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
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95
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Fornage M, Beecham AH. The emerging genetic landscape of cerebral white matter hyperintensities. Neurology 2019; 92:355-356. [PMID: 30659142 DOI: 10.1212/wnl.0000000000006936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Myriam Fornage
- From the Institute of Molecular Medicine and Human Genetics Center (M.F.), University of Texas Health Science Center at Houston; and John P. Hussman Institute for Human Genomics (A.H.B.), University of Miami, FL.
| | - Ashley H Beecham
- From the Institute of Molecular Medicine and Human Genetics Center (M.F.), University of Texas Health Science Center at Houston; and John P. Hussman Institute for Human Genomics (A.H.B.), University of Miami, FL
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96
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Nagy M, Azeem MU, Soliman Y, Nawab SA, Jun-O'Connell AH, Goddeau RP, Moonis M, Silver B, Henninger N. Pre-existing White Matter Hyperintensity Lesion Burden and Diagnostic Certainty of Transient Ischemic Attack. J Stroke Cerebrovasc Dis 2019; 28:944-953. [PMID: 30630754 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
GOALS There are no validated biomarkers that allow for reliable distinction between TIA and other transient neurological symptoms that mimic TIA. We sought to determine whether the degree of pre-existing white matter hyperintensity (WMH) lesion burden relates to the diagnostic certainty of TIA in a cohort of patients presenting with transient neurological symptoms. MATERIALS AND METHODS We retrospectively analyzed 144 consecutive patients with available brain MRI to quantify and normalize the WMH volume for brain atrophy (adjusted white matter hyperintensity [aWMHV]). We first stratified subjects to probable (n = 62) versus possible (n = 82) TIA as per existing guidelines. Receiver-operating characteristic curves were used to determine a critical aWMHV-threshold (7.8 mL) that best differentiated probable from possible TIA. We then further stratified patients with possible TIA to likely (n = 52) versus unlikely (n = 30) TIA after independent chart review and adjudication. Finally, multivariable logistic and multinomial regression was used to determine whether the defined aWMHV independently related to probable and likely TIA after adjustment for pertinent confounders. FINDINGS With the exception of age (P < .001) and use of antiplatelets (P = .017), baseline characteristics were similar between patients with probable, likely, and unlikely TIA. In the fully adjusted multinomial model, the aWMHV cut-off greater than 7.8 mL (odds ratio 3.8, 95% confidence interval 1.3-10.9, P = .012) was significantly more frequent in patients with a probable TIA as compared to those with an unlikely TIA diagnosis. CONCLUSIONS We provide proof-of-principle that WMH may serve as a neuroimaging marker of diagnostic certainty of TIA after neurological workup has been completed.
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Affiliation(s)
- Muhammad Nagy
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Muhammad U Azeem
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Youssef Soliman
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sahil A Nawab
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Biochemistry, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Adalia H Jun-O'Connell
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Richard P Goddeau
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Majaz Moonis
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Brian Silver
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
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97
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Shaaban CE, Jorgensen DR, Gianaros PJ, Mettenburg J, Rosano C. Cerebrovascular disease: Neuroimaging of cerebral small vessel disease. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:225-255. [DOI: 10.1016/bs.pmbts.2019.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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98
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Ye S, Dong S, Tan J, Chen L, Yang H, Chen Y, Peng Z, Huo Y, Liu J, Tang M, Li Y, Zhou H, Tao Y. White-Matter Hyperintensities and Lacunar Infarcts Are Associated with an Increased Risk of Alzheimer's Disease in the Elderly in China. J Clin Neurol 2019; 15:46-53. [PMID: 30618216 PMCID: PMC6325371 DOI: 10.3988/jcn.2019.15.1.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/03/2023] Open
Abstract
Background and Purpose This study investigated the contribution of white-matter hyperintensities (WMH) and lacunar infarcts (LI) to the risk of Alzheimer's disease (AD) in an elderly cohort in China. Methods Older adults who were initially cognitively normal were examined with MRI at baseline, and followed for 5 years. WMH were classified as mild, moderate, or severe, and LI were classified into a few LI (1 to 3) or many LI (≥4). Cognitive function was assessed using the Mini Mental State Examination and the Activities of Daily Living scale. Results Among the 2,626 subjects, 357 developed AD by the end of the 5-year follow-up period. After adjusting for age and other potential confounders, having only WMH, having only LI, and having both WMH and LI were associated with an increased risk of developing AD compared with having neither WMH nor LI. Moderate and severe WMH were associated with an increased risk of developing AD compared with no WMH. Furthermore, patients with many LI had an increased risk of developing AD compared with no LI. Conclusions Having moderate or severe WMH and many LI were associated with an increased risk of developing AD, with this being particularly striking when both WMH and LI were present.
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Affiliation(s)
- Shuai Ye
- Battalion 3 of Cadet Brigade, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuyang Dong
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Postgraduate School, Bengbu Medical College, Anhui, China
| | - Jun Tan
- Rashid Laboratory for Developmental Neurobiology, Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Le Chen
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Postgraduate School, Bengbu Medical College, Anhui, China
| | - Hai Yang
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Chen
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zeyan Peng
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Postgraduate School, Bengbu Medical College, Anhui, China
| | - Yingchao Huo
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Juan Liu
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mingshan Tang
- Department of Neurology, the People's Hospital of Banan District, Chongqing, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Neurology, Qianjiang National Hospital, Chongqing, China.
| | - Yong Tao
- Department of Neurology, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
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99
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Deary IJ, Ritchie SJ, Muñoz Maniega S, Cox SR, Valdés Hernández MC, Luciano M, Starr JM, Wardlaw JM, Bastin ME. Brain Peak Width of Skeletonized Mean Diffusivity (PSMD) and Cognitive Function in Later Life. Front Psychiatry 2019; 10:524. [PMID: 31402877 PMCID: PMC6676305 DOI: 10.3389/fpsyt.2019.00524] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
It is suggested that the brain's peak width of skeletonized water mean diffusivity (PSMD) is a neuro-biomarker of processing speed, an important aspect of cognitive aging. We tested whether PSMD is more strongly correlated with processing speed than with other cognitive domains, and more strongly than other structural brain MRI indices. Participants were 731 Lothian Birth Cohort 1936 members, mean age = 73 years (SD = 0.7); analytical sample was 656-680. Cognitive domains tested were as follows: processing speed (5 tests), visuospatial (3), memory (3), and verbal (3). Brain-imaging variables included PSMD, white matter diffusion parameters, hyperintensity volumes, gray and white matter volumes, and perivascular spaces. PSMD was significantly associated with processing speed (-0.27), visuospatial ability (-0.23), memory ability (-0.17), and general cognitive ability (-0.25); comparable correlations were found with other brain-imaging measures. In a multivariable model with the other imaging variables, PSMD provided independent prediction of visuospatial ability and general cognitive ability. This incremental prediction, coupled with its ease to compute and possibly better tractability, might make PSMD a useful brain biomarker in studies of cognitive aging.
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Affiliation(s)
- Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Stuart J Ritchie
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Susana Muñoz Maniega
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), University of Edinburgh, Edinburgh, United Kingdom
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), University of Edinburgh, Edinburgh, United Kingdom
| | - Maria C Valdés Hernández
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Dementia Research Centre, Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Michelle Luciano
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Dementia Research Centre, Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom.,Brain Research Imaging Centre, Division of Neuroimaging Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), University of Edinburgh, Edinburgh, United Kingdom
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100
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Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis. Neurol Sci 2018; 40:509-514. [PMID: 30554353 DOI: 10.1007/s10072-018-3683-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We investigated whether completeness of the circle of Willis (CoW) protected patients with severe internal carotid artery (ICA) stenosis against white matter hyperintensities (WMHs). METHODS We included 115 patients with unilateral ICA stenosis ≥ 70%. The completeness of CoW was assessed and WMHs were rated on a visual scale. The score of deep and periventricular WMHs was compared between patients with complete and incomplete CoW and between the two hemispheres, ipsilateral and contralateral to stenosed ICA. RESULTS We included 115 patients with severe ICA stenosis, 60 patients had a complete CoW (52.17%) and 55 had an incomplete CoW (47.83%). The patients with incomplete CoW had higher score of deep WMHs (OR = 1.82, 95% CI 1.08-3.06, P = 0.023) and periventricular WMHs (OR = 4.53, 95% CI 2.09-9.81, P = 0.000) than those with complete CoW. In the patients with incomplete CoW, the score of deep WMHs (OR = 4.14, 95% CI 1.33-12.93, P = 0.014) and periventricular WMHs (OR = 5.46, 95% CI 1.16-25.62, P = 0.032) was higher in the hemisphere ipsilateral to stenosed ICA than that in the contralateral hemisphere. In the patients with complete CoW, there was no significant difference in the score of deep WMHs (OR = 2.10, 95% CI 0.37-11.91, P = 0.401) and periventricular WMHs (OR = 2.83, 95% CI 0.99-8.05, P = 0.051) between the ipsilateral and contralateral hemispheres to stenosed ICA. CONCLUSION The completeness of CoW protected patients with severe ICA stenosis against WMHs.
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