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Kim BJ, Lee EJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kang DW, Kwon SU, Lee J, Kang DW, Rha JH, Park JM, Lee YS, Lee JH, Kim YJ, Hong KS, Yu KH, Sohn SI, Ahn SH, Cha JK, Park MS, Kim JS, Yoon BW, Lee BC, Nam CM, Koo JS, Nam HS, Park KY, Park JM, Lee JH, Kim DH, Rha JH, Nah HW, Lee YS, Cho YJ, Kim DE, Han MK, Lee KB, Heo SH, Heo JH, Kim BJ, Cho KH, Kim HY, Kim YD, Cho AH, Lee KY, Lee JS, Park JH, Seo WK, Kim EG, Koh IS, Choi NC, Kwon JH, Lee J, Hwang YH, Song HJ, Shin BS, Kim JT, Lee SJ, Chung PW, Kim SH, Lee JH, Shin DI, Do JK, Lee SB, Lee YB, Yoo BG, Sung SM, Jung JM, Park JW, Lee TK, Navarro JC, San Jos MCZ, Roxas A, Mallarl-Alvarez RJ, Collantes MEV, WONG LK, Fong WC, Tsoi TH, Ng PW, Lee EJ, Lee JS. Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial. Lancet Neurol 2018; 17:509-518. [DOI: 10.1016/s1474-4422(18)30128-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/18/2022]
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Tsai HH, Kim JS, Jouvent E, Gurol ME. Updates on Prevention of Hemorrhagic and Lacunar Strokes. J Stroke 2018; 20:167-179. [PMID: 29886717 PMCID: PMC6007298 DOI: 10.5853/jos.2018.00787] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022] Open
Abstract
Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eric Jouvent
- Department of Neurology, University Paris Diderot, Paris, France
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mimenza-Alvarado A, Aguilar-Navarro SG, Yeverino-Castro S, Mendoza-Franco C, Ávila-Funes JA, Román GC. Neuroimaging Characteristics of Small-Vessel Disease in Older Adults with Normal Cognition, Mild Cognitive Impairment, and Alzheimer Disease. Dement Geriatr Cogn Dis Extra 2018; 8:199-206. [PMID: 29928288 PMCID: PMC6006607 DOI: 10.1159/000488705] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Cerebral small-vessel disease (SVD) represents the most frequent type of vascular brain lesions, often coexisting with Alzheimer disease (AD). By quantifying white matter hyperintensities (WMH) and hippocampal and parietal atrophy, we aimed to describe the prevalence and severity of SVD among older adults with normal cognition (NC), mild cognitive impairment (MCI), and probable AD and to describe associated risk factors. Methods This study included 105 older adults evaluated with magnetic resonance imaging and clinical and neuropsychological tests. We used the Fazekas scale (FS) for quantification of WMH, the Scheltens scale (SS) for hippocampal atrophy, and the Koedam scale (KS) for parietal atrophy. Logistic regression models were performed to determine the association between FS, SS, and KS scores and the presence of NC, MCI, or probable AD. Results Compared to NC subjects, SVD was more prevalent in MCI and probable AD subjects. After adjusting for confounding factors, logistic regression showed a positive association between higher scores on the FS and probable AD (OR = 7.6, 95% CI 2.7–20, p < 0.001). With the use of the SS and KS (OR = 4.5, 95% CI 3.5–58, p = 0.003 and OR = 8.9, 95% CI 1–72, p = 0.04, respectively), the risk also remained significant for probable AD. Conclusions These results suggest an association between severity of vascular brain lesions and neurodegeneration.
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Affiliation(s)
- Alberto Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sara G Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sara Yeverino-Castro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - César Mendoza-Franco
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Alberto Ávila-Funes
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Gustavo C Román
- Department of Neurology, Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
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Scarapicchia V, Mazerolle EL, Fisk JD, Ritchie LJ, Gawryluk JR. Resting State BOLD Variability in Alzheimer's Disease: A Marker of Cognitive Decline or Cerebrovascular Status? Front Aging Neurosci 2018; 10:39. [PMID: 29515434 PMCID: PMC5826397 DOI: 10.3389/fnagi.2018.00039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 02/02/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Alzheimer's disease (AD) is a neurodegenerative disorder that may benefit from early diagnosis and intervention. Therefore, there is a need to identify early biomarkers of AD using non-invasive techniques such as functional magnetic resonance imaging (fMRI). Recently, novel approaches to the analysis of resting-state fMRI data have been developed that focus on the moment-to-moment variability in the blood oxygen level dependent (BOLD) signal. The objective of the current study was to investigate BOLD variability as a novel early biomarker of AD and its associated psychophysiological correlates. Method: Data were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) 2 database from 19 participants with AD and 19 similarly aged controls. For each participant, a map of BOLD signal variability (SDBOLD) was computed as the standard deviation of the BOLD timeseries at each voxel. Group comparisons were performed to examine global differences in resting state SDBOLD in AD versus healthy controls. Correlations were then examined between participant SDBOLD maps and (1) ADNI-derived composite scores of memory and executive function and (2) neuroimaging markers of cerebrovascular status. Results: Between-group comparisons revealed significant (p < 0.05) increases in SDBOLD in patients with AD relative to healthy controls in right-lateralized frontal regions. Lower memory scores and higher WMH burden were associated with greater SDBOLD in the healthy control group (p < 0.1), but not individuals with AD. Conclusion: The current study provides proof of concept of a novel resting state fMRI analysis technique that is non-invasive, easily accessible, and clinically compatible. To further explore the potential of SDBOLD as a biomarker of AD, additional studies in larger, longitudinal samples are needed to better understand the changes in SDBOLD that characterize earlier stages of disease progression and their underlying psychophysiological correlates.
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Affiliation(s)
| | - Erin L. Mazerolle
- Department of Radiology and The Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - John D. Fisk
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Psychology, Nova Scotia Health Authority, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lesley J. Ritchie
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Jodie R. Gawryluk
- Department of Psychology, University of Victoria, Victoria, BC, Canada
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Masjuan J, Gállego J, Aguilera JM, Arenillas JF, Castellanos M, Díaz F, Portilla JC, Purroy F. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease. Neurologia 2018; 36:1-8. [PMID: 29325730 DOI: 10.1016/j.nrl.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. METHODS A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. RESULTS These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. CONCLUSIONS This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence.
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Affiliation(s)
- J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Invictus Plus, Red Nacional de Investigación en Ictus, Madrid, España.
| | - J Gállego
- Complejo Hospitalario de Navarra, Pamplona, España
| | - J M Aguilera
- Hospital Universitario de Nuestra Señora de Valme, Sevilla, España
| | - J F Arenillas
- Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Castellanos
- Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de Coruña INIBIC, La Coruña, España
| | - F Díaz
- Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J C Portilla
- Hospital Universitario San Pedro de Alcántara, Cáceres, España
| | - F Purroy
- Hospital Arnau de Vilanova, Lérida, España
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56
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Lin PC, Chang FC, Huang HC, Tsai JY, Lin YY, Chung CP. Greater periventricular white matter hyperintensity severity in basilar artery branch atheromatous disease. BMC Neurol 2017; 17:135. [PMID: 28716089 PMCID: PMC5514534 DOI: 10.1186/s12883-017-0918-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Basilar artery branch atheromatous disease (BABAD), in which basilar artery atheroma occludes penetrating arteries at their origin, is a common etiology of posterior circulation stroke (PCS). It is currently unknown whether white matter hyperintensity(WMH), a marker of small vessel disease(SVD), is associated with BABAD. Methods The present study analyzed data from patients with PCS who were enrolled in the Taipei Veterans General Hospital Stroke Registry between January 1, 2010 and February 28, 2014. WMH severity was rated using the Scheltens scale. We used multivariate analyses to: (1) compare the severity of WMH between patients with BABAD, patients with large-artery > 50% atherosclerotic stenosis-related PCS(LAA), and non-stroke subjects(NS); and (2) evaluate the relationship between WMH severity and the 3-month prognosis of patients with BABAD. Results The study pool included 151 BABAD, 97 LAA, and 78 non-stroke patients. Multivariate analyses adjusting for age, sex, and vascular risk factors showed that compared to patients with LAA [Odds ratio(OR) = 0.51, p = 0.037] and NS (OR = 0.40, p = 0.004), patients with BABAD (OR = 1) had greater WMH severity (score ≥ 50th percentile) in periventricular, but not subcortical, regions. Moreover, greater periventricular WMH severity predicted poor 3-month functional outcomes (modified Rankin Scale > 3) with an OR of 3.21 (p = 0.028) in BABAD patients. Conclusions We are the first to show a significant association between WMH and BABAD that is independent of vascular risk factors and atherosclerotic large-artery disease. Our results suggest that small vessel abnormalities other than lipohyalinosis may be involved in BABAD pathophysiology. A future management strategy should include both large and small vessel protection.
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Affiliation(s)
- Po-Chen Lin
- Department of Neurology, Taipei Veterans General Hospital, No. 201 Sec.2, Shihpai Road, Peitou, Taipei, 11217, Taiwan.,National Yang Ming University, Taipei, Taiwan
| | - Feng-Chi Chang
- National Yang Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Chi Huang
- Department of Neurology, Taipei Veterans General Hospital, No. 201 Sec.2, Shihpai Road, Peitou, Taipei, 11217, Taiwan.,National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jui-Yao Tsai
- Department of Neurology, Taipei Veterans General Hospital, No. 201 Sec.2, Shihpai Road, Peitou, Taipei, 11217, Taiwan.,National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Yang Lin
- Department of Neurology, Taipei Veterans General Hospital, No. 201 Sec.2, Shihpai Road, Peitou, Taipei, 11217, Taiwan.,National Yang Ming University, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, No. 201 Sec.2, Shihpai Road, Peitou, Taipei, 11217, Taiwan. .,National Yang Ming University, Taipei, Taiwan.
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van Dalen JW, Moll van Charante EP, Caan MW, Scheltens P, Majoie CB, Nederveen AJ, van Gool WA, Richard E. Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions. Stroke 2017; 48:1842-1848. [DOI: 10.1161/strokeaha.117.017207] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Jan Willem van Dalen
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Eric P. Moll van Charante
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Matthan W.A. Caan
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Philip Scheltens
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Charles B.L.M. Majoie
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Aart J. Nederveen
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Willem A. van Gool
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
| | - Edo Richard
- From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Netherlands (P.S.); Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands (E.R.)
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Is Dynamic Cerebral Autoregulation Bilaterally Impaired after Unilateral Acute Ischemic Stroke? J Stroke Cerebrovasc Dis 2017; 26:1081-1087. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/16/2016] [Accepted: 12/24/2016] [Indexed: 11/20/2022] Open
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Abstract
Incident stroke has long been recognized to cause dementia shortly after the event. Patients who survive stroke without early-onset poststroke dementia (PSD) are at a high risk of developing dementia months to years after the initial stroke incident, which has generated enthusiasm for exploring treatments to prevent delayed-onset PSD in survivors of stroke. However, results from clinical trials completed in the past 10-15 years have been disappointing. In light of these results, the present Review revisits the mechanisms of both early-onset and delayed-onset PSD and proposes preventive strategies and directions for future clinical trials. Early-onset PSD results from a complex interplay between stroke lesion features and brain resilience, whereas delayed-onset PSD is associated mainly with the presence of severe sporadic small vessel disease (SVD), and to a lesser extent with Alzheimer disease pathology or recurrent stroke. As well as preventing stroke and delivering acute stroke treatments to reduce initial brain damage, measures to increase brain resilience could also reduce the risk of developing dementia if an incident stroke occurs. Future efforts to prevent delayed-onset PSD should focus on the study of sporadic SVD and on evaluating whether other strategies, in addition to conventional secondary stroke prevention, are effective in dementia prevention in this high-risk group.
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60
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Song SH, Kim JH, Lee JH, Yun YM, Choi DH, Kim HY. Elevated blood viscosity is associated with cerebral small vessel disease in patients with acute ischemic stroke. BMC Neurol 2017; 17:20. [PMID: 28143595 PMCID: PMC5282628 DOI: 10.1186/s12883-017-0808-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased level of blood viscosity, which is one of the major factors that determine blood rheology, has been reported as a risk factor or predictor for cerebrovascular events. We investigated how blood viscosity is associated with acute stroke and chronic radiological manifestations of cerebral small vessel disease, and how blood viscosity changes after stroke. METHODS We prospectively enrolled consecutive patients with acute ischemic stroke. Whole blood viscosities at a low or high shear rate were measured using a scanning capillary tube viscometer, and were referred to as diastolic blood viscosity (DBV) and systolic blood viscosity (SBV), respectively. Correlations between blood viscosity and acute stroke etiology or chronic radiological manifestations of cerebral small vessel disease were investigated. The temporal profiles of blood viscosity at the onset of stroke and follow-up at 1 and 5 weeks were investigated. RESULTS Of the 127 patients admitted with acute ischemic stroke, 63 patients were included in the final analyses. DBV at the onset of stroke was significantly higher in small artery occlusion (SAO) stroke than in other stroke subtypes (p = 0.037). DBV showed a significant positive correlation with the number of chronic lacunes (r = 0.274, p = 0.030). The temporal profiles of DBV in SAO stroke showed a transient decrease due to the hydration therapy after 1 week and recurrent elevation at 5 week follow-up (p = 0.009). CONCLUSIONS Our study suggests that elevated DBV may play a role in the development of acute and chronic manifestations of cerebral small vessel disease. The recurring elevation of DBV in SAO stroke indicates that sufficient hydration and additional therapeutic interventions targeting blood viscosity may be needed in patients with SAO stroke.
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Affiliation(s)
- Seung Hoon Song
- Department of Neurology, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jeong Hee Kim
- Department of Neurology, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Joon Hwa Lee
- Department of Neurology, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dong-Hee Choi
- Department of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea.
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Cerebral amyloid is associated with greater white-matter hyperintensity accrual in cognitively normal older adults. Neurobiol Aging 2016; 48:48-52. [PMID: 27639120 DOI: 10.1016/j.neurobiolaging.2016.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/29/2016] [Accepted: 08/13/2016] [Indexed: 11/20/2022]
Abstract
Cross-sectional studies show that elevated cerebral amyloid is associated with greater white-matter hyperintensity (WMH) burden in cognitively normal (CN) older adults. However, the relative time courses of amyloid and WMH accrual are unclear. To address this, we tested the associations between known WMH correlates-age, hypertension, and amyloid-with WMH accrual rate. We used brain magnetic resonance imaging to measure WMH change in 112 CN Alzheimer's Disease Neuroimaging Initiative (GO/2) participants over a 2-year period. A linear mixed effects model assessed baseline cerebrospinal fluid amyloid beta (Aβ) 1-42, hypertension, age, and their interactions, as predictors of greater WMH accrual. Greater amyloid burden was associated with greater WMH accrual over time. Those with hypertension showed a stronger association between greater amyloid burden and WMH accrual rate. Greater age was not significantly associated with greater WMH accrual in this model. Although the direction of the relationship cannot be tested in this model, CN individuals harboring cerebral amyloid had greater accrual of WMH over a 2-year period after accounting for hypertension and age. Impaired amyloid clearance and cerebral small vessel disease may both underlie the more rapid emergence of WM lesions. The role of cerebral amyloid burden in white-matter injury should thus be considered as a relevant factor when WMHs are detected clinically.
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Kwan JSK, Myint PK, Wong A, Mok V, Lau GKK, Mak KFH. Antithrombotic therapy to prevent cognitive decline in people with small vessel disease on neuroimaging but without dementia. Hippokratia 2016. [DOI: 10.1002/14651858.cd012269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joseph SK Kwan
- The University of Hong Kong, Queen Mary Hospital; Department of Medicine; 102 Pok Fu Lam Road Hong Kong China
| | - Phyo K Myint
- University of Aberdeen; Division of Applied Health Sciences, School of Medicine & Dentistry; Room 4:013 Polwarth Building Foresterhill Aberdeen UK AB25 2ZD
| | - Adrian Wong
- The Chinese University of Hong Kong; Medicine and Therapeutics; 10/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital Shatin, N.T. Hong Kong
| | - Vincent Mok
- The Chinese University of Hong Kong; Medicine and Therapeutics; 10/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital Shatin, N.T. Hong Kong
| | - Gary KK Lau
- The University of Hong Kong; Division of Neurology, Department of Medicine, LKS Faculty of Medicine; Hong Kong Hong Kong
| | - Ka-Fung Henry Mak
- The University of Hong Kong; Diagnostic Radiology; Room 406, Block K, Queen Mary Hospital, 102 Pokfulam Road Hong Kong Hong Kong
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Kapasi A, Schneider JA. Vascular contributions to cognitive impairment, clinical Alzheimer's disease, and dementia in older persons. BIOCHIMICA ET BIOPHYSICA ACTA 2016; 1862:878-86. [PMID: 26769363 PMCID: PMC11062590 DOI: 10.1016/j.bbadis.2015.12.023] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 12/27/2022]
Abstract
There is growing evidence suggesting that vascular pathologies and dysfunction play a critical role in cognitive impairment, clinical Alzheimer's disease, and dementia. Vascular pathologies such as macroinfarcts, microinfarcts, microbleeds, small and large vessel cerebrovascular disease, and white matter disease are common especially in the brains of older persons where they contribute to cognitive impairment and lower the dementia threshold. Vascular dysfunction resulting in decreased cerebral blood flow, and abnormalities in the blood brain barrier may also contribute to the Alzheimer's disease (AD) pathophysiologic process and AD dementia. This review provides a clinical-pathological perspective on the role of vessel disease, vascular brain injury, alterations of the neurovascular unit, and mixed pathologies in the Alzheimer's disease pathophysiologic process and Alzheimer's dementia. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- A Kapasi
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Street, IL 60612, Chicago, USA.
| | - J A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, 600 S. Paulina Street, IL 60612, Chicago, USA.
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De Silva TM, Miller AA. Cerebral Small Vessel Disease: Targeting Oxidative Stress as a Novel Therapeutic Strategy? Front Pharmacol 2016; 7:61. [PMID: 27014073 PMCID: PMC4794483 DOI: 10.3389/fphar.2016.00061] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/04/2016] [Indexed: 12/25/2022] Open
Abstract
Cerebral small vessel disease (SVD) is a major contributor to stroke, and a leading cause of cognitive impairment and dementia. Despite the devastating effects of cerebral SVD, the pathogenesis of cerebral SVD is still not completely understood. Moreover, there are no specific pharmacological strategies for its prevention or treatment. Cerebral SVD is characterized by marked functional and structural abnormalities of the cerebral microcirculation. The clinical manifestations of these pathological changes include lacunar infarcts, white matter hyperintensities, and cerebral microbleeds. The main purpose of this review is to discuss evidence implicating oxidative stress in the arteriopathy of both non-amyloid and amyloid (cerebral amyloid angiopathy) forms of cerebral SVD and its most important risk factors (hypertension and aging), as well as its contribution to cerebral SVD-related brain injury and cognitive impairment. We also highlight current evidence of the involvement of the NADPH oxidases in the development of oxidative stress, enzymes that are a major source of reactive oxygen species in the cerebral vasculature. Lastly, we discuss potential pharmacological strategies for oxidative stress in cerebral SVD, including some of the historical and emerging NADPH oxidase inhibitors.
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Affiliation(s)
- T. Michael De Silva
- Department of Pharmacology, Biomedicine Discovery Institute, Monash UniversityMelbourne, VIC, Australia
| | - Alyson A. Miller
- Cerebrovascular and Stroke Laboratory, School of Health and Biomedical Sciences, RMIT UniversityMelbourne, VIC, Australia
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Abstract
OBJECTIVE Orthostatic dizziness without orthostatic hypotension is common but underlying pathophysiology is poorly understood. This study describes orthostatic cerebral hypoperfusion syndrome (OCHOs). OCHOs is defined by (1) abnormal orthostatic drop of cerebral blood flow velocity (CBFv) during the tilt test and (2) absence of orthostatic hypotension, arrhythmia, vascular abnormalities, or other causes of abnormal orthostatic CBFv. METHODS This retrospective study included patients referred for evaluation of unexplained orthostatic dizziness. Patients underwent standardized autonomic testing, including 10 min of tilt test. The following signals were monitored: heart rate, end tidal CO2, blood pressure, and CBFv from the middle cerebral artery using transcranial Doppler. Patients were screened for OCHOs. Patients who fulfilled the OCHOs criteria were compared to age- and gender-matched controls. RESULTS From 1279 screened patients, 102 patients (60/42 women/men, age 51.1 ± 14.9, range 19-84 years) fulfilled criteria of OCHOs. There was no difference in baseline supine hemodynamic variables between OCHOs and the control group. During the tilt, mean CBFv decreased 24.1 ± 8.2% in OCHOs versus 4.2 ± 5.6% in controls (p < 0.0001) without orthostatic hypotension in both groups. Supine mean blood pressure (OCHOs/controls, 90.5 ± 10.6/91.1 ± 9.4 mmHg, p = 0.62) remained unchanged during the tilt (90.4 ± 9.7/92.1 ± 9.6 mmHg, p = 0.2). End tidal CO2 and heart rate responses to the tilt were normal and equal in both groups. CONCLUSION OCHOs is a novel syndrome of low orthostatic CBFv. Two main pathophysiological mechanisms are proposed, including active cerebral vasoconstriction and passive increase of peripheral venous compliance. OCHOs may be a common cause of orthostatic dizziness.
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Affiliation(s)
- Peter Novak
- Department of Neurology, Brigham and Women's Faulkner Hospital, Harvard Medical School , Boston, MA , USA
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Dyslipidemia and its association with meibomian gland dysfunction. Int Ophthalmol 2015; 36:469-76. [DOI: 10.1007/s10792-015-0149-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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