101
|
Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Charlton RA, Barrick TR. Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change. Neuroimage Clin 2017; 16:330-342. [PMID: 28861335 PMCID: PMC5568143 DOI: 10.1016/j.nicl.2017.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 02/02/2023]
Abstract
Cerebral small vessel disease (SVD) is the primary cause of vascular cognitive impairment and is associated with decline in executive function (EF) and information processing speed (IPS). Imaging biomarkers are needed that can monitor and identify individuals at risk of severe cognitive decline. Recently there has been interest in combining several magnetic resonance imaging (MRI) markers of SVD into a unitary score to describe disease severity. Here we apply a diffusion tensor image (DTI) segmentation technique (DSEG) to describe SVD related changes in a single unitary score across the whole cerebrum, to investigate its relationship with cognitive change over a three-year period. 98 patients (aged 43-89) with SVD underwent annual MRI scanning and cognitive testing for up to three years. DSEG provides a vector of 16 discrete segments describing brain microstructure of healthy and/or damaged tissue. By calculating the scalar product of each DSEG vector in reference to that of a healthy ageing control we generate an angular measure (DSEG θ) describing the patients' brain tissue microstructural similarity to a disease free model of a healthy ageing brain. Conventional MRI markers of SVD brain change were also assessed including white matter hyperintensities, cerebral atrophy, incident lacunes, cerebral-microbleeds, and white matter microstructural damage measured by DTI histogram parameters. The impact of brain change on cognition was explored using linear mixed-effects models. Post-hoc sample size analysis was used to assess the viability of DSEG θ as a tool for clinical trials. Changes in brain structure described by DSEG θ were related to change in EF and IPS (p < 0.001) and remained significant in multivariate models including other MRI markers of SVD as well as age, gender and premorbid IQ. Of the conventional markers, presence of new lacunes was the only marker to remain a significant predictor of change in EF and IPS in the multivariate models (p = 0.002). Change in DSEG θ was also related to change in all other MRI markers (p < 0.017), suggesting it may be used as a surrogate marker of SVD damage across the cerebrum. Sample size estimates indicated that fewer patients would be required to detect treatment effects using DSEG θ compared to conventional MRI and DTI markers of SVD severity. DSEG θ is a powerful tool for characterising subtle brain change in SVD that has a negative impact on cognition and remains a significant predictor of cognitive change when other MRI markers of brain change are accounted for. DSEG provides an automatic segmentation of the whole cerebrum that is sensitive to a range of SVD related structural changes and successfully predicts cognitive change. Power analysis shows DSEG θ has potential as a monitoring tool in clinical trials. As such it may provide a marker of SVD severity from a single imaging modality (i.e. DTIs).
Collapse
Affiliation(s)
- Owen A. Williams
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Eva A. Zeestraten
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital Campus, Imperial College NHS Trust, London, UK
| | - Christian Lambert
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Andrew J. Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Andrew D. Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hugh S. Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
102
|
Using DTI to assess white matter microstructure in cerebral small vessel disease (SVD) in multicentre studies. Clin Sci (Lond) 2017; 131:1361-1373. [PMID: 28487471 PMCID: PMC5461938 DOI: 10.1042/cs20170146] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 12/22/2022]
Abstract
Diffusion tensor imaging (DTI) metrics such as fractional anisotropy (FA) and mean diffusivity (MD) have been proposed as clinical trial markers of cerebral small vessel disease (SVD) due to their associations with outcomes such as cognition. However, studies investigating this have been predominantly single-centre. As clinical trials are likely to be multisite, further studies are required to determine whether associations with cognition of similar strengths can be detected in a multicentre setting. One hundred and nine patients (mean age =68 years) with symptomatic lacunar infarction and confluent white matter hyperintensities (WMH) on MRI was recruited across six sites as part of the PRESERVE DTI substudy. After handling missing data, 3T-MRI scanning was available from five sites on five scanner models (Siemens and Philips), alongside neuropsychological and quality of life (QoL) assessments. FA median and MD peak height were extracted from DTI histogram analysis. Multiple linear regressions were performed, including normalized brain volume, WMH lesion load, and n° lacunes as covariates, to investigate the association of FA and MD with cognition and QoL. DTI metrics from all white matter were significantly associated with global cognition (standardized β =0.268), mental flexibility (β =0.306), verbal fluency (β =0.376), and Montreal Cognitive Assessment (MoCA) (β =0.273). The magnitudes of these associations were comparable with those previously reported from single-centre studies found in a systematic literature review. In this multicentre study, we confirmed associations between DTI parameters and cognition, which were similar in strength to those found in previous single-centre studies. The present study supports the use of DTI metrics as biomarkers of disease progression in multicentre studies.
Collapse
|
103
|
Apathy, but not depression, is associated with executive dysfunction in cerebral small vessel disease. PLoS One 2017; 12:e0176943. [PMID: 28493898 PMCID: PMC5426624 DOI: 10.1371/journal.pone.0176943] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/19/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the prevalence of apathy and depression in cerebral small vessel disease (SVD), and the relationships between both apathy and depression with cognition. To examine whether apathy is specifically related to impairment in executive functioning and processing speed. Methods 196 patients with a clinical lacunar stroke and an anatomically corresponding lacunar infarct on MRI were compared to 300 stroke-free controls. Apathy and depression were measured using the Geriatric Depression Scale, and cognitive functioning was assessed using an SVD cognitive screening tool, the Brief Memory and Executive Test, which measures executive functioning/processing speed and memory/orientation. Path analysis and binary logistic regression were used to assess the relation between apathy, depression and cognitive impairment. Results 31 participants with SVD (15.8%) met criteria for apathy only, 23 (11.8%) for both apathy and depression, and 2 (1.0%) for depression only. In the SVD group the presence of apathy was related to global cognition, and specifically to impaired executive functioning/processing speed, but not memory/orientation. The presence of depression was not related to global cognition, impaired executive functioning/processing speed or memory/orientation. Conclusions Apathy is a common feature of SVD and is associated with impaired executive functioning/processing speed suggesting the two may share biological mechanisms. Screening for apathy should be considered in SVD, and further work is required to develop and evaluate effective apathy treatment or management in SVD.
Collapse
|
104
|
Dichgans M, Leys D. Vascular Cognitive Impairment. Circ Res 2017; 120:573-591. [PMID: 28154105 DOI: 10.1161/circresaha.116.308426] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/28/2016] [Accepted: 08/29/2016] [Indexed: 01/10/2023]
Abstract
Cerebrovascular disease typically manifests with stroke, cognitive impairment, or both. Vascular cognitive impairment refers to all forms of cognitive disorder associated with cerebrovascular disease, regardless of the specific mechanisms involved. It encompasses the full range of cognitive deficits from mild cognitive impairment to dementia. In principle, any of the multiple causes of clinical stroke can cause vascular cognitive impairment. Recent work further highlights a role of microinfarcts, microhemorrhages, strategic white matter tracts, loss of microstructural tissue integrity, and secondary neurodegeneration. Vascular brain injury results in loss of structural and functional connectivity and, hence, compromise of functional networks within the brain. Vascular cognitive impairment is common both after stroke and in stroke-free individuals presenting to dementia clinics, and vascular pathology frequently coexists with neurodegenerative pathology, resulting in mixed forms of mild cognitive impairment or dementia. Vascular dementia is now recognized as the second most common form of dementia after Alzheimer's disease, and there is increasing awareness that targeting vascular risk may help to prevent dementia, even of the Alzheimer type. Recent advances in neuroimaging, neuropathology, epidemiology, and genetics have led to a deeper understanding of how vascular disease affects cognition. These new findings provide an opportunity for the present reappraisal of vascular cognitive impairment. We further briefly address current therapeutic concepts.
Collapse
Affiliation(s)
- Martin Dichgans
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.).
| | - Didier Leys
- From the Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Munich, Germany (M.D.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (M.D.); Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.); and University of Lille, INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, F-59000 Lille, France (D.L.)
| |
Collapse
|
105
|
Abstract
Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.
Collapse
Affiliation(s)
- Helena C Chui
- Department of Neurology, University of Southern California, 1540 Alcazar Street, CHP215, Los Angeles, CA 90033, USA.
| | - Liliana Ramirez Gomez
- Department of Neurology, University of California San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA
| |
Collapse
|
106
|
Cognitive Impairment in Chronic Kidney Disease: Vascular Milieu and the Potential Therapeutic Role of Exercise. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2726369. [PMID: 28503567 PMCID: PMC5414492 DOI: 10.1155/2017/2726369] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease (CKD) is considered a model of accelerated aging. More specifically, CKD leads to reduced physical functioning and increased frailty, increased vascular dysfunction, vascular calcification and arterial stiffness, high levels of systemic inflammation, and oxidative stress, as well as increased cognitive impairment. Increasing evidence suggests that the cognitive impairment associated with CKD may be related to cerebral small vessel disease and overall impairment in white matter integrity. The triad of poor physical function, vascular dysfunction, and cognitive impairment places patients living with CKD at an increased risk for loss of independence, poor health-related quality of life, morbidity, and mortality. The purpose of this review is to discuss the available evidence of cerebrovascular-renal axis and its interconnection with early and accelerated cognitive impairment in patients with CKD and the plausible role of exercise as a therapeutic modality. Understanding the cerebrovascular-renal axis pathophysiological link and its interconnection with physical function is important for clinicians in order to minimize the risk of loss of independence and improve quality of life in patients with CKD.
Collapse
|
107
|
Seiler S, Pirpamer L, Gesierich B, Hofer E, Duering M, Pinter D, Jouvent E, Fazekas F, Mangin JF, Chabriat H, Ropele S, Schmidt R. Lower Magnetization Transfer Ratio in the Forceps Minor Is Associated with Poorer Gait Velocity in Older Adults. AJNR Am J Neuroradiol 2017; 38:500-506. [PMID: 27979793 DOI: 10.3174/ajnr.a5036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 10/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gait disturbances in the elderly are disabling and a major public health issue but are poorly understood. In this multimodal MR imaging study, we used 2 voxel-based analysis methods to assess the voxelwise relationship of magnetization transfer ratio and white matter hyperintensity location with gait velocity in older adults. MATERIALS AND METHODS We assessed 230 community-dwelling participants of the Austrian Stroke Prevention Family Study. Every participant underwent 3T MR imaging, including magnetization transfer imaging. Voxel-based magnetization transfer ratio-symptom mapping correlated the white matter magnetization transfer ratio of each voxel with gait velocity. To assess a possible relationship between white matter hyperintensity location and gait velocity, we applied voxel-based lesion-symptom mapping. RESULTS We found a significant association between the magnetization transfer ratio within the forceps minor and gait velocity (β = 0.134; 95% CI, 0.011-0.258; P = .033), independent of demographics, general physical performance, vascular risk factors, and brain volume. White matter hyperintensities did not significantly change this association. CONCLUSIONS Our study provides new evidence for the importance of magnetization transfer ratio changes in gait disturbances at an older age, particularly in the forceps minor. The histopathologic basis of these findings is yet to be determined.
Collapse
Affiliation(s)
- S Seiler
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - L Pirpamer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - B Gesierich
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - E Hofer
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
- Institute of Medical Informatics, Statistics and Documentation (E.H.), Medical University of Graz, Graz, Austria
| | - M Duering
- Institute for Stroke and Dementia Research (B.G., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - D Pinter
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - E Jouvent
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - F Fazekas
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - J-F Mangin
- Neurospin (J.-F.M.), Commissariat à l'Energie Atomique et aux Energies Alternatives Saclay, Gif/Yvette, France
| | - H Chabriat
- Department of Neurology (E.J., H.C.), Institut National de la Santé et de la Recherche Médicale, UMR-740, Centre Hospitalo-Universitaire Lariboisière, Paris, France
| | - S Ropele
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| | - R Schmidt
- From the Department of Neurology (S.S., L.P., E.H., D.P., F.F., S.R., R.S.)
| |
Collapse
|
108
|
Zhang CE, Wong SM, Uiterwijk R, Staals J, Backes WH, Hoff EI, Schreuder T, Jeukens CRLPN, Jansen JFA, van Oostenbrugge RJ. Intravoxel Incoherent Motion Imaging in Small Vessel Disease: Microstructural Integrity and Microvascular Perfusion Related to Cognition. Stroke 2017; 48:658-663. [PMID: 28196940 DOI: 10.1161/strokeaha.116.015084] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/22/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) is associated with cognitive impairment. This may be because of decreased microstructural integrity and microvascular perfusion, but data on these relationships are scarce. We determined the relationship between cognition and microvascular perfusion and microstructural integrity in SVD patients, using intravoxel incoherent motion imaging-a diffusion-weighted magnetic resonance imaging technique designed to determine microvascular perfusion and microstructural integrity simultaneously. METHODS Seventy-three patients with SVD and 39 controls underwent intravoxel incoherent motion imaging and neuropsychological assessment. Parenchymal diffusivity D (a surrogate measure of microstructural integrity) and perfusion-related measure fD* were calculated for the normal appearing white matter, white matter hyperintensities, and cortical gray matter. The associations between cognitive performance and D and fD* were determined. RESULTS In SVD patients, multivariable analysis showed that lower fD* in the normal appearing white matter and cortical gray matter was associated with lower overall cognition (P=0.03 and P=0.002, respectively), lower executive function (P=0.04 and P=0.01, respectively), and lower information-processing speed (P=0.04 and P=0.01, respectively). D was not associated with cognitive function. In controls, no association was found between D, fD*, and cognition. CONCLUSIONS In SVD patients, lower cognitive performance is associated with lower microvascular perfusion in the normal appearing white matter and cortical gray matter. Our results support recent findings that both cortical gray matter and normal appearing white matter perfusion may play a role in the pathophysiology of cognitive dysfunction in SVD. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR3786.
Collapse
Affiliation(s)
- C Eleana Zhang
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.).
| | - Sau May Wong
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Renske Uiterwijk
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Julie Staals
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Walter H Backes
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Erik I Hoff
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Tobien Schreuder
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Cécile R L P N Jeukens
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Jacobus F A Jansen
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| | - Robert J van Oostenbrugge
- From the Department of Neurology, Maastricht University Medical Centre, The Netherlands (C.E.Z., R.U., J.S., R.J.v.O.); Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, The Netherlands (S.M.W., W.H.B., C.R.L.P.N.J., J.F.A.J.); Cardiovascular Research Institute Maastricht (CARIM), The Netherlands (C.E.Z., J.S., R.J.v.O.); School for Mental Health and Neuroscience (MHeNs), The Netherlands (C.E.Z., S.M.W., R.U., W.H.B., J.F.A.J., R.J.v.O.); and Department of Neurology, Zuyderland Medical Centre Heerlen, The Netherlands (E.I.H., T.S.)
| |
Collapse
|
109
|
Diciotti S, Orsolini S, Salvadori E, Giorgio A, Toschi N, Ciulli S, Ginestroni A, Poggesi A, De Stefano N, Pantoni L, Inzitari D, Mascalchi M. Resting state fMRI regional homogeneity correlates with cognition measures in subcortical vascular cognitive impairment. J Neurol Sci 2017; 373:1-6. [DOI: 10.1016/j.jns.2016.12.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/19/2016] [Accepted: 12/02/2016] [Indexed: 02/03/2023]
|
110
|
Moonen JEF, Foster-Dingley JC, van den Berg-Huijsmans AA, de Ruijter W, de Craen AJM, van der Grond J, van der Mast RC. Influence of Small Vessel Disease and Microstructural Integrity on Neurocognitive Functioning in Older Individuals: The DANTE Study Leiden. AJNR Am J Neuroradiol 2017; 38:25-30. [PMID: 27659190 DOI: 10.3174/ajnr.a4934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/20/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Small vessel disease is a major cause of neurocognitive dysfunction in the elderly. Small vessel disease may manifest as white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and atrophy, all of which are visible on conventional MR imaging or as microstructural changes determined by diffusion tensor imaging. This study investigated whether microstructural integrity is associated with neurocognitive dysfunction in older individuals, irrespective of the conventional features of small vessel disease. MATERIALS AND METHODS The study included 195 participants (75 years of age or older) who underwent conventional 3T MR imaging with DTI to assess fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. Cognitive tests were administered to assess cognitive domains, and the Geriatric Depression Scale-15 and Apathy Scale of Starkstein were used to assess symptoms of depression and apathy, respectively. The association between DTI measures and neurocognitive function was analyzed by using linear regression models. RESULTS In gray matter, a lower fractional anisotropy and higher mean diffusivity, axial diffusivity, and radial diffusivity were associated with worse executive function, psychomotor speed, and overall cognition and, in white matter, also with memory. Findings were independent of white matter hyperintensities, lacunar infarcts, and cerebral microbleeds. However, after additional adjustment for normalized brain volume, only lower fractional anisotropy in white and gray matter and higher gray matter radial diffusivity remained associated with executive functioning. DTI measures were not associated with scores on the Geriatric Depression Scale-15 or the Apathy Scale of Starkstein. CONCLUSIONS Microstructural integrity was associated with cognitive but not psychological dysfunction. Associations were independent of the conventional features of small vessel disease but attenuated after adjusting for brain volume.
Collapse
Affiliation(s)
- J E F Moonen
- From the Departments of Psychiatry (J.E.F.M., J.C.F.-D., R.C.v.d.M.)
| | | | | | | | - A J M de Craen
- Gerontology and Geriatrics (A.J.M.d.C.), Leiden University Medical Center, Leiden, the Netherlands
| | | | - R C van der Mast
- From the Departments of Psychiatry (J.E.F.M., J.C.F.-D., R.C.v.d.M.)
- Department of Psychiatry (R.C.v.d.M.), Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
111
|
Jung NY, Han CE, Kim HJ, Yoo SW, Kim HJ, Kim EJ, Na DL, Lockhart SN, Jagust WJ, Seong JK, Seo SW. Tract-Specific Correlates of Neuropsychological Deficits in Patients with Subcortical Vascular Cognitive Impairment. J Alzheimers Dis 2016; 50:1125-35. [PMID: 26836179 DOI: 10.3233/jad-150841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The white matter tract-specific correlates of neuropsychological deficits are not fully established in patients with subcortical vascular cognitive impairment (SVCI), where white matter tract damage may be a critical factor in cognitive impairment. The purpose of this study is to investigate the tract-specific correlates of neuropsychological deficits in SVCI patients using tract-specific statistical analysis (TSSA). We prospectively recruited 114 SVCI patients, and 55 age-, gender-, and education-matched individuals with normal cognition (NC). All participants underwent diffusion weighted imaging and neuropsychological testing. We classified tractography results into fourteen major fiber tracts and analyzed group comparison and correlation with cognitive impairments. Relative to NC subjects, SVCI patients showed decreased fractional anisotropy values in bilateral anterior-thalamic radiation, cingulum, superior-longitudinal fasciculus, uncinate fasciculus, corticospinal tract, and left inferior-longitudinal fasciculus. Focal disruptions in specific tracts were associated with specific cognitive impairments. Our findings suggest that disconnection of specific white matter tracts, especially those neighboring and providing connections between gray matter regions important to certain cognitive functions, may contribute to specific cognitive impairments in SVCI.
Collapse
Affiliation(s)
- Na-Yeon Jung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Cheol E Han
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.,Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Wook Yoo
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.,Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea
| | - Hee-Jong Kim
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.,Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Samuel N Lockhart
- Helen Wills Neuroscience Institute, University of California, Berkeley, USA.,Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, USA.,Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Joon-Kyung Seong
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea.,Department of Bio-convergence Engineering, Korea University, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| |
Collapse
|
112
|
Tuladhar AM, Lawrence A, Norris DG, Barrick TR, Markus HS, de Leeuw F. Disruption of rich club organisation in cerebral small vessel disease. Hum Brain Mapp 2016; 38:1751-1766. [PMID: 27935154 PMCID: PMC6866838 DOI: 10.1002/hbm.23479] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 11/07/2022] Open
Abstract
Cerebral small vessel disease (SVD) is an important cause of vascular cognitive impairment. Recent studies have demonstrated that structural connectivity of brain networks in SVD is disrupted. However, little is known about the extent and location of the reduced connectivity in SVD. Here they investigate the rich club organisation-a set of highly connected and interconnected regions-and investigate whether there is preferential rich club disruption in SVD. Diffusion tensor imaging (DTI) and cognitive assessment were performed in a discovery sample of SVD patients (n = 115) and healthy control subjects (n = 50). Results were replicated in an independent dataset (49 SVD with confluent WMH cases and 108 SVD controls) with SVD patients having a similar SVD phenotype to that of the discovery cases. Rich club organisation was examined in structural networks derived from DTI followed by deterministic tractography. Structural networks in SVD patients were less dense with lower network strength and efficiency. Reduced connectivity was found in SVD, which was preferentially located in the connectivity between the rich club nodes rather than in the feeder and peripheral connections, a finding confirmed in both datasets. In discovery dataset, lower rich club connectivity was associated with lower scores on psychomotor speed (β = 0.29, P < 0.001) and executive functions (β = 0.20, P = 0.009). These results suggest that SVD is characterized by abnormal connectivity between rich club hubs in SVD and provide evidence that abnormal rich club organisation might contribute to the development of cognitive impairment in SVD. Hum Brain Mapp 38:1751-1766, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Anil M. Tuladhar
- Department of NeurologyRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- Centre for Cognitive NeuroimagingRadboud University, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Andrew Lawrence
- Department of Clinical Neurosciences, Neurology UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - David. G. Norris
- Centre for Cognitive NeuroimagingRadboud University, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg‐EssenArendahls Wiese 199, Tor 3EssenD‐45141Germany
- MIRA Institute for Biomedical Technology and Technical Medicine, University of TwenteEnschedeThe Netherlands
| | - Thomas R. Barrick
- St. George's University of London, Neuroscience Research Centre, Cardiovascular and Cell Sciences Research InstituteLondonUnited Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, Neurology UnitUniversity of CambridgeCambridgeUnited Kingdom
| | - Frank‐Erik de Leeuw
- Department of NeurologyRadboud University Medical Center, Donders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| |
Collapse
|
113
|
Fernández-Cabello S, Valls-Pedret C, Schurz M, Vidal-Piñeiro D, Sala-Llonch R, Bargallo N, Ros E, Bartrés-Faz D. White matter hyperintensities and cognitive reserve during a working memory task: a functional magnetic resonance imaging study in cognitively normal older adults. Neurobiol Aging 2016; 48:23-33. [DOI: 10.1016/j.neurobiolaging.2016.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/08/2016] [Accepted: 08/09/2016] [Indexed: 01/16/2023]
|
114
|
Wu Y, Sun D, Wang Y, Wang Y, Ou S. Segmentation of the Cingulum Bundle in the Human Brain: A New Perspective Based on DSI Tractography and Fiber Dissection Study. Front Neuroanat 2016; 10:84. [PMID: 27656132 PMCID: PMC5013069 DOI: 10.3389/fnana.2016.00084] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/17/2016] [Indexed: 11/24/2022] Open
Abstract
The cingulum bundle (CB) is a critical white matter fiber tract in the brain, which forms connections between the frontal lobe, parietal lobe and temporal lobe. In non-human primates, the CB is actually divided into distinct subcomponents on the basis of corticocortical connections. However, at present, no study has verified similar distinct subdivisions in the human brain. In this study, we reconstructed these distinct subdivisions in the human brain, and determined their exact cortical connections using high definition fiber tracking (HDFT) technique on 10 healthy adults and a 488-subject template from the Human Connectome Project (HCP-488). Fiber dissections were performed to verify tractography results. Five CB segments were identified. CB-I ran from the subrostral areas to the precuneus and splenium, encircling the corpus callosum (CC). CB-II arched around the splenium and extended anteriorly above the CC to the medial aspect of the superior frontal gyrus (SFG). CB-III connected the superior parietal lobule (SPL) and precuneus with the medial aspect of the SFG. CB-IV was a relatively minor subcomponent from the SPL and precuneus to the frontal region. CB-V, the para-hippocampal cingulum, stemmed from the medial temporal lobe and fanned out to the occipital lobes. Our findings not only provide a more accurate and detailed description on the associated architecture of the subcomponents within the CB, but also offer new insights into the functional role of the CB in the human brain.
Collapse
Affiliation(s)
- Yupeng Wu
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University Shenyang, China
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University Shenyang, China
| | - Yong Wang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University Shenyang, China
| | - Yibao Wang
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University Shenyang, China
| | - Shaowu Ou
- Department of Neurosurgery, The First Affiliated Hospital of China Medical University Shenyang, China
| |
Collapse
|
115
|
Reginold W, Itorralba J, Luedke AC, Fernandez-Ruiz J, Reginold J, Islam O, Garcia A. Tractography at 3T MRI of Corpus Callosum Tracts Crossing White Matter Hyperintensities. AJNR Am J Neuroradiol 2016; 37:1617-22. [PMID: 27127001 DOI: 10.3174/ajnr.a4788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/16/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The impact of white matter hyperintensities on the diffusion characteristics of crossing tracts is unclear. This study used quantitative tractography at 3T MR imaging to compare, in the same individuals, the diffusion characteristics of corpus callosum tracts that crossed white matter hyperintensities with the diffusion characteristics of corpus callosum tracts that did not pass through white matter hyperintensities. MATERIALS AND METHODS Brain T2 fluid-attenuated inversion recovery-weighted and diffusion tensor 3T MR imaging scans were acquired in 24 individuals with white matter hyperintensities. Tractography data were generated by the Fiber Assignment by Continuous Tracking method. White matter hyperintensities and corpus callosum tracts were manually segmented. In the corpus callosum, the fractional anisotropy, radial diffusivity, and mean diffusivity of tracts crossing white matter hyperintensities were compared with the fractional anisotropy, radial diffusivity, and mean diffusivity of tracts that did not cross white matter hyperintensities. The cingulum, long association fibers, corticospinal/bulbar tracts, and thalamic projection fibers were included for comparison. RESULTS Within the corpus callosum, tracts that crossed white matter hyperintensities had decreased fractional anisotropy compared with tracts that did not pass through white matter hyperintensities (P = .002). Within the cingulum, tracts that crossed white matter hyperintensities had increased radial diffusivity compared with tracts that did not pass through white matter hyperintensities (P = .001). CONCLUSIONS In the corpus callosum and cingulum, tracts had worse diffusion characteristics when they crossed white matter hyperintensities. These results support a role for white matter hyperintensities in the disruption of crossing tracts.
Collapse
Affiliation(s)
- W Reginold
- From the Departments of Medical Imaging (W.R.) Memory Clinics (W.R., A.G.), Division of Geriatric Medicine, Department of Medicine
| | - J Itorralba
- Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
| | - A C Luedke
- Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
| | - J Fernandez-Ruiz
- Facultad de Medicina, (J.F.-R.), Universidad Nacional Autonoma de Mexico, Coyoacán, Mexico
| | - J Reginold
- Life Sciences (J.R.), University of Toronto, Toronto, Ontario, Canada
| | - O Islam
- Department of Diagnostic Radiology (O.I.), Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - A Garcia
- Memory Clinics (W.R., A.G.), Division of Geriatric Medicine, Department of Medicine Centre for Neuroscience Studies (J.I., A.G., A.C.L.), Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
116
|
Baykara E, Gesierich B, Adam R, Tuladhar AM, Biesbroek JM, Koek HL, Ropele S, Jouvent E, Chabriat H, Ertl-Wagner B, Ewers M, Schmidt R, de Leeuw FE, Biessels GJ, Dichgans M, Duering M. A Novel Imaging Marker for Small Vessel Disease Based on Skeletonization of White Matter Tracts and Diffusion Histograms. Ann Neurol 2016; 80:581-92. [PMID: 27518166 DOI: 10.1002/ana.24758] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To establish a fully automated, robust imaging marker for cerebral small vessel disease (SVD) and related cognitive impairment that is easy to implement, reflects disease burden, and is strongly associated with processing speed, the predominantly affected cognitive domain in SVD. METHODS We developed a novel magnetic resonance imaging marker based on diffusion tensor imaging, skeletonization of white matter tracts, and histogram analysis. The marker (peak width of skeletonized mean diffusivity [PSMD]) was assessed along with conventional SVD imaging markers. We first evaluated associations with processing speed in patients with genetically defined SVD (n = 113). Next, we validated our findings in independent samples of inherited SVD (n = 57), sporadic SVD (n = 444), and memory clinic patients with SVD (n = 105). The new marker was further applied to healthy controls (n = 241) and to patients with Alzheimer's disease (n = 153). We further conducted a longitudinal analysis and interscanner reproducibility study. RESULTS PSMD was associated with processing speed in all study samples with SVD (p-values between 2.8 × 10(-3) and 1.8 × 10(-10) ). PSMD explained most of the variance in processing speed (R(2) ranging from 8.8% to 46%) and consistently outperformed conventional imaging markers (white matter hyperintensity volume, lacune volume, and brain volume) in multiple regression analyses. Increases in PSMD were linked to vascular but not to neurodegenerative disease. In longitudinal analysis, PSMD captured SVD progression better than other imaging markers. INTERPRETATION PSMD is a new, fully automated, and robust imaging marker for SVD. PSMD can easily be applied to large samples and may be of great utility for both research studies and clinical use. Ann Neurol 2016;80:581-592.
Collapse
Affiliation(s)
- Ebru Baykara
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Benno Gesierich
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Ruth Adam
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Anil Man Tuladhar
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Department of Neurology, Nijmegen, the Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Huiberdina L Koek
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Eric Jouvent
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 National Institute for Health and Medical Research (INSERM), Paris, France.,Departement Hospitalo-Universitaire NeuroVasc Sorbonne Paris Cité, Paris, France.,Department of Neurology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Hugues Chabriat
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 National Institute for Health and Medical Research (INSERM), Paris, France.,Departement Hospitalo-Universitaire NeuroVasc Sorbonne Paris Cité, Paris, France.,Department of Neurology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Michael Ewers
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behavior, Department of Neurology, Nijmegen, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany.
| |
Collapse
|
117
|
Ciulli S, Citi L, Salvadori E, Valenti R, Poggesi A, Inzitari D, Mascalchi M, Toschi N, Pantoni L, Diciotti S. Prediction of Impaired Performance in Trail Making Test in MCI Patients With Small Vessel Disease Using DTI Data. IEEE J Biomed Health Inform 2016; 20:1026-33. [DOI: 10.1109/jbhi.2016.2537808] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
118
|
Mascalchi M, Pantoni L, Giannelli M, Valenti R, Bianchi A, Pracucci G, Orsolini S, Ciulli S, Tessa C, Poggesi A, Pescini F, Inzitari D, Diciotti S. Diffusion Tensor Imaging to Map Brain Microstructural Changes in CADASIL. J Neuroimaging 2016; 27:85-91. [PMID: 27357066 DOI: 10.1111/jon.12374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/19/2016] [Accepted: 05/31/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Diffusion tensor imaging (DTI) is sensitive to brain microstructural changes. The aims of this DTI study were to map voxelwise the spatial distribution of brain microstructural changes in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and to investigate any correlation between DTI-derived indices and extension of T2 hyperintensity. METHODS Eighteen patients with CADASIL and 18 age-, sex-, and education-level-matched healthy controls underwent magnetic resonance imaging at 3 T. Differences in DTI-derived indices (mean diffusivity [MD], fractional anisotropy [FA], axial [AD] and radial [RD] diffusivities, and mode of anisotropy [MO]) of brain white matter (WM) between CADASIL patients and healthy subjects were assessed through tract-based spatial statistics. Then, DTI-derived indices were correlated with the patient's score on the extended Fazekas visual scale of the T2 hyperintensity. RESULTS When compared to healthy controls, CADASIL patients showed extensive symmetric areas of increased MD/RD and decreased AD/FA/MO that involved almost the entire hemispheric cerebral WM (internal and external capsule, WM of the temporal poles, superior and inferior longitudinal fasciculus, inferior frontal-occipital fasciculus, uncinate fasciculus, cingulum, forceps major and minor, corticospinal tracts, and thalamic radiations), thalami, and corpus callosum. Additional areas of increased RD were observed in pons, midbrain, cerebellar peduncles, and cerebellar WM. Only FA was negatively correlated with extended Fazekas visual score. CONCLUSIONS Our results indicate that brain damage in CADASIL is associated with extensive microstructural changes implying impairment of intra- and inter-hemispheric cerebral, thalamocortical, and cerebrocerebellar connections. Severity of microstructural changes correlates with extension of T2 hyperintensity.
Collapse
Affiliation(s)
- Mario Mascalchi
- Neuroradiology Unit A. Meyer Children Hospital of Florence, Italy.,Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy
| | - Leonardo Pantoni
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Raffaella Valenti
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Andrea Bianchi
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy
| | - Giovanni Pracucci
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Stefano Orsolini
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Stefano Ciulli
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Italy.,Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,School of Computer Science and Electronic Engineering, University of Essex, Colchester, UK
| | - Carlo Tessa
- Unit of Radiology, Versilia Hospital, Azienda USL 12 Viareggio, Lido di Camaiore (Lu), Italy
| | - Anna Poggesi
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Inzitari
- Department NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| |
Collapse
|
119
|
Gorelick PB, Counts SE, Nyenhuis D. Vascular cognitive impairment and dementia. BIOCHIMICA ET BIOPHYSICA ACTA 2016; 1862:860-8. [PMID: 26704177 PMCID: PMC5232167 DOI: 10.1016/j.bbadis.2015.12.015] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/12/2015] [Accepted: 12/14/2015] [Indexed: 01/11/2023]
Abstract
Vascular contributions to cognitive impairment are receiving heightened attention as potentially modifiable factors for dementias of later life. These factors have now been linked not only to vascular cognitive disorders but also Alzheimer's disease. In this chapter we review 3 related topics that address vascular contributions to cognitive impairment: 1. vascular pathogenesis and mechanisms; 2. neuropsychological and neuroimaging phenotypic manifestations of cerebrovascular disease; and 3. prospects for prevention of cognitive impairment of later life based on cardiovascular and stroke risk modification. 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.
Collapse
Affiliation(s)
- Philip B Gorelick
- Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, Mercy Health Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA.
| | - Scott E Counts
- Translational Science & Molecular Medicine and Family Medicine, Michigan State University College of Human Medicine, Mercy Health Hauenstein Neurosciences, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
| | - David Nyenhuis
- Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, Neuropsychology Program, Mercy Health Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
| |
Collapse
|
120
|
Pasi M, van Uden IWM, Tuladhar AM, de Leeuw FE, Pantoni L. White Matter Microstructural Damage on Diffusion Tensor Imaging in Cerebral Small Vessel Disease: Clinical Consequences. Stroke 2016; 47:1679-84. [PMID: 27103015 DOI: 10.1161/strokeaha.115.012065] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marco Pasi
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Inge W M van Uden
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Anil M Tuladhar
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Frank-Erik de Leeuw
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.)
| | - Leonardo Pantoni
- From the NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy (M.P., L.P.); and Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands (I.W.M.v.U., A.M.T., F.-E.d.L.).
| |
Collapse
|
121
|
Smith CD, Johnson ES, Van Eldik LJ, Jicha GA, Schmitt FA, Nelson PT, Kryscio RJ, Murphy RR, Wellnitz CV. Peripheral (deep) but not periventricular MRI white matter hyperintensities are increased in clinical vascular dementia compared to Alzheimer's disease. Brain Behav 2016; 6:e00438. [PMID: 26925303 PMCID: PMC4754499 DOI: 10.1002/brb3.438] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Vascular dementia (VAD) is a complex diagnosis at times difficult to distinguish from Alzheimer's disease (AD). MRI scans often show white matter hyperintensities (WMH) in both conditions. WMH increase with age, and both VAD and AD are associated with aging, thus presenting an attribution conundrum. In this study, we sought to show whether the amount of WMH in deep white matter (dWMH), versus periventricular white matter (PVH), would aid in the distinction between VAD and AD, independent of age. METHODS Blinded semiquantitative ratings of WMH validated by objective quantitation of WMH volume from standardized MRI image acquisitions. PVH and dWMH were rated separately and independently by two different examiners using the Scheltens scale. Receiver operator characteristic (ROC) curves were generated using logistic regression to assess classification of VAD (13 patients) versus AD (129 patients). Clinical diagnoses were made in a specialty memory disorders clinic. RESULTS Using PVH rating alone, overall classification (area under the ROC curve, AUC) was 75%, due only to the difference in age between VAD and AD patients in our study and not PVH. In contrast, dWMH rating produced 86% classification accuracy with no independent contribution from age. A global Longstreth rating that combines dWMH and PVH gave an 88% AUC. CONCLUSIONS Increased dWMH indicate a higher likelihood of VAD versus AD. Assessment of dWMH on MRI scans using Scheltens and Longstreth scales may aid the clinician in distinguishing the two conditions.
Collapse
Affiliation(s)
- Charles D Smith
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Eleanor S Johnson
- Magnetic Resonance Imaging and Spectroscopy Center University of Kentucky Lexington Kentucky
| | - Linda J Van Eldik
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington Kentucky
| | - Gregory A Jicha
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Frederick A Schmitt
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | - Peter T Nelson
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Pathology & Laboratory Medicine University of Kentucky College of Medicine Lexington Kentucky
| | - Richard J Kryscio
- Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky; Department of Statistics University of Kentucky Lexington Kentucky
| | - Ronan R Murphy
- Department of Neurology University of Kentucky College of Medicine Lexington Kentucky; Alzheimers Disease Center Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky
| | | |
Collapse
|
122
|
Altered tract-specific white matter microstructure is related to poorer cognitive performance: The Rotterdam Study. Neurobiol Aging 2016; 39:108-17. [PMID: 26923407 DOI: 10.1016/j.neurobiolaging.2015.11.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/24/2015] [Accepted: 11/26/2015] [Indexed: 01/23/2023]
|
123
|
Banerjee G, Wilson D, Jäger HR, Werring DJ. Novel imaging techniques in cerebral small vessel diseases and vascular cognitive impairment. Biochim Biophys Acta Mol Basis Dis 2015; 1862:926-38. [PMID: 26687324 DOI: 10.1016/j.bbadis.2015.12.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
Dementia is a global growing concern, affecting over 35 million people with a global economic impact of over $604 billion US. With an ageing population the number of people affected is expected double over the next two decades. Vascular cognitive impairment can be caused by various types of cerebrovascular disease, including cortical and subcortical infarcts, and the more diffuse white matter injury due to cerebral small vessel disease. Although this type of cognitive impairment is usually considered the second most common form of dementia after Alzheimer's disease, there is increasing recognition of the vascular contribution to neurodegeneration, with both pathologies frequently coexisting. The aim of this review is to highlight the recent advances in the understanding of vascular cognitive impairment, with a focus on small vessel diseases of the brain. We discuss recently identified small vessel imaging markers that have been associated with cognitive impairment, namely cerebral microbleeds, enlarged perivascular spaces, cortical superficial siderosis, and microinfarcts. We will also consider quantitative techniques including diffusion tensor imaging, magnetic resonance perfusion imaging with arterial spin labelling, functional magnetic resonance imaging and positron emission tomography. As well as potentially shedding light on the mechanism by which cerebral small vessel diseases cause dementia, these novel imaging biomarkers are also of increasing relevance given their ability to guide diagnosis and reflect disease progression, which may in the future be useful for therapeutic interventions. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
Collapse
Affiliation(s)
- Gargi Banerjee
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| | - Hans R Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, 10-12 Russell Square, London WC1B 3EE, UK
| |
Collapse
|
124
|
van Uden I, van der Holst H, Schaapsmeerders P, Tuladhar A, van Norden A, de Laat K, Norris D, Claassen J, van Dijk E, Richard E, Kessels R, de Leeuw FE. Baseline white matter microstructural integrity is not related to cognitive decline after 5 years: The RUN DMC study. BBA CLINICAL 2015; 4:108-114. [PMID: 26676146 PMCID: PMC4661735 DOI: 10.1016/j.bbacli.2015.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/18/2015] [Accepted: 10/21/2015] [Indexed: 01/20/2023]
Affiliation(s)
- I.W.M. van Uden
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - H.M. van der Holst
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - P. Schaapsmeerders
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - A.M. Tuladhar
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | | | - K.F. de Laat
- HagaZiekenhuis Den Haag, Department of Neurology, The Netherlands
| | - D.G. Norris
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Arendahls Wiese 199, Tor 3, D-45141 Essen, Germany
| | - J.A.H.R. Claassen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
| | - E.J. van Dijk
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - E. Richard
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| | - R.P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - F.-E. de Leeuw
- Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, The Netherlands
| |
Collapse
|
125
|
Hollocks MJ, Lawrence AJ, Brookes RL, Barrick TR, Morris RG, Husain M, Markus HS. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain 2015; 138:3803-15. [PMID: 26490330 PMCID: PMC4655344 DOI: 10.1093/brain/awv304] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/26/2015] [Indexed: 01/30/2023] Open
Abstract
Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and apathy, depression and cognitive impairment; and (ii) if apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with apathy but not directly with depressive symptoms. These results suggest that apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
Collapse
Affiliation(s)
- Matthew J Hollocks
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew J Lawrence
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Rebecca L Brookes
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- 2 St. Georges, University of London, Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, London, UK
| | - Robin G Morris
- 3 King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Masud Husain
- 4 University of Oxford, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Hugh S Markus
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| |
Collapse
|
126
|
Tuladhar AM, van Dijk E, Zwiers MP, van Norden AGW, de Laat KF, Shumskaya E, Norris DG, de Leeuw FE. Structural network connectivity and cognition in cerebral small vessel disease. Hum Brain Mapp 2015; 37:300-10. [PMID: 26466741 DOI: 10.1002/hbm.23032] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/28/2015] [Accepted: 10/05/2015] [Indexed: 12/17/2022] Open
Abstract
Cerebral small vessel disease (SVD), including white matter hyperintensities (WMH), lacunes and microbleeds, and brain atrophy, are related to cognitive impairment. However, these magnetic resonance imaging (MRI) markers for SVD do not account for all the clinical variances observed in subjects with SVD. Here, we investigated the relation between conventional MRI markers for SVD, network efficiency and cognitive performance in 436 nondemented elderly with cerebral SVD. We computed a weighted structural connectivity network from the diffusion tensor imaging and deterministic streamlining. We found that SVD-severity (indicated by higher WMH load, number of lacunes and microbleeds, and lower total brain volume) was related to networks with lower density, connection strengths, and network efficiency, and to lower scores on cognitive performance. In multiple regressions models, network efficiency remained significantly associated with cognitive index and psychomotor speed, independent of MRI markers for SVD and mediated the associations between these markers and cognition. This study provides evidence that network (in)efficiency might drive the association between SVD and cognitive performance. This highlights the importance of network analysis in our understanding of SVD-related cognitive impairment in addition to conventional MRI markers for SVD and might provide an useful tool as disease marker.
Collapse
Affiliation(s)
- Anil M Tuladhar
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, the Netherlands.,Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Ewoud van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, the Netherlands
| | - Marcel P Zwiers
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Department of Psychiatry, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | | | | | - Elena Shumskaya
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany.,MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, the Netherlands
| |
Collapse
|