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DeCarli C. Clinically asymptomatic vascular brain injury: a potent cause of cognitive impairment among older individuals. J Alzheimers Dis 2013; 33 Suppl 1:S417-26. [PMID: 23034523 PMCID: PMC3786369 DOI: 10.3233/jad-2012-129004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cerebrovascular risk factors and stroke are highly prevalent with advancing age, and stroke may be more common than Alzheimer's disease, particularly among older men. While stroke mortality continues to decline, the prevalence of individuals with various vascular risk factors continues to rise and many are undiagnosed or undertreated. Asymptomatic cerebrovascular brain injury that includes asymptomatic brain infarction and white matter hyperintensities as well as accelerated brain atrophy is even more frequent than clinical stroke. Moreover, the impact of cerebrovascular risk factors on brain injury appears to begin in middle life and additively increases the likelihood of later life dementia. This review focuses on the use of neuroimaging and genetics to understand the impact of asymptomatic vascular risk factors on the trajectories of cognitive aging as well as incident cognitive impairment, stroke, and mortality. Results of this review emphasize the need for early detection and treatment of vascular risk factors to improve the cognitive health of our rapidly aging population.
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Affiliation(s)
- Charles DeCarli
- Alzheimer's Disease Center, Imaging of Dementia and Aging (IDeA) Laboratory, Department of Neurology and Center for Neuroscience, University of California at Davis, CA 95817, USA.
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202
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Yang FM, Grigorenko A, Tommet D, Farias S, Mungas D, Bennett DA, Jones RN, Crane PK. AD pathology and cerebral infarctions are associated with memory and executive functioning one and five years before death. J Clin Exp Neuropsychol 2012; 35:24-34. [PMID: 23205616 PMCID: PMC3605227 DOI: 10.1080/13803395.2012.740001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We provide rigorous psychometric evidence for distinct patterns of cognitive impairment for Alzheimer's disease (AD) and cerebral infarctions using 440 participants from the Religious Order Study. Latent variable models were used to decompose the effects of AD pathology and cerebral infarctions assessed at autopsy on overall cognition and specific neuropsychological tests at one and five years prior to death. Results support clinical and univariate psychometric analyses that memory impairment is more pronounced in AD, and executive impairment is more pronounced in the presence of cerebral infarctions. These specific effects are subtle relative to the stronger associations of both AD neuropathology and cerebral infarctions with overall levels of cognitive impairment.
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Affiliation(s)
- Frances M. Yang
- Harvard Medical School, Department of Medicine Beth Israel Deaconess Medical Center Institute for Aging Research, Hebrew SeniorLife 1200 Centre St. Boston, MA 02131 Author managed the literature searches, analyses, and each draft of the manuscript
| | - Alexander Grigorenko
- Harvard School of Public Health Institute for Aging Research, Hebrew SeniorLife () Author made contributions to the statistical analyses and significant edits to the manuscript
| | - Doug Tommet
- Institute for Aging Research, Hebrew SeniorLife () Author undertook the statistical analysis and made significant edits to the manuscript
| | - Sarah Farias
- University of California, Davis, Department of Neurology UC Davis Alzheimer's Center () Author conducted literature review and contributed to the clinical implications in the discussion section of the manuscript
| | - Dan Mungas
- University of California, Davis, Department of Neurology UC Davis Alzheimer's Center () Author made significant contributions regarding the clinical implications of the study and contributed in writing subsequent drafts of the manuscript
| | - David A. Bennett
- Rush University, Rush Alzheimer's Disease Center () Author designed the data set, contributed to the interpretation of the data, and made extensive edits to the manuscript
| | - Richard N. Jones
- Harvard Medical School, Department of Medicine Beth Israel Deaconess Medical Center Institute for Aging Research, Hebrew SeniorLife () Author undertook the statistical analysis and made important contributions to the analyses and drafts of the manuscript
| | - Paul K. Crane
- University of Washington, Department of Medicine () Author contributed to statistical analyses, writing subsequent drafts, and the final edits of the manuscript
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203
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Williamson JB, Lewis GF, Nyenhuis DL, Stebbins GT, Murphy C, Handelman M, Harden E, Heilman KM, Gorelick PB, Porges SW. The effects of cerebral white matter changes on cardiovascular responses to cognitive and physical activity in a stroke population. Psychophysiology 2012; 49:1618-28. [PMID: 23095094 PMCID: PMC11225105 DOI: 10.1111/j.1469-8986.2012.01467.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 07/02/2012] [Indexed: 12/31/2022]
Abstract
Autonomic nervous system (ANS) control may be disrupted by cerebrovascular disease. We investigated the relationship between alterations in white matter integrity and regulation of the ANS in 23 participants who sustained a stroke within 5 years. These participants underwent diffusion tensor imaging, and fractional anisotropy values were calculated (DTI-FA) for each hemisphere and lobe. Cognitive and physical exertion tasks were performed while recording an electrocardiogram. Respiratory sinus arrhythmia (RSA) decreased more during a verbal fluency task with lower left hemisphere DTI-FA. Further, the physical stressor yielded decreases in RSA with lower frontal DTI-FA and higher temporal lobe DTI-FA, p < .05 (perhaps a release effect on the central autonomic network). Decrements in ANS regulation may have functional consequences that alter behavior, as well as potentially increasing the risk for further vascular disease.
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Affiliation(s)
- J B Williamson
- Department of Neurology, University of Florida, Gainesville, FL 32610-0236, USA.
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Arterial spin labeling MRI: an emerging biomarker for Alzheimer's disease and other neurodegenerative conditions. Curr Opin Neurol 2012; 25:421-8. [PMID: 22610458 DOI: 10.1097/wco.0b013e328354ff0a] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The search for biomarkers that detect and track disease progression in early Alzheimer's disease has been a major pursuit for two decades. Functional measures reflecting alterations of synaptic activity associated with neuronal dysfunction have displayed promise for following disease course in early stages. Although fluorodeoxyglucose positron emission tomography (FDG PET) and blood oxygen level-dependent functional MRI (BOLD fMRI) have been studied extensively for this purpose, this review will discuss the emergence and potential role of arterial spin labeling (ASL) MRI, which measures cerebral blood flow (CBF), in neurodegeneration. RECENT FINDINGS Several recent studies have explored ASL MRI in early and prodromal Alzheimer's disease and have reported areas of hypoperfusion that overlap considerably with hypometabolism frequently reported with FDG PET. However, some studies have also noted increased regional CBF of patients with prodromal and early stage clinical Alzheimer's disease, which may have implications for pathophysiology and the role of compensatory responses to neurodegeneration. Additionally, a few recent studies have begun to use this modality to explore the role of cerebrovascular factors in cognitive decline and the relationship to Alzheimer's disease. SUMMARY ASL MRI is just beginning to be applied more widely to various neurodegenerative conditions. Initial data suggest that this methodology may provide similar information to FDG PET, but with several advantages in the ease of acquisition and expense. Additional applications of this modality, including task-related studies and testing of pharmacological effects, are underexplored, but are potentially of significant value in understanding disease-related functional changes and treatment effects.
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205
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Papma JM, den Heijer T, de Koning I, Mattace-Raso FU, van der Lugt A, van der Lijn F, van Swieten JC, Koudstaal PJ, Smits M, Prins ND. The influence of cerebral small vessel disease on default mode network deactivation in mild cognitive impairment. NEUROIMAGE-CLINICAL 2012; 2:33-42. [PMID: 24179756 PMCID: PMC3778258 DOI: 10.1016/j.nicl.2012.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 11/23/2022]
Abstract
Introduction Cerebral small vessel disease (CSVD) is thought to contribute to cognitive dysfunction in patients with mild cognitive impairment (MCI). The underlying mechanisms, and more specifically, the effects of CSVD on brain functioning in MCI are incompletely understood. The objective of the present study was to examine the effects of CSVD on brain functioning, activation and deactivation, in patients with MCI using task-related functional MRI (fMRI). Methods We included 16 MCI patients with CSVD, 26 MCI patients without CSVD and 25 controls. All participants underwent a physical and neurological examination, neuropsychological testing, structural MRI, and fMRI during a graded working memory paradigm. Results MCI patients with and without CSVD had a similar neuropsychological profile and task performance during fMRI, but differed with respect to underlying (de)activation patterns. MCI patients with CSVD showed impaired deactivation in the precuneus/posterior cingulate cortex, a region known to be involved in the default mode network. In MCI patients without CSVD, brain activation depended on working memory load, as they showed relative ‘hyperactivation’ during vigilance, and ‘hypoactivation’ at a high working memory load condition in working memory related brain regions. Conclusions We present evidence that the potential underlying mechanism of CSVD affecting cognition in MCI is through network interference. The observed differences in brain activation and deactivation between MCI patients with and without CSVD, who had a similar ‘clinical phenotype’, support the view that, in patients with MCI, different types of pathology can contribute to cognitive impairment through different pathways.
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Affiliation(s)
- Janne M Papma
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, The Netherlands ; Department of Radiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Wang S, Yuan J, Guo X, Peng P, Gu H, Niu S, Fregni F, Chen ACN, Hu W. Neurochemical correlates of cognitive dysfunction in patients with leukoaraiosis: a proton magnetic resonance spectroscopy study. Neurol Res 2012; 34:989-97. [PMID: 23146302 DOI: 10.1179/1743132812y.0000000104] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Leukoaraiosis (LA) is a common radiological finding in the elderly and may reflect cerebral small vessel disease (SVD). Although SVD has been identified as a major cause of vascular cognitive impairment or vascular dementia, the mechanisms for this association remain unclear. We therefore aimed to measure brain metabolites in LA using proton magnetic resonance spectroscopy ((1)H-MRS) as to determine the relationship between cognitive function and neurochemical white matter profile. METHODS We recruited 23 patients with LA and 23 age- and sex-matched healthy controls consecutively. Multi-voxel (1)H-MRS was performed with a volume of interest located in centrum semiovale that contained mainly white matter voxels. Three main ratios of N-acetyl aspartate (NAA)/Cr, choline (Cho)/Cr and NAA/Cho were obtained. Spearman rank correlation coefficients were calculated between the cognitive function and the measured metabolite ratios. RESULTS We found significantly lower levels of NAA/Cho and NAA/Cr ratios in lesioned white matter in patients with LA than healthy controls (P<0.05). The ratios of NAA/Cho and NAA/Cr in normal appearing white matter (NAWM) were higher than lesioned white matter and lower than controls, but this difference was not significant (P>0.05). There was a positive relationship between Mini-Mental State Examination (MMSE) and NAA/Cho in NAWM (r = 0.417, P = 0.048), and also a positive relationship between MMSE and NAA/Cr in lesioned white matter (r = 0.551, P = 0.006) in patients with LA. A positive relationship between the Z scores of the executive function and NAA/Cho in lesioned white matter (r = 0.557, P = 0.006) was also found. CONCLUSION The main finding of this study was a significant reduction in the ratios of NAA/Cr and NAA/Cho in lesioned white matter, which indicates a marker of neuronal loss or dysfunction in patients with LA, which was correlated with cognitive function. This relationship between cognitive function and metabolic changes suggests that (1)H-MRS can be explored as a marker for cognitive dysfunction in patients with LA.
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Affiliation(s)
- Shuangkun Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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207
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Olazarán J, Navarro E, Rojo JM. Alzheimer's disease with vascular component: a distinct clinical entity? Dement Geriatr Cogn Dis Extra 2012; 2:400-10. [PMID: 23139685 PMCID: PMC3493007 DOI: 10.1159/000342346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Longitudinal reports on the clinical features of patients with Alzheimer's disease (AD) and concomitant cerebrovascular disease are scarce. Methods We elaborated a working definition of AD with vascular component (ADVC), and this definition was retrospectively investigated in a cohort of patients with cognitive deterioration who were prescribed a cholinesterase inhibitor during usual practice. Results A total of 137 patients with probable AD and 66 patients with ADVC were studied during a mean follow-up period of 2.8 years. Univariate analyses demonstrated worse functional evolution and anticipation of psychotic symptoms and agitation in the ADVC group. Conclusions The present results are consistent with an additive model of predominantly frontal-subcortical vascular damage in AD.
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Affiliation(s)
- Javier Olazarán
- Hermanos Sangro Specialties Clinic, Service of Neurology, Gregorio Marañón University Hospital, Spain ; Alzheimer Disease Research Unit, CIEN Foundation, Carlos III Institute of Health, Alzheimer Center Reina Sofía Foundation, Spain
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208
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Petrovic IN, Stefanova E, Kozic D, Semnic R, Markovic V, Daragasevic NT, Kostic VS. White matter lesions and depression in patients with Parkinson's disease. J Neurol Sci 2012; 322:132-6. [DOI: 10.1016/j.jns.2012.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/01/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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Brain atrophy associations with white matter lesions in the ageing brain: the Lothian Birth Cohort 1936. Eur Radiol 2012; 23:1084-92. [PMID: 23114884 DOI: 10.1007/s00330-012-2677-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 09/04/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cerebral atrophy and white matter lesions (WMLs) are common in older people with common risk factors, but it is unclear if they are related. We investigated whether and to what degree they are related in deep and superficial structures using both volumetric and visual ratings. METHODS The intracranial, total brain tissue (TBV), cerebrospinal fluid (CSF), ventricular superficial subarachnoid space (SSS), grey matter, normal-appearing white matter, WMLs, and combined CSF, venous sinuses and dural volumes were measured. WMLs were also rated using the Fazekas scale. RESULTS Amongst 672 adults (mean age 73 ± 1 years), WMLs were associated with global brain atrophy (TBV, β = -0.43 mm(3), P < 0.01) and specifically with deep (ventricular enlargement, β = 0.10 mm(3), P = 0.03) rather than superficial (SSS, β = 0.09 mm(3), P = 0.55) atrophy. A 1 mm(3) increase in WML volume was associated with a 0.43 mm(3) decrease in TBV and 0.10 mm(3) increase in ventricular volume. WMLs were associated with combined CSF + Venous Sinuses + Meninges volumes, but not CSF volume alone. Some of the associations were attenuated after correcting for vascular risk factors. The associations were similar for visually scored WMLs. CONCLUSION WMLs are associated with brain atrophy, primarily with deep brain structures. Measures of brain atrophy should include all intracranial structures when assessing brain shrinkage.
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210
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Bolandzadeh N, Davis JC, Tam R, Handy TC, Liu-Ambrose T. The association between cognitive function and white matter lesion location in older adults: a systematic review. BMC Neurol 2012; 12:126. [PMID: 23110387 PMCID: PMC3522005 DOI: 10.1186/1471-2377-12-126] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
Abstract
Background Maintaining cognitive function is essential for healthy aging and to function autonomously within society. White matter lesions (WMLs) are associated with reduced cognitive function in older adults. However, whether their anatomical location moderates these associations is not well-established. This review systematically evaluates peer-reviewed evidence on the role of anatomical location in the association between WMLs and cognitive function. Methods In accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement, databases of EMBASE, PUBMED, MEDLINE, and CINAHL, and reference lists of selected papers were searched. We limited our search results to adults aged 60 years and older, and studies published in the English language from 2000 to 2011. Studies that investigated the association between cognitive function and WML location were included. Two independent reviewers extracted: 1) study characteristics including sample size, sample characteristic, and study design; 2) WML outcomes including WML location, WML quantification method (scoring or volume measurement), strength of the MRI magnet in Tesla, and MRI sequence used for WML detection; and 3) cognitive function outcomes including cognitive tests for two cognitive domains of memory and executive function/processing speed. Results Of the 14 studies included, seven compared the association of subcortical versus periventricular WMLs with cognitive function. Seven other studies investigated the association between WMLs in specific brain regions (e.g., frontal, parietal lobes) and cognitive function. Overall, the results show that a greater number of studies have found an association between periventricular WMLs and executive function/processing speed, than subcortical WMLs. However, whether WMLs in different brain regions have a differential effect on cognitive function remains unclear. Conclusions Evidence suggests that periventricular WMLs may have a significant negative impact on cognitive abilities of older adults. This finding may be influenced by study heterogeneity in: 1) MRI sequences, WML quantification methods, and neuropsychological batteries; 2) modifying effect of cardiovascular risk factors; and 3) quality of studies and lack of sample size calculation.
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Affiliation(s)
- Niousha Bolandzadeh
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
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King KS, Peshock RM, Warren MW, Alhilali L, Hulsey K, McColl R, Weiner MF, Ayers C, Whittemore A. Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location. AJNR Am J Neuroradiol 2012; 34:797-801. [PMID: 23079403 DOI: 10.3174/ajnr.a3283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Age-related white matter hyperintensities have prognostic implications, but no accepted clinical standard exists for their assessment. We propose a simple objective visual rating system by using 3T brain MR imaging. MATERIALS AND METHODS MR imaging from 559 participants was processed by using an automated method to determine WMH volumes and evaluated with a new visual rating scale based on the single largest WMH lesion diameter regardless of location. The reproducibility of the visual system was assessed. The association of WMH visual scores and automated volumes was then compared with cognitive scores from the Montreal Cognitive Assessment, which was available for 510 participants. RESULTS Inter-reader reproducibility was good for subsamples with both high (n=52) and low (n=40) prevalence of large automated WMH volumes (agreement of 67% and 87.5%, κ=0.71 and 0.76, respectively). Correlation between increased WMH and cognitive deficit measurements was equal for our visual ratings and automated volumes (Spearman ρ=0.118 and 0.109; P values=0.008 and 0.014, respectively). The visual scale retained a significant association with MoCA score after adjusting for age, sex, and education (standardized β=-0.087, P=.042). CONCLUSIONS We propose a simple visual WMH scoring system suitable for use as a baseline evaluation in clinical practice.
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Affiliation(s)
- K S King
- Department of Radiology, Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Tiel C, Sudo FK, Alves CEO, Alves GS, Ericeira-Valente L, Moreira DM, Laks J, Engelhardt E. Behavioral and psychological symptoms and hippocampal atrophy in subcortical ischaemic vascular disease. Dement Neuropsychol 2012; 6:175-179. [PMID: 29213793 PMCID: PMC5618966 DOI: 10.1590/s1980-57642012dn06030011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Neuropsychiatric symptoms are common in patients with cognitive impairments,
mediated by both neurodegenerative processes and cerebrovascular disease.
Previous studies have reported that Behavioral and Psychological Symptoms of
Dementia (BPSD) might correlate with severity of cognitive decline. Thus
far, the impact of the association between white-matter hyperintensities
(WHM) and hippocampal atrophy (HA) on the incidence of these symptoms has
been less studied. Objective This cross-sectional study aimed to describe the clinical profile of a sample
with large extensions of WMH, examining the association between different
degrees of HA and cognitive, functional, and behavioral status. Methods Fifty outpatients (mean age: 76.86±8.70 years; 58% female; mean
schooling: 7.44±4.69 years) with large extensions of WMH
(modified-Fazekas scale=3) on MRI and different degrees of hippocampal
atrophy (according to de Leon Score) underwent cognitive, functional, and
behavioral assessments. Results Patients with mild-moderate to severe HA had worse performance on the
Mini-Mental State Examination, Cambridge Cognitive Examination, Clinical
Dementia Rating and Pfeffer's Functional Activities Questionnaire, compared
to the group with none or questionable HA. Appetite/Eating Behavior was the
only cluster of neuropsychiatric symptoms associated with presence of HA in
Vascular Cognitive Impairment patients. Discussion Although HA may exhibit distinct impact on cognitive performance and
functional status, it appears to have little effect on behavioral symptoms
in patients with high severity WMH.
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Affiliation(s)
- Chan Tiel
- Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Cognitive and Behavioral Neurology Unit, INDC-CDA/IPUB, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Felipe Kenji Sudo
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Carlos Eduardo Oliveira Alves
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Gilberto Sousa Alves
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Letice Ericeira-Valente
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Denise Madeira Moreira
- Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Hospital Pró-Cardíaco, Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Universidade do Estado Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Eliasz Engelhardt
- Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Cognitive and Behavioral Neurology Unit, INDC-CDA/IPUB, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
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213
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Sudo FK, Alves CEO, Alves GS, Ericeira-Valente L, Tiel C, Moreira DM, Laks J, Engelhardt E. Dysexecutive syndrome and cerebrovascular disease in non-amnestic mild cognitive impairment: A systematic review of the literature. Dement Neuropsychol 2012; 6:145-151. [PMID: 29213788 PMCID: PMC5618961 DOI: 10.1590/s1980-57642012dn06030006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Non-amnestic dysexecutive Vascular Mild Cognitive Impairment (VaMCI) may
represent preclinical Vascular Dementia (VaD). The aim of this study was to
summarize the clinical, neuropsychological and neuroimaging aspects of
VaMCI; and to assess its patterns of progression to dementia. Methods Searches were made in the ISI Web of Knowledge, PubMed and Lilacs databases,
using the terms "mild cognitive impairment" and "executive function".
Altogether, 944 articles were retrieved. Results VaMCI cases had poorer performances on fronto-executive tasks, a higher
prevalence of stroke, presence of periventricular and profound white matter
hyperintensities on MRI images, as well as more extrapyramidal signs and
behavioral symptoms. Executive dysfunction might be associated with
disconnection of fronto-parietal-subcortical circuits. Progression to
dementia was associated with baseline deficits in executive function, in
simple sustained attention and language, and large periventricular WMH. Discussion VaMCI develops with impairment in non-memory domains and subcortical white
matter changes on MRI images, which are consistent with clinical and
neuroimaging findings in VaD.
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Affiliation(s)
- Felipe Kenji Sudo
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Carlos Eduardo Oliveira Alves
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Gilberto Sousa Alves
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Letice Ericeira-Valente
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Chan Tiel
- Instituto de Neurologia Deolindo Couto (INDC), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Cognitive and Behavioral Neurology Unit, INDC-CDA/IPUB, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Denise Madeira Moreira
- Instituto de Neurologia Deolindo Couto (INDC), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Hospital Pró-Cardíaco, Rio de Janeiro, Rio de Janeiro RJ, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Center for Alzheimer's Disease (CDA/IPUB), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Universidade do Estado do Rio de Janeiro
| | - Eliasz Engelhardt
- Instituto de Neurologia Deolindo Couto (INDC), Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil.,Cognitive and Behavioral Neurology Unit, INDC-CDA/IPUB, Universidade Federal do Rio de Janeiro, Rio de Janeiro RJ, Brazil
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Hommet C, Mondon K, Constans T, Beaufils E, Desmidt T, Camus V, Cottier JP. Review of cerebral microangiopathy and Alzheimer's disease: relation between white matter hyperintensities and microbleeds. Dement Geriatr Cogn Disord 2012; 32:367-78. [PMID: 22301385 DOI: 10.1159/000335568] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2011] [Indexed: 01/18/2023] Open
Abstract
Although Alzheimer's disease (AD) is basically considered to be a neurodegenerative disorder, cerebrovascular disease is also involved. The role of vascular risk factors and vascular disease in the progression of AD remains incompletely understood. With the development of brain MRI, it is now possible to detect small-vessel disease, whose prevalence and severity increase with age. The first types of small-vessel disease to be described were white matter hyperintensities (WMHs). More recently, small areas of signal loss on T(2)*-weighted images, also called microbleeds (MBs), have been reported. Cerebral MBs are focal deposits of hemosiderin that indicate prior microhemorrhages around small vessels, related to either ruptured atherosclerotic microvessels or amyloid angiopathy. Consequently, using brain MRI for the detection of microangiopathy may prove useful to improve our understanding of the impact of the vascular burden in AD pathology. The relationship between microangiopathy and the clinical course of AD or the conversion of mild cognitive impairment to AD remains questionable in terms of cognitive or affective symptoms, particularly if we consider MBs.
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Affiliation(s)
- C Hommet
- Médecine Interne Gériatrique et CMRR, Hôpital Bretonneau, CHRU Tours, Tours, France.
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Lee JY, Insel P, Mackin RS, Schuff N, Chui H, DeCarli C, Park KH, Mueller SG, Weiner MW. Different associations of white matter lesions with depression and cognition. BMC Neurol 2012; 12:83. [PMID: 22920586 PMCID: PMC3482604 DOI: 10.1186/1471-2377-12-83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/20/2012] [Indexed: 11/24/2022] Open
Abstract
Background To test the hypothesis that white matter lesions (WML) are primarily associated with regional frontal cortical volumes, and to determine the mediating effects of these regional frontal cortices on the associations of WML with depressive symptoms and cognitive dysfunction. Methods Structural brains MRIs were performed on 161 participants: cognitively normal, cognitive impaired but not demented, and demented participants. Lobar WML volumes, regional frontal cortical volumes, depressive symptom severity, and cognitive abilities were measured. Multiple linear regression analyses were used to identify WML volume effects on frontal cortical volume. Structural equation modeling was used to determine the MRI-depression and the MRI-cognition path relationships. Results WML predicted frontal cortical volume, particularly in medial orbirtofrontal cortex, irrespective of age, gender, education, and group status. WML directly predicted depressive score, and this relationship was not mediated by regional frontal cortices. In contrast, the association between WML and cognitive function was indirect and mediated by regional frontal cortices. Conclusions These findings suggest that the neurobiological mechanisms underpinning depressive symptoms and cognitive dysfunction in older adults may differ.
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Affiliation(s)
- Jun-Young Lee
- Center for Imaging of Neurodegenerative Diseases, Veterans Affairs Medical Center, San Francisco, CA 94121, USA
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216
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Cortical thinning related to periventricular and deep white matter hyperintensities. Neurobiol Aging 2012; 33:1156-67. [DOI: 10.1016/j.neurobiolaging.2010.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 12/01/2010] [Accepted: 12/04/2010] [Indexed: 11/17/2022]
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Impact of subcortical hyperintensities on dual-tasking in Alzheimer disease and aging. Alzheimer Dis Assoc Disord 2012; 26:28-35. [PMID: 21502852 DOI: 10.1097/wad.0b013e3182172c58] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Subcortical hyperintensities (SHs) on brain magnetic resonance imaging are associated with cognitive and gait impairment in elderly but their impact on dual-tasking (performing cognitive tasks while walking) in patients with Alzheimer disease (AD) is unknown. This study explored the costs of dual-tasking in relation to SH severity in AD and normal controls (NCs). Cadence while walking on a treadmill, and speed-accuracy-tradeoff (SAT), on 3 working memory tasks, were measured during single-task and dual-task conditions. Dual-task costs (DTC) on SAT, cadence, and overall DTC were measured for each of these tasks. On visual rating of SH severity, AD and NC groups were subdivided into high-SH and low-SH subgroups. Compared with the NC, the AD group performed poorly on all working memory tasks across both conditions, decreased cadence on dual-tasking, and showed a decrement in overall DTC (all P<0.01). When grouped according to SH severity, the low-SH-NC group performed superiorly on working memory tasks (P<0.001) and the high-SH-AD group (P=0.001) showed a decrease in dual-task costs of cadence. Although the AD group showed a decrement in overall DTC (P<0.01) compared with NC, when assessed in terms of SH severity, the high-SH-AD group showed the largest decrement in DTC (P<0.01). Greater SH severity is associated with a decrement in overall dual-tasking ability in AD.
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Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyuzaki Y, Ogawa E, Uchiyama T, Yamamoto T. Vascular incontinence: incontinence in the elderly due to ischemic white matter changes. Neurol Int 2012; 4:e13. [PMID: 23139851 PMCID: PMC3490472 DOI: 10.4081/ni.2012.e13] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 12/17/2011] [Accepted: 01/16/2012] [Indexed: 01/21/2023] Open
Abstract
This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh Panicker
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Clare J Fowler
- Uro-Neurology, the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Fuyuki Tateno
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Masahiko Kishi
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Yohei Tsuyuzaki
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Emina Ogawa
- Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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220
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DeCarli C, Kawas C, Morrison JH, Reuter-Lorenz PA, Sperling RA, Wright CB. Session II: Mechanisms of age-related cognitive change and targets for intervention: neural circuits, networks, and plasticity. J Gerontol A Biol Sci Med Sci 2012; 67:747-53. [PMID: 22570135 DOI: 10.1093/gerona/gls111] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Age-related changes in neural circuits, neural networks, and their plasticity are central to our understanding of age changes in cognition and brain structure and function. This paper summarizes selected findings on these topics presented at the Cognitive Aging Summit II. Specific areas discussed were synaptic vulnerability and plasticity, including the role of different types of synaptic spines, and hormonal effects in the dorsolateral prefrontal cortex of nonhuman primates, the impact of both compensatory processes and dedifferentiation on demand-dependent differences in prefrontal activation in relation to age and performance, the role of vascular disease, indexed by white matter signal abnormalities, on prefrontal activation during a functional magnetic resonance imaging-based cognitive control paradigm, and the influence of amyloid-β neuropathology on memory performance in older adults and the networks of brain activity underlying variability in performance. A greater understanding of age-related changes in brain plasticity and neural networks in healthy aging and in the presence of underlying vascular disease or amyloid pathology will be essential to identify new targets for intervention. Moreover, this understanding will assist in promoting the utilization of existing interventions, such as lifestyle and therapeutic modifiers of vascular disease.
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Affiliation(s)
- Charles DeCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis, USA
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221
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He ZL, Deng W, Li ML, Chen ZF, Collier DA, Ma X, Li T. Detection of metabolites in the white matter of frontal lobes and hippocampus with proton in first-episode treatment-naïve schizophrenia patients. Early Interv Psychiatry 2012; 6:166-75. [PMID: 21951785 DOI: 10.1111/j.1751-7893.2011.00291.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to investigate the changes of the metabolites in the white matter of frontal lobes and hippocampus in schizophrenia by using proton magnetic resonance spectroscopy ((1) H-MRS). METHODS Sixty-three first-episode treatment-naïve schizophrenia (FES) patients and 63 age-, gender- and education level-matched healthy controls were recruited. The relative levels of metabolites including N-acetylaspartate (NAA), choline-containing compounds (Cho), (Cr) and myo-inositol (MI) were detected with (1) H-MRS, and the laterality index (Li) was calculated. The severity of symptoms was assessed using the Positive and Negative Syndrome Scale. RESULTS Compared with controls, FES patients did not show significant differences in all metabolites. The severity of positive symptoms was negatively correlated with the NAA/Cho in the white matter of the left frontal lobe and positively correlated with the Cho/Cr in the right white matter of frontal lobes. A negative correlation was observed between the severity of negative symptoms and the NAA/Cr in the white matter of bilateral frontal lobes. No difference was shown in the Li of metabolites between FES patients and controls. CONCLUSIONS The metabolites such as NAA, Cho and MI in white matter of frontal lobes and hippocampus were not significantly altered in FES patients. The lower axonal integrity/number (NAA concentration) may be associated with more severe negative symptoms, and dysmetabolism in process of myelination in the white matter of frontal lobes associated with more severe positive symptoms.
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Affiliation(s)
- Zong-Ling He
- The Mental Health Center and the Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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222
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Hedden T, Van Dijk KRA, Shire EH, Sperling RA, Johnson KA, Buckner RL. Failure to modulate attentional control in advanced aging linked to white matter pathology. Cereb Cortex 2012; 22:1038-51. [PMID: 21765181 PMCID: PMC3328340 DOI: 10.1093/cercor/bhr172] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advanced aging is associated with reduced attentional control and less flexible information processing. Here, the origins of these cognitive effects were explored using a functional magnetic resonance imaging task that systematically varied demands to shift attention and inhibit irrelevant information across task blocks. Prefrontal and parietal regions previously implicated in attentional control were recruited by the task and most so for the most demanding task configurations. A subset of older individuals did not modulate activity in frontal and parietal regions in response to changing task requirements. Older adults who did not dynamically modulate activity underperformed their peers and scored more poorly on neuropsychological measures of executive function and speed of processing. Examining 2 markers of preclinical pathology in older adults revealed that white matter hyperintensities (WMHs), but not high amyloid burden, were associated with failure to modulate activity in response to changing task demands. In contrast, high amyloid burden was associated with alterations in default network activity. These results suggest failure to modulate frontal and parietal activity reflects a disruptive process in advanced aging associated with specific neuropathologic processes.
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Affiliation(s)
- Trey Hedden
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.
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Abstract
The impact of perimenopause on cognition seems to be characterized by an absence of improved scores rather than a decline. In the SWAN, the perimenopausal decrement in cognitive performance was not accounted for; however, increases in anxiety and depressive symptoms had independent, unfavorable effects on performance. Estradiol has been found to protect against changes resulting from serotonin withdrawal and defend against changes from cholinergic depletion. There is support for the critical timing hypothesis--that estrogen benefits cognitive function when instituted early, but not later. The menopausal transition may affect cognitive function in older age owing to worsened cardiovascular risk factors.
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Affiliation(s)
- Gail A Greendale
- Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Los Angeles, CA 90095-1687, USA
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Differences in brain cholesterol metabolism and insulin in two subgroups of patients with different CSF biomarkers but similar white matter lesions suggest different pathogenic mechanisms. Neurosci Lett 2012; 510:121-6. [DOI: 10.1016/j.neulet.2012.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 12/19/2011] [Accepted: 01/06/2012] [Indexed: 11/17/2022]
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Abstract
There are many reports of relations between age and cognitive variables and of relations between age and variables representing different aspects of brain structure and a few reports of relations between brain structure variables and cognitive variables. These findings have sometimes led to inferences that the age-related brain changes cause the age-related cognitive changes. Although this conclusion may well be true, it is widely recognized that simple correlations are not sufficient to warrant causal conclusions, and other types of correlational information, such as mediation and correlations between longitudinal brain changes and longitudinal cognitive changes, also have limitations with respect to causal inferences. These issues are discussed, and the existing results on relations of regional volume, white matter hyperintensities, and diffusion tensor imaging measures of white matter integrity to age and to measures of cognitive functioning are reviewed. It is concluded that at the current time the evidence that these aspects of brain structure are neuroanatomical substrates of age-related cognitive decline is weak. The final section contains several suggestions concerning measurement and methodology that may lead to stronger conclusions in the future.
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Affiliation(s)
- Timothy A Salthouse
- Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400, USA.
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226
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García-Panach J, Lull N, Lull JJ, Ferri J, Martínez C, Sopena P, Robles M, Chirivella J, Noé E. A voxel-based analysis of FDG-PET in traumatic brain injury: regional metabolism and relationship between the thalamus and cortical areas. J Neurotrauma 2012; 28:1707-17. [PMID: 21770759 DOI: 10.1089/neu.2011.1851] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective was to study the correlations and the differences in glucose metabolism between the thalamus and cortical structures in a sample of severe traumatic brain injury (TBI) patients with different neurological outcomes. We studied 49 patients who had suffered a severe TBI and 10 healthy control subjects using 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). The patients were divided into three groups: a vegetative or minimally-conscious state (MCS&VS) group (n=17), which included patients who were in a vegetative or a minimally conscious state; an In-post-traumatic amnesia (In-PTA) group (n=12), which included patients in PTA; and an Out-PTA group (n=20), which included patients who had recovered from PTA. SPM5 software was used to determine the metabolic differences between the groups. FDG-PET images were normalized and four regions of interest were generated around the thalamus, precuneus, and the frontal and temporal lobes. The groups were parameterized using Student's t-test. Principal component analysis was used to obtain an intensity-estimated-value per subject to correlate the function between the structures. Differences in glucose metabolism in all structures were related to the neurological outcome, and the most severe patients showed the most severe hypometabolism. We also found a significant correlation between the cortico-thalamo-cortical metabolism in all groups. Voxel-based analysis suggests a functional correlation between these four areas, and decreased metabolism was associated with less favorable outcomes. Higher levels of activation of the cortico-cortical connections appear to be related to better neurological condition. Differences in the thalamo-cortical correlations between patients and controls may be related to traumatic dysfunction due to focal or diffuse lesions.
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Affiliation(s)
- Javier García-Panach
- Grupo de Informática Biomédica, Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universidad Politécnica de Valencia, Valencia, Spain
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227
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Risk factors for selective cognitive decline in dialyzed patients with end-stage renal disease: evidence from verbal fluency analysis. J Int Neuropsychol Soc 2012; 18:162-7. [PMID: 22088797 DOI: 10.1017/s1355617711001445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although dialyzed patients often have cognitive problems, little is known about the nature of these deficits. We hypothesized that, in contrast to semantic fluency relying mainly on temporal lobes, phonemic fluency, preferentially depending on functions of frontal-subcortical systems, would be particularly sensitive to the constellation of physiological pathological processes associated with end-stage renal disease and dialysis. Therefore, we longitudinally compared phonemic and semantic fluency performance between 49 dialyzed patients and 30 controls. Overall, patients performed below controls only on the phonemic fluency task. Furthermore, their performance on this task declined over time, whereas there was no change in semantic fluency. Moreover, this decline was related to the presence of hypertension and higher blood urea nitrogen. We suggest that these findings may be due to a combination of vascular and topic effects that impact more on fronto-subcortical than temporal lobe networks, but this speculation requires direct confirmation.
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228
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CNS involvement in primary Sjogren Syndrome: assessment of gray and white matter changes with MRI and voxel-based morphometry. AJR Am J Roentgenol 2011; 197:1207-12. [PMID: 22021516 DOI: 10.2214/ajr.10.5984] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate with MRI the involvement of gray matter and white matter structures in patients with primary Sjögren syndrome. SUBJECTS AND METHODS Fifty-three patients with primary Sjögren syndrome, 18 age- and disease duration-matched patients with systemic sclerosis, and 35 age-matched control subjects were examined for differences in white matter hyperintensities (WMHIs) detected on FLAIR MR images. Differences in brain volume between patients with primary Sjögren syndrome and controls were studied by application of voxel-based morphometry to a 3D T1-weighted sequence. RESULTS WMHIs were observed in 38 of the 53 patients with primary Sjögren syndrome, six of 18 patients with systemic sclerosis, and 17 of 35 controls. The numbers of WMHIs 2 mm or larger and the number smaller than 2 mm were higher in patients with primary Sjögren syndrome than in controls (≥ 2 mm, p = 0.004; < 2 mm, p < 0.001). No significant difference was observed in the number of WMHIs in primary Sjögren syndrome patients and that in systemic sclerosis patients. After control for age, a positive relation was found between disease duration and total number of WMHIs (p = 0.037) and number of WMHIs 2 mm or larger (p = 0.023) in patients with primary Sjögren syndrome. In comparison with the controls, patients with primary Sjögren syndrome had decreased gray matter volume in the cortex, deep gray matter, and cerebellum. Associated loss of white matter volume was observed in areas corresponding to gray matter atrophy and in the corpus callosum (p < 0.05). CONCLUSION Patients with primary Sjögren syndrome have WMHIs and gray and white matter atrophy, probably related to cerebral vasculitis.
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229
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Ku BD, Na DL, Moon SY, Kim SY, Seo SW, Cheong HK, Park KW, Park KH, Lee JY, Cha KR, Shim YS, Youn YC, Chung CS, Kim JE, Kang HY, Kim SY, Choi SH, Han SH. Neuropsychological correlates of the proportional impact of white matter hyperintensities on mild to moderate dementia: the MRI 300 study. Dement Geriatr Cogn Disord 2011; 31:397-405. [PMID: 21734395 DOI: 10.1159/000328624] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND White matter hyperintensities (WMH) increase cognitive impairment in patients with dementia. OBJECTIVE We investigated the impact of WMH on the neuropsychological profiles in patients with mild to moderate dementia. METHODS We consecutively recruited newly diagnosed patients with mild to moderate dementia across South Korea for 1 year. The participants completed neuropsychological tests, magnetic resonance imaging, and structured neurological evaluations. The patients were divided into 3 categories, i.e. minimal, moderate, and severe WMH groups, according to the proportional degree of WMH. RESULTS 289 patients were recruited; 140 (48.3%) for the minimal WMH group, 99 (34.2%) for the moderate group, and 50 (17.5%) for the severe group. Both advanced age and low general cognitive level were significant contributors to WMH in patients with dementia. After adjusting for age, the neuropsychological correlates of the proportional impact of WMH were frontal executive, language, and attention profiles. However, the only significant neuropsychological correlate was the recognition memory profile after adjusting for both age and general cognitive level simultaneously. CONCLUSION The results suggest that the most significant neuropsychological profile impacting the burden of WMH in patients with mild to moderate dementia was the recognition memory profile, regardless of age and general cognitive function.
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Affiliation(s)
- Bon D Ku
- Department of Neurology, College of Medicine, Kwandong University Myongji Hospital, Koyang, Korea
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Kaup AR, Mirzakhanian H, Jeste DV, Eyler LT. A review of the brain structure correlates of successful cognitive aging. J Neuropsychiatry Clin Neurosci 2011. [PMID: 21304134 DOI: 10.1176/appi.neuropsych.23.1.6] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Unimpaired cognition is an important feature of successful aging. Differences in cognitive performance among healthy older adults may be related to differences in brain structure. The authors reviewed the literature to examine the relationship between brain-structure size and cognitive performance in older adults. Eighty-three percent of studies found at least one positive relationship between these factors; however, findings were variable. Positive relationships emerged most consistently between the hippocampal formation and global cognition and memory and between frontal measures and executive function. Additional longitudinal study is needed to further evaluate structure-cognition relationships in older adulthood and across the adult lifespan.
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Affiliation(s)
- Allison R Kaup
- Department of Psychiatry, University of California San Diego, San Diego, CA 92161, USA.
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231
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Lenfeldt N, Larsson A, Nyberg L, Birgander R, Eklund A, Malm J. Diffusion tensor imaging reveals supplementary lesions to frontal white matter in idiopathic normal pressure hydrocephalus. Neurosurgery 2011; 68:1586-93; discussion 1593. [PMID: 21336219 DOI: 10.1227/neu.0b013e31820f3401] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic normal-pressure hydrocephalus (INPH) is associated with white matter lesions, but the extent and severity of the lesions do not cohere with symptoms or improvement after shunting, implying the presence of further, yet undisclosed, injuries to white matter in INPH. OBJECTIVE To apply diffusion tensor imaging (DTI) to explore white matter lesions in patients with INPH before and after drainage of cerebrospinal fluid (CSF). METHODS Eighteen patients and 10 controls were included. DTI was performed in a 1.5T MRI scanner before and after 3-day drainage of 400 mL of CSF. Regions of interest included corpus callosum, capsula interna, frontal and lateral periventricular white matter, and centrum semiovale. White matter integrity was quantified by assessing fractional anisotropies (FA) and apparent diffusion coefficients (ADC), comparing them between patients and controls and between patients before and after drainage. The significance level corresponded to .05 (Bonferroni corrected). RESULTS Decreased FA in patients was found in 3 regions (P<.002, P<.001, and P<.001) in anterior frontal white matter, whereas elevated ADC was found in genu corpus callosum (P<.001) and areas of centrum semiovale associated with the precentral gyri (P<.002). Diffusion patterns in these areas did not change after drainage. CONCLUSION DTI reveals subtle injuries-interpreted as axonal loss and gliosis-to anterior frontal white matter where high-order motor systems between frontal cortex and basal ganglia travel, further supporting the notion that motor symptoms in INPH are caused by a chronic ischemia to the neuronal systems involved in the planning processes of movements.
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Affiliation(s)
- Niklas Lenfeldt
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.
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232
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Villeneuve S, Belleville S. The nature of memory failure in mild cognitive impairment: examining association with neurobiological markers and effect of progression. Neurobiol Aging 2011; 33:1967-78. [PMID: 22088679 DOI: 10.1016/j.neurobiolaging.2011.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 08/08/2011] [Accepted: 10/04/2011] [Indexed: 10/15/2022]
Abstract
The main goal of this study was to assess vulnerability to proactive interference and memory binding capacity, the ability to combine different information into a single coherent memory event, in persons with mild cognitive impairment (MCI). We also examined whether hippocampal atrophy and vascular burden were differentially related to these memory capacities in MCI. We further assessed whether memory performance and brain changes differ as a function of later development (or not) of dementia and whether they can predict progression to dementia. The study included 77 participants, 49 meeting the criteria for MCI and 28 healthy older adults. Results showed binding deficits and greater vulnerability to proactive interference in persons with MCI compared with healthy older adults. Hippocampal volume was associated with binding capacity, whereas vascular burden was associated with resistance to interference in persons with MCI. Follow-up analyses indicated that binding deficits predict progression from MCI to dementia. In conclusion, binding deficits and vulnerability to proactive interference are present in persons with MCI and are associated with different brain markers. However, only binding deficits predict progression to dementia.
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Affiliation(s)
- Sylvia Villeneuve
- Research Centre, Institut universitaire de Gériatrie de Montréal, Quebec, Canada
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233
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Neurologic signs in relation to cognitive function in subcortical ischemic vascular dementia: a CREDOS (Clinical Research Center for Dementia of South Korea) study. Neurol Sci 2011; 33:839-46. [PMID: 22068220 DOI: 10.1007/s10072-011-0845-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
Abstract
The objective of this study was to investigate the relationship between neurologic signs and cognitive dysfunction in subcortical ischemic vascular dementia (SIVD). 121 patients with SIVD were recruited from multiple nationwide hospitals. The patients' neurologic signs were evaluated using the Focal Neurologic Sign Score (FNSS). The FNSS scores did not correlate with the composite neuropsychology scores and Korean Mini-Mental State Examination scores. The FNSS scores correlated with the letter fluency and Rey-Osterrieth Complex Figure (ROCF) copy scores. Using a multivariate regression analysis controlled for age, sex, and educational level, the FNSS scores had a significant relationship with the letter fluency test scores (R (2) = 0.08, β = -2.28, p = 0.02) and ROCF copy scores (R (2) = 0.08, β = -0.42, p = 0.03). These findings suggest that the neurologic signs in patients with SIVD do not correlate with global cognitive functions; however, these signs do correlate with executive dysfunction in these patients.
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Long B, Anderson V, Jacobs R, Mackay M, Leventer R, Barnes C, Spencer-Smith M. Executive Function Following Child Stroke: The Impact of Lesion Size. Dev Neuropsychol 2011; 36:971-87. [PMID: 22004019 DOI: 10.1080/87565641.2011.581537] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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235
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Marchant NL, Reed BR, DeCarli CS, Madison CM, Weiner MW, Chui HC, Jagust WJ. Cerebrovascular disease, β-amyloid, and cognition in aging. Neurobiol Aging 2011; 33:1006.e25-36. [PMID: 22048124 DOI: 10.1016/j.neurobiolaging.2011.10.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/28/2011] [Accepted: 10/03/2011] [Indexed: 12/22/2022]
Abstract
The present study evaluated cerebrovascular disease (CVD), β-amyloid (Aβ), and cognition in clinically normal elderly adults. Fifty-four participants underwent magnetic resonance imaging (MRI), Pittsburgh compound B (PIB)-positron emission tomography (PET) imaging, and neuropsychological evaluation. High white matter hyperintensity burden and/or presence of infarct defined CVD status (CVD-: n = 27; CVD+: n = 27). PIB-positron emission tomography ratios of Aβ deposition were extracted using Logan plotting (cerebellar reference). Presence of high levels of Aβ in prespecified regions determined PIB status (PIB-: n = 33; PIB+: n = 21). Executive functioning and episodic memory were measured using composite scales. CVD and Aβ, defined as dichotomous or continuous variables, were unrelated to one another. CVD+ participants showed lower executive functioning (p = 0.001) when compared with CVD- individuals. Neither PIB status nor amount of Aβ affected cognition (ps ≥ 0.45), and there was no statistical interaction between CVD and PIB on either cognitive measure. Within this spectrum of normal aging CVD and Aβ aggregation appear to be independent processes with CVD primarily affecting cognition.
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Affiliation(s)
- Natalie L Marchant
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA 94720, USA.
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236
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Abstract
Age-related structural, functional and biochemical changes of the brain can be visualized by neuroimaging methods. Physiological aging of the brain has to be clearly distinguished from pathological alterations of the brain for reliable and early diagnoses of neurodegenerative diseases. Concerning the speed of the cerebral aging process, significant inter-individual differences can be observed. In general, aging is associated with a decline of cognitive functions. Simultaneously, a decay of the average brain volume, especially in the frontal lobe accompanies the process of aging. Correspondingly, a strong susceptibility for age-related degeneration has been observed in the fronto-striato-thalamic network. Due to increasing age the white matter is affected by a progressive loss of fiber integrity mirrored in a significant decay of the fractionated anisotropy (FA) measured by diffusion tensor imaging (DTI). Age-related degeneration of the white matter further leads to a growing number of T2 hyperintense white-matter lesions. Aging also influences the cerebral perfusion pattern leading to a perceptible decay of the global cerebral blood flow (CBF) and blood volume (CBV). During life, iron accumulates in the brain, predominantly in the globus pallidus and in the substantia nigra. By 1H-MR spectroscopy, a decrease of N-acetyl-aspartate (NAA) as a correlate for reduced neuronal metabolism is found in the brain of elderly individuals.
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Affiliation(s)
- L Schuster
- Abt E010, Radiologie, Deutsches Krebsforschungszentrum Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Deutschland.
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237
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Ota M, Nemoto K, Sato N, Mizukami K, Yamashita F, Asada T. Relationship between white matter T2 hyperintensity and cortical volume changes on magnetic resonance imaging in healthy elders. Int J Geriatr Psychiatry 2011; 26:886-92. [PMID: 20872420 DOI: 10.1002/gps.2618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 07/21/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE T2 white matter hyperintensity (WMH) on magnetic resonance imaging (MRI) is associated with brain atrophy. Some previous studies examined the relation between the WMH and cortical atrophy, however, little is known about how the WMHs affect the pattern of cortical atrophy. Recent studies have revealed that patho-physiological role of WMH in affecting cortical atrophy may be different between hyperintensities in basal ganglia and thalami (B&T) and those in other regions. Based on a longitudinal study up to 5 years, we attempt to examine the temporal relation between the WMHs and cortical atrophy with special attention to the hyperintensities in the B&T. METHODS We evaluated the temporal pattern of cortical atrophy in 74 cognitively normal subjects lacking hyperintensities in B&T (first analysis) and 13 cognitively normal subjects with hyperintensities in B&T (second analysis). The relationship between the baseline WMH severity and the cortical volume change during the observation period (mean: 3.8 years) was voxel basically evaluated on the images. RESULTS The first analysis showed fairly axisymmetrical atrophy pattern in parietal, occipital, and precentral cortices, while the findings gained from the second appear to lack such systematic orderliness of the atrophy. CONCLUSION This result shows that WMH may affect atrophy in multiple cerebral cortices even in cognitively normal subjects. Understanding the impact of WMH on the shrinkage shown in the brains of cognitively healthy older individuals is an important base for assessing the temporal pattern of atrophy of the individual with neurodegenerative disorder like AD.
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Affiliation(s)
- Miho Ota
- Department of Radiology, National Center of Neurology and Psychiatry, Ogawahigashi, Kodaira, Tokyo, Japan.
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238
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Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011; 2011:617927. [PMID: 21876810 PMCID: PMC3163144 DOI: 10.4061/2011/617927] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
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Affiliation(s)
- Yun Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shatin 999077, Hong Kong
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239
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The nature of episodic memory deficits in MCI with and without vascular burden. Neuropsychologia 2011; 49:3027-35. [PMID: 21763333 DOI: 10.1016/j.neuropsychologia.2011.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/10/2011] [Accepted: 07/01/2011] [Indexed: 11/22/2022]
Abstract
This study measured episodic memory deficits in individuals with mild cognitive impairment (MCI) as a function of their vascular burden. Vascular burden was determined clinically by computing the number of vascular risk factors and diseases and neuroradiologically by assessing the presence and severity of white matter lesions (WML). Strategic memory processes were measured with free recall and temporal contextual memory tasks requiring self-initiated retrieval. Nonstrategic memory retrieval processes were appraised with a five-choice recognition procedure. Results showed that MCI participants with high vascular burden displayed impairment of strategic memory processes, whereas MCI participants with no vascular burden showed impairment of both strategic and nonstrategic memory processes. A similar pattern was found whether vascular burden was measured using a clinical index of vascular risk profile or whether it was measured neuroradiologically by assessing the extent and severity of subcortical WML. However, the effect of WML on memory differed as function of level of education, used here as a proxy for cognitive reserve. Among participants with MCI, those who had higher education and no WML were the least memory impaired. The study also examined memory as a function of whether patients later progressed to dementia after a three-year follow-up. When examining progressors' performance, strategic and nonstrategic processes were both impaired in progressors with no concomitant vascular conditions, whereas progressors with a high vascular burden showed less impairment of nonstrategic than strategic processes. Overall, results indicate that the presence of vascular burden in MCI is associated with selective impairment of strategic memory processes.
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240
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Executive function mediates effects of white matter hyperintensities on episodic memory. Neuropsychologia 2011; 49:2817-24. [PMID: 21689669 DOI: 10.1016/j.neuropsychologia.2011.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 05/18/2011] [Accepted: 06/02/2011] [Indexed: 11/21/2022]
Abstract
This study examined the relationship between white matter hyperintensities (WMH) and executive functioning on episodic memory in a group of older adults who were cognitively normal or diagnosed with MCI or dementia. Volumetric magnetic resonance imaging (MRI) measures of total brain volume, white matter hyperintensity volume, and hippocampal volume along with age, education, and gender were evaluated as predictors of episodic memory. WMH were found to influence both episodic memory and executive functioning independently of other variables. The influence WMH on episodic memory was mediated by executive functioning and was completely eliminated when the interaction between executive functioning and hippocampal volume was entered in the regression model. The results indicate that executive functioning mediates the effects of WMH on episodic memory but that executive functioning and hippocampal volume can also interact such that executive functioning can exacerbate or ameliorate the influence of hippocampal volume on episodic memory.
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241
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Telles S, Raghavendra BR. Neurophysiological Changes in Meditation Correlated with Descriptions from the Ancient Texts. ACTA ACUST UNITED AC 2011. [DOI: 10.5298/1081-5937-39.2.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Meditation is currently considered to be associated with increased awareness. In ancient yoga texts, two separate meditative states have been described. These are meditative focusing (dharana) and a state of mental expansiveness (dhyana). Two more mental states are described in another yoga text. These are random thinking (cancalata) and focusing while not in meditation (ekagrata). The physiological effects of these states have been assessed using autonomic variables, evoked potentials, functional magnetic resonance imaging, and performance in a cancellation task. The findings suggest that dhyana is associated with reduced sympathetic activity and increased vagal tone, whereas dharana does indeed improve performance in an attention task. Hence, correlating findings from ancient texts with contemporary science can be useful.
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242
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Rouhl RPW, Damoiseaux JGMC, Lodder J, Theunissen ROMFIH, Knottnerus ILH, Staals J, Henskens LHG, Kroon AA, de Leeuw PW, Tervaert JWC, van Oostenbrugge RJ. Vascular inflammation in cerebral small vessel disease. Neurobiol Aging 2011; 33:1800-6. [PMID: 21601314 DOI: 10.1016/j.neurobiolaging.2011.04.008] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/24/2011] [Accepted: 04/08/2011] [Indexed: 10/18/2022]
Abstract
Cerebral small vessel disease (CSVD) is considered to be caused by an increased permeability of the blood-brain barrier and results in enlargement of Virchow Robin spaces (VRs), white matter lesions, brain microbleeds, and lacunar infarcts. The increased permeability of the blood-brain barrier may relate to endothelial cell activation and activated monocytes/macrophages. Therefore, we hypothesized that plasma markers of endothelial activation (adhesion molecules) and monocyte/macrophage activation (neopterin) relate to CSVD manifestations. In 163 first-ever lacunar stroke patients and 183 essential hypertensive patients, we assessed CSVD manifestations on brain magnetic resonance imaging (MRI) and levels of C-reactive protein (CRP), neopterin, as well as circulating soluble adhesion molecules (sICAM-1, sVCAM-1, sE-selectin, sP-selectin). Neopterin, sICAM-1 and sVCAM-1 levels were higher in patients with extensive CSVD manifestations than in those without (p < 0.01). Neopterin levels independently related to higher numbers of enlarged Virchow Robin spaces (p < 0.001). An inflammatory process with activated monocytes/macrophages may play a role in the increased permeability of the blood brain barrier in patients with CSVD.
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Affiliation(s)
- Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands.
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243
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Mayda ABV, Westphal A, Carter CS, DeCarli C. Late life cognitive control deficits are accentuated by white matter disease burden. Brain 2011; 134:1673-83. [PMID: 21482547 DOI: 10.1093/brain/awr065] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent evidence suggests that age-related impairments in cognition may be mediated by a specific deficit in the ability to maintain goal-relevant information, a critical component of cognitive control dependent on the dorsolateral prefrontal cortex, although the underlying neural mechanism of these deficits remains unclear. To examine white matter hyperintensities as a neurobiological mechanism of these impairments, older individuals with severe white matter hyperintensity burden, older individuals with low white matter hyperintensity burden, and young adults were assessed in an event-related functional imaging scan while performing the 'AX'-continuous performance task. Individuals with severe white matter hyperintensity burden showed a significant reduction in dorsolateral prefrontal cortex activity during the high cognitive control cue condition relative to the low white matter hyperintensity group and young individuals. Conversely, those with severe white matter hyperintensity burden showed greater activity in rostral anterior cingulate cortex compared to young individuals. These results are consistent with impaired cognitive control and a possible failure to deactivate default-mode regions in these subjects. Additionally, those with severe white matter hyperintensity burden showed reduced functional connectivity between dorsolateral prefrontal cortex and task-relevant brain regions including middle frontal gyrus, and supramarginal gyrus relative to young subjects and those with minimal white matter hyperintensity burden. These results suggest that age-related goal maintenance impairments and associated dorsolateral prefrontal cortex dysfunction may partly reflect incipient white matter disease of interconnected cognitive networks.
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Affiliation(s)
- Adriane B V Mayda
- Centre for Neuroscience, University of California, Davis, Department of Neurology 4860 Y St., Suite 3700 Sacramento, CA 95817, USA
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244
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Aine CJ, Sanfratello L, Adair JC, Knoefel JE, Caprihan A, Stephen JM. Development and decline of memory functions in normal, pathological and healthy successful aging. Brain Topogr 2011; 24:323-39. [PMID: 21452018 DOI: 10.1007/s10548-011-0178-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 03/16/2011] [Indexed: 11/28/2022]
Abstract
Many neuroimaging studies of age-related memory decline interpret resultant differences in brain activation patterns in the elderly as reflecting a type of compensatory response or regression to a simpler state of brain organization. Here we review a series of our own studies which lead us to an alternative interpretation, and highlights a couple of potential confounds in the aging literature that may act to increase the variability of results within age groups and across laboratories. From our perspective, level of cognitive functioning achieved by a group of elderly is largely determined by the health of individuals within this group. Individuals with a history of hypertension, for example, are likely to have multiple white matter insults which compromise cognitive functioning, independent of aging processes. The health of the elderly group has not been well-documented in most previous studies and elderly participants are rarely excluded, or placed into a separate group, due to health-related problems. In addition, recent results show that white matter tracts within the frontal and temporal lobes, regions critical for higher cognitive functions, continue to mature well into the 4th decade of life. This suggests that a young age group may not be the best control group for understanding aging effects on the brain since development is ongoing within this age range. Therefore, we have added a middle-age group to our studies in order to better understand normal development across the lifespan as well as effects of pathology on cognitive functioning in the aging brain.
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Affiliation(s)
- C J Aine
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA.
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245
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Stanek KM, Grieve SM, Brickman AM, Korgaonkar MS, Paul RH, Cohen RA, Gunstad JJ. Obesity is associated with reduced white matter integrity in otherwise healthy adults. Obesity (Silver Spring) 2011; 19:500-4. [PMID: 21183934 DOI: 10.1038/oby.2010.312] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Existing work demonstrates that obesity is independently associated with cognitive dysfunction and macrostructural brain changes; however, little is known about the association between obesity and white matter (WM) integrity. We explore this relationship in a large cohort of otherwise healthy subjects. The present study classified 103 adult participants from the Brain Resource International Database between 21 and 86 years of age without history of neurological, medical, or psychiatric illness according to BMI (normal weight, overweight, obese) and subjected them to diffusion tensor imaging (DTI). Resulting fractional anisotropy (FA) indexes for the corpus callosum and fornix were examined in relation to BMI and age in a multiple regression framework. Results indicated that increasing BMI was independently associated with lower FA in the genu, splenium, and fornix, and a BMI × age interaction emerged for FA in the splenium and body of the corpus callosum. When categorized, obese persons demonstrated lower FA than normal and overweight persons for all WM indexes, but no FA differences emerged between overweight and normal persons. Results indicate both a direct association between obesity and reduced WM tract integrity and an interaction between obesity and aging processes on certain WM tracts in otherwise healthy adults. While such findings suggest a possible role for adiposity in WM dysfunction and associated cognitive deficits, prospective studies are needed to clarify the nature of these relationships and elucidate underlying mechanisms.
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Affiliation(s)
- Kelly M Stanek
- Department of Psychology, Kent State University, Kent, Ohio, USA
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246
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Abstract
Pure vascular parkinsonism without evidence of nigral Lewy body pathology may occur as a distinct clinicopathological entity, but a much more frequent occurrence is the comorbid presence of age-associated white matter lesions (WMLs) in idiopathic Parkinson disease (PD). WMLs are associated with motor and cognitive symptoms in otherwise normal elderly individuals. Comorbid WMLs are, therefore, expected to contribute to clinical symptoms in PD. Studies of WMLs in PD differ with regard to methods of assessment of WML burden and the patient populations selected for analysis, but converging evidence suggests that postural stability and gait motor functions are predominantly affected. WMLs are described to contribute to dementia in Alzheimer disease, and emerging but inconclusive evidence indicates similar effects in PD. In this article, we review the literature addressing the occurrence and impact of WMLs in PD, and suggest that WMLs may exacerbate or contribute to some motor and cognitive deficits associated with PD. We review existing and emerging methods for studying white matter pathology in vivo, and propose future research directions.
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247
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Påhlman U, Gutiérrez-pérez C, Sävborg M, Knopp E, Tarkowski E. Cognitive function and improvement of balance after stroke in elderly people: the Gothenburg Cognitive Stroke Study in the Elderly. Disabil Rehabil 2011; 33:1952-62. [DOI: 10.3109/09638288.2011.553703] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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248
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Kaup AR, Mirzakhanian H, Jeste DV, Eyler LT. A review of the brain structure correlates of successful cognitive aging. J Neuropsychiatry Clin Neurosci 2011; 23:6-15. [PMID: 21304134 PMCID: PMC3068909 DOI: 10.1176/jnp.23.1.jnp6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Unimpaired cognition is an important feature of successful aging. Differences in cognitive performance among healthy older adults may be related to differences in brain structure. The authors reviewed the literature to examine the relationship between brain-structure size and cognitive performance in older adults. Eighty-three percent of studies found at least one positive relationship between these factors; however, findings were variable. Positive relationships emerged most consistently between the hippocampal formation and global cognition and memory and between frontal measures and executive function. Additional longitudinal study is needed to further evaluate structure-cognition relationships in older adulthood and across the adult lifespan.
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Affiliation(s)
- Allison R. Kaup
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California
,Department of Psychiatry; University of California, San Diego; San Diego, California
| | - Heline Mirzakhanian
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology; San Diego, California
,Department of Psychiatry; University of California, San Diego; San Diego, California
| | - Dilip V. Jeste
- Department of Psychiatry; University of California, San Diego; San Diego, California
,Sam and Rose Stein Institute for Research on Aging; University of California, San Diego; San Diego, California
| | - Lisa T. Eyler
- Department of Psychiatry; University of California, San Diego; San Diego, California
,Mental Illness Research, Education and Clinical Center; Veterans Affairs San Diego Healthcare System; San Diego, California
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249
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Abstract
Magnetic resonance imaging plays an important role in the diagnosis and management of cerebrovascular diseases. In addition to stroke, it can also demonstrate changes apparent in the white matter such as leukoaraiosis. These as well as other changes occurring with increasing age can be visualized. Among others, there is an increase in the number and size of perivascular spaces. Although many of these alterations may be clinically silent, with increasing load they may become symptomatic. Other vascular pathological findings such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and the posterior reversible encephalopathy syndrome can also provoke changes in the cerebral white matter that are visible on magnetic resonance imaging and are discussed.
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250
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Murray ME, Senjem ML, Petersen RC, Hollman JH, Preboske GM, Weigand SD, Knopman DS, Ferman TJ, Dickson DW, Jack CR. Functional impact of white matter hyperintensities in cognitively normal elderly subjects. ACTA ACUST UNITED AC 2010; 67:1379-85. [PMID: 21060015 DOI: 10.1001/archneurol.2010.280] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the impact white matter hyperintensities (WMH) detected on magnetic resonance imaging have on motor dysfunction and cognitive impairment in elderly subjects without dementia. DESIGN Cross-sectional study. SETTING Population-based study on the incidence and prevalence of cognitive impairment in Olmsted County, Minnesota. PARTICIPANTS A total of 148 elderly subjects (65 men) without dementia ranging in age from 73 to 91 years. MAIN OUTCOME MEASURES We measured the percentage of the total white matter volume classified as WMH in a priori-defined brain regions (ie, frontal, temporal, parietal, occipital, periventricular, or subcortical). Motor impairment was evaluated qualitatively using the Unified Parkinson's Disease Rating Scale summary measures of motor skills and quantitatively using a digitized portable walkway system. Four cognitive domains were evaluated using z scores of memory, language, executive function, and visuospatial reasoning. RESULTS A higher WMH proportion in all regions except the occipital lobe was associated with lower executive function z score (P value <.01). A higher WMH proportion in all regions, but most strongly for the parietal lobe, correlated with higher Unified Parkinson's Disease Rating Scale gait, posture, and postural stability sum (P value <.01). A higher WMH proportion, whether periventricular, subcortical, or lobar, correlated with reduced velocity (P value <.001). CONCLUSIONS We conclude that executive function is the primary cognitive domain affected by WMH burden. The data suggest that WMH in the parietal lobe are chiefly responsible for reduced balance and postural support compared with the other 3 lobes and may alter integration of sensory information via parietal lobe dysfunction in the aging brain. Parietal white matter changes were not the predominant correlate with motor speed, lending evidence to a global involvement of neural networks in gait velocity.
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Affiliation(s)
- Melissa E Murray
- Department of Neuroscience (Neuropathology), Mayo Clinic, Jacksonville, Florida, USA
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