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Li G, Wang C, Wang S, Wang L, Hao Y, Xiong Y, Zhao X. Clinical significance of the Microbleed Anatomical Rating Scale score in ischemic stroke patients treated with intravenous thrombolysis. Postgrad Med J 2024; 100:421-426. [PMID: 38366658 DOI: 10.1093/postmj/qgae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Conflicting results were shown on the relationship between cerebral microbleeds (CMBs) burden and functional outcomes in patients treated with intravenous tissues plasminogen activator (IV tPA). We aimed to investigate the relationship between CMBs burden and functional outcomes using the Microbleed Anatomical Rating Scale (MARS) and determine its optimal cutoff value. METHODS A retrospective study was conducted to include patients treated with IV tPA in our stroke center, and the MARS was used to assess the CMBs burden. Other clinical data including demographic factors, stroke severity, vascular risk factors, and clinical outcomes were also documented. Another mediation analysis was performed to investigate whether early neurological improvement could mediate the association between MARS and functional outcomes. RESULTS A total of 408 patients were included. A cutoff value of 1.5 could predict functional outcomes in patients treated with IV tPA. Based on that cutoff value, MARS showed an independent relationship with functional outcomes [adjusted OR (Odds Ratio) 0.841, 95% confidence interval (CI) 0.720-0.982, P = .029]. A shift analysis showed that higher MARS score (MARS ≥1.5) was related with poor functional outcome according to mRS score distribution (OR = 0.519, 95% CI 0.336-0.803, P = .003). Total effect (indirect + direct effect) was calculated and showed in figure. Early neurological improvement mediated 24% of the effect of MARS score on functional outcomes. CONCLUSION Our study showed that MARS could be a potential method to assess the functional outcome based on CMBs in patients treated with IV tPA, and MARS score ≥ 1.5 might be an optimal threshold for poor functional outcome.
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Affiliation(s)
- Guangshuo Li
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
| | - Chuanying Wang
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
| | - Shang Wang
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Liyuan Wang
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
| | - Yahui Hao
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
| | - Yunyun Xiong
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing 100070, China
- Chinese Institute for Brain Research, Beijing Tiantan Hospital, Beijing 100070, China
| | - Xingquan Zhao
- Department of Neurology, Capital Medical University, Beijing Tiantan Hospital, Beijing 100070, China
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Kozberg MG, Munting LP, Maresco LH, Auger CA, van den Berg ML, Denis de Senneville B, Hirschler L, Warnking JM, Barbier EL, Farrar CT, Greenberg SM, Bacskai BJ, van Veluw SJ. Loss of spontaneous vasomotion precedes impaired cerebrovascular reactivity and microbleeds in a mouse model of cerebral amyloid angiopathy. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.26.591414. [PMID: 38746419 PMCID: PMC11092483 DOI: 10.1101/2024.04.26.591414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease in which amyloid-β accumulates in vessel walls. CAA is a leading cause of symptomatic lobar intracerebral hemorrhage and an important contributor to age-related cognitive decline. Recent work has suggested that vascular dysfunction may precede symptomatic stages of CAA, and that spontaneous slow oscillations in arteriolar diameter (termed vasomotion), important for amyloid-β clearance, may be impaired in CAA. Methods To systematically study the progression of vascular dysfunction in CAA, we used the APP23 mouse model of amyloidosis, which is known to develop spontaneous cerebral microbleeds mimicking human CAA. Using in vivo 2-photon microscopy, we longitudinally imaged unanesthetized APP23 transgenic mice and wildtype littermates from 7 to 14 months of age, tracking amyloid-β accumulation and vasomotion in individual pial arterioles over time. MRI was used in separate groups of 12-, 18-, and 24-month-old APP23 transgenic mice and wildtype littermates to detect microbleeds and to assess cerebral blood flow and cerebrovascular reactivity with pseudo-continuous arterial spin labeling. Results We observed a significant decline in vasomotion with age in APP23 mice, while vasomotion remained unchanged in wildtype mice with age. This decline corresponded in timing to initial vascular amyloid-β deposition (∼8-10 months of age), although was more strongly correlated with age than with vascular amyloid-β burden in individual arterioles. Declines in vasomotion preceded the development of MRI-visible microbleeds and the loss of smooth muscle actin in arterioles, both of which were observed in APP23 mice by 18 months of age. Additionally, evoked cerebrovascular reactivity was intact in APP23 mice at 12 months of age, but significantly lower in APP23 mice by 24 months of age. Conclusions Our findings suggest that a decline in spontaneous vasomotion is an early, potentially pre-symptomatic, manifestation of CAA and vascular dysfunction, and a possible future treatment target.
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Duan Q, Lyu J, Cheng K, Wang X, Meng Z, Wu X, Chen W, Wang G, Niu Q, Li X, Bian Y, Han D, Guo W, Yang S, Bian X, Lan Y, Wang L, Zhang T, Duan C, Tian C, Lou X. MRI Assessment of Brain Frailty and Clinical Outcome in Patients With Acute Posterior Perforating Artery Infarction. J Magn Reson Imaging 2024; 59:340-349. [PMID: 37183874 DOI: 10.1002/jmri.28768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Global brain health has gained increasing attention recently. Imaging markers of brain frailty have been related to functional outcomes in previous studies on anterior circulation; however, little data are available on imaging markers and posterior circulation. PURPOSE To investigate the impact of brain frailty on functional outcomes in patients with acute perforating artery infarction (PAI) of the posterior circulation. STUDY TYPE Prospective. POPULATION One hundred patients (60.78 ± 9.51 years, 72% men) with acute posterior circulation PAI (determined by diffusion-weighted magnetic resonance imaging (MRI)/time-of-flight MR angiography). FIELD STRENGTH/SEQUENCE T1- and T2-weighted fast spin echo, T2-weighted fluid-attenuated inversion recovery, diffusion-weighted echo planar, gradient echo (susceptibility-weight imaging), and 3D time-of-flight MR angiography sequences at 3.0 T. ASSESSMENT Periventricular and deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) in the basal ganglia and centrum semiovale area, lacunes, cerebral microbleeds (CMB), and total brain frailty score by calculating the above imaging characters were rated visually by three radiologists with 9, 10, and 11 years of experience and one neuroradiologist with 12. Infarction volume was assessed using baseline diffusion-weighted imaging (DWI) data obtained within 24 hours of symptom onset. A modified Rankin Scale (mRS) score >1 on day 90 defined an adverse functional outcome. Associations between the imaging markers of brain frailty and functional outcomes were assessed. STATISTICAL TESTS Fisher's exact test, Mann-Whitney U test, and multivariable binary logistic regression. A P value <0.05 was considered statistically significant. RESULTS Adverse prognoses (mRS > 1) were observed in 34 (34%) patients. Infarction volume, periventricular WMH, deep WMH, basal ganglia EPVS, CMB, and the brain frailty score were significantly associated with adverse functional outcomes. An increased brain frailty score was significantly associated with unfavorable mRS score on day 90 (odds ratio 1.773, 95% confidence interval 1.237-2.541). DATA CONCLUSION Advanced MRI imaging markers of brain frailty, individually or combined as a total brain frailty score, were associated with worse functional outcomes after acute posterior circulation PAI. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Qi Duan
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Kun Cheng
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Xueyang Wang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Zhihua Meng
- Department of Radiology, Yuebei People's Hospital, Shaoguan, China
| | - Xiaoyan Wu
- Department of Radiology, Anshan Changda Hospital, Anshan, China
| | - Wen Chen
- Department of Radiology, Shiyan Taihe Hospital, Shiyan, China
| | - Guohua Wang
- Department of Radiology, Qingdao Municipal Hospital Affiliated to Qingdao University, Qingdao, China
| | - Qingliang Niu
- Department of Radiology, WeiFang Traditional Chinese Hospital, Weifang, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Jilin University, Jilin, China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dan Han
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Weiting Guo
- Department of Radiology, Shanxi Provincial People's Hospital, Xi'an, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Xiangbing Bian
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Yina Lan
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Liuxian Wang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Tingyang Zhang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Chenglin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
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Naïm G, Malissin I, Mégarbane B. Cerebral microbleeds in the poisoned patient: An observational magnetic resonance imaging study. Basic Clin Pharmacol Toxicol 2023; 133:770-777. [PMID: 37732931 DOI: 10.1111/bcpt.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/20/2023] [Accepted: 09/18/2023] [Indexed: 09/22/2023]
Abstract
Critical illness-associated cerebral microbleeds of poorly understood pathophysiology have been observed on magnetic resonance imaging (MRI) in severely hypoxaemic patients similarly to high-altitude cerebral oedema patients. The prevalence and circumstances of occurrence of such cerebral microbleeds in the severely poisoned patients are unknown. We retrospectively reviewed all cerebral MRIs performed in the poisoned patients with atypical neurological presentation or outcome admitted to our intensive care unit in 2014-2021. Three out of 64 patients (4.7%) investigated with cerebral MRI among the 2986 severely poisoned patients presented cerebral microbleeds. Microbleeds were localized in the white cerebral matter mainly in the corpus callosum. Ingested toxicants included dichlorvos, methadone and tramadol. Patients were found comatose with possibly prolonged severe hypoxaemia requiring prompt tracheal intubation and mechanical ventilation. They presented delayed arousal and dysexecutive syndrome leading to sequelae. Microbleeds on MRI can occur in the critically ill poisoned patients and seems to be a multifactorial phenomenon. A direct relationship with the toxicant seems improbable. Physicians should be aware of such a non-specific complication accounting for sequelae.
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Affiliation(s)
- Giulia Naïm
- Department of Medical and Toxicological Critical Care, Lariboisière hospital, Paris, France
- INSERM UMRS-1144, Paris-Cité University, Paris, France
| | - Isabelle Malissin
- Department of Medical and Toxicological Critical Care, Lariboisière hospital, Paris, France
- INSERM UMRS-1144, Paris-Cité University, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière hospital, Paris, France
- INSERM UMRS-1144, Paris-Cité University, Paris, France
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Lv K, Liu Y, Chen Y, Buch S, Wang Y, Yu Z, Wang H, Zhao C, Fu D, Wang H, Wang B, Zhang S, Luo Y, Haacke EM, Shen W, Chai C, Xia S. The iron burden of cerebral microbleeds contributes to brain atrophy through the mediating effect of white matter hyperintensity. Neuroimage 2023; 281:120370. [PMID: 37716591 DOI: 10.1016/j.neuroimage.2023.120370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/04/2023] [Accepted: 09/08/2023] [Indexed: 09/18/2023] Open
Abstract
The goal of this work was to explore the total iron burden of cerebral microbleeds (CMBs) using a semi-automatic quantitative susceptibility mapping and to establish its effect on brain atrophy through the mediating effect of white matter hyperintensities (WMH). A total of 95 community-dwelling people were enrolled. Quantitative susceptibility mapping (QSM) combined with a dynamic programming algorithm (DPA) was used to measure the characteristics of 1309 CMBs. WMH were evaluated according to the Fazekas scale, and brain atrophy was assessed using a 2D linear measurement method. Histogram analysis was used to explore the distribution of CMBs susceptibility, volume, and total iron burden, while a correlation analysis was used to explore the relationship between volume and susceptibility. Stepwise regression analysis was used to analyze the risk factors for CMBs and their contribution to brain atrophy. Mediation analysis was used to explore the interrelationship between CMBs and brain atrophy. We found that the frequency distribution of susceptibility of the CMBs was Gaussian in nature with a mean of 201 ppb and a standard deviation of 84 ppb; however, the volume and total iron burden of CMBs were more Rician in nature. A weak but significant correlation between the susceptibility and volume of CMBs was found (r = -0.113, P < 0.001). The periventricular WMH (PVWMH) was a risk factor for the presence of CMBs (number: β = 0.251, P = 0.014; volume: β = 0.237, P = 0.042; total iron burden: β = 0.238, P = 0.020) and was a risk factor for brain atrophy (third ventricle width: β = 0.325, P = 0.001; Evans's index: β = 0.323, P = 0.001). PVWMH had a significant mediating effect on the correlation between CMBs and brain atrophy. In conclusion, QSM along with the DPA can measure the total iron burden of CMBs. PVWMH might be a risk factor for CMBs and may mediate the effect of CMBs on brain atrophy.
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Affiliation(s)
- Ke Lv
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Yanzhen Liu
- Department of Radiology, Tianjin Chest Hospital, Tianjin, China
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Sagar Buch
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Ying Wang
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Zhuo Yu
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Huiying Wang
- The School of Medicine, Nankai University, Tianjin, China
| | - Chenxi Zhao
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Dingwei Fu
- Department of Radiology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Huapeng Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Beini Wang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin, China
| | | | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - E Mark Haacke
- Department of Neurology, Wayne State University, Detroit, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA; Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Wen Shen
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China
| | - Chao Chai
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China.
| | - Shuang Xia
- Department of Radiology, Tianjin Institute of Imaging Medicine, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China.
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Faakye J, Nyúl-Tóth Á, Gulej R, Csik B, Tarantini S, Shanmugarama S, Prodan C, Mukli P, Yabluchanskiy A, Conley S, Toth P, Csiszar A, Ungvari Z. Imaging the time course, morphology, neuronal tissue compression, and resolution of cerebral microhemorrhages in mice using intravital two-photon microscopy: insights into arteriolar, capillary, and venular origin. GeroScience 2023; 45:2851-2872. [PMID: 37338779 PMCID: PMC10643488 DOI: 10.1007/s11357-023-00839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023] Open
Abstract
Cerebral microhemorrhages (CMHs, microbleeds), a manifestation of age-related cerebral small vessel disease, contribute to the pathogenesis of cognitive decline and dementia in older adults. Histological studies have revealed that CMHs exhibit distinct morphologies, which may be attributed to differences in intravascular pressure and the size of the vessels of origin. Our study aimed to establish a direct relationship between the size/morphology of CMHs and the size/anatomy of the microvessel of origin. To achieve this goal, we adapted and optimized intravital two-photon microscopy-based imaging methods to monitor the development of CMHs in mice equipped with a chronic cranial window upon high-energy laser light-induced photodisruption of a targeted cortical arteriole, capillary, or venule. We assessed the time course of extravasation of fluorescently labeled blood and determined the morphology and size/volume of the induced CMHs. Our findings reveal striking similarities between the bleed morphologies observed in hypertension-induced CMHs in models of aging and those originating from different targeted vessels via multiphoton laser ablation. Arteriolar bleeds, which are larger (> 100 μm) and more widely dispersed, are distinguished from venular bleeds, which are smaller and exhibit a distinct diffuse morphology. Capillary bleeds are circular and smaller (< 10 μm) in size. Our study supports the concept that CMHs can occur at any location in the vascular tree, and that each type of vessel produces microbleeds with a distinct morphology. Development of CMHs resulted in immediate constriction of capillaries, likely due to pericyte activation and constriction of precapillary arterioles. Additionally, tissue displacement observed in association with arteriolar CMHs suggests that they can affect an area with a radius of ~ 50 μm to ~ 100 μm, creating an area at risk for ischemia. Longitudinal imaging of CMHs allowed us to visualize reactive astrocytosis and bleed resolution during a 30-day period. Our study provides new insights into the development and morphology of CMHs, highlighting the potential clinical implications of differentiating between the types of vessels involved in the pathogenesis of CMHs. This information may help in the development of targeted interventions aimed at reducing the risk of cerebral small vessel disease-related cognitive decline and dementia in older adults.
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Affiliation(s)
- Janet Faakye
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ádám Nyúl-Tóth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
| | - Rafal Gulej
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Boglarka Csik
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Santny Shanmugarama
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter Mukli
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter Toth
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration, and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary.
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA.
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7
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Kuriyama N, Koyama T, Ozaki E, Saito S, Ihara M, Matsui D, Watanabe I, Kondo M, Marunaka Y, Takada A, Akazawa K, Tomida S, Nagamitsu R, Miyatani F, Miyake M, Nakano E, Kobayashi D, Watanabe Y, Mizuno S, Maekawa M, Yoshida T, Nukaya Y, Mizuno T, Yamada K, Uehara R. Association Between Cerebral Microbleeds and Circulating Levels of Mid-Regional Pro-Adrenomedullin. J Alzheimers Dis 2022; 88:731-741. [DOI: 10.3233/jad-220195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Mid-regional pro-adrenomedullin (MR-proADM) is a novel biomarker for cognitive decline based on its association with cerebral small vessel disease (SVD). Cerebral microbleeds (MBs) are characteristic of SVD; however, a direct association between MR-proADM and MBs has not been explored. Objective: We aimed to examine whether circulating levels of MR-proADM are associated with the identification of MBs by brain magnetic resonance imaging (MRI) and whether this association could be linked with cognitive impairment. Methods: In total, 214 participants (mean age: 75.9 years) without history of cerebral infarction or dementia were prospectively enrolled. All participants underwent brain MRI, higher cognitive function testing, blood biochemistry evaluation, lifestyle examination, and blood MR-proADM measurement using a time-resolved amplified cryptate emission technology assay. For between-group comparisons, the participants were divided into two groups according to whether their levels of MR-proADM were normal (< 0.65 nmol/L) or high (≥0.65 nmol/L). Results: The mean MR-proADM level was 0.515±0.127 nmol/L. There were significant between-group differences in age, hypertension, and HbA1c levels (p < 0.05). In the high MR-proADM group, the MR-proADM level was associated with the identification of MBs on brain MR images and indications of mild cognitive impairment (MCI). In participants with ≥3 MBs and MCI, high MR-proADM levels remained a risk factor after multivariate adjustment (OR: 2.94; p < 0.05). Conclusion: High levels of MR-proADM may be a surrogate marker for the early detection of cognitive decline associated with the formation of cerebral MBs. This marker would be valuable during routine clinical examinations of geriatric patients.
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Affiliation(s)
- Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Social Health Medicine, Shizuoka Graduate University of Public Health
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Etsuko Ozaki
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Saito
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Stroke and Cerebrovascular Diseases, Division of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Daisuke Matsui
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Watanabe
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Kondo
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinori Marunaka
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
- Research Center for Drug Discovery and Pharmaceutical Development Science, Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan
| | - Akihiro Takada
- Medical Research Institute, Kyoto Industrial Health Association, Kyoto, Japan
| | - Kentaro Akazawa
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satomi Tomida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Reo Nagamitsu
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumitaro Miyatani
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eri Nakano
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Yoshiyuki Watanabe
- Faculty of Health and Medical Sciences, Kyoto University of Advanced Science
| | - Shigeto Mizuno
- Department of Endoscopy, Kindai University Nara Hospital, Nara Prefecture, Japan
| | - Mizuho Maekawa
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tamami Yoshida
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiko Nukaya
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ritei Uehara
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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8
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Cipriano L, Saracino D, Oliva M, Campana V, Puoti G, Conforti R, Fulgione L, Signoriello E, Bonavita S, Coppola C. Systematic Review on the Role of Lobar Cerebral Microbleeds in Cognition. J Alzheimers Dis 2022; 86:1025-1035. [PMID: 35180115 DOI: 10.3233/jad-215323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are small round/oval lesions seen in MRI-specific sequences. They are divided in deep and lobar according to their location. Lobar CMBs (L-CMBs) are commonly associated with amyloid angiopathy. Although CMBs have been considered clinically silent for a long time, a growing body of evidence has shown that they could play a crucial role in cognitive functioning. OBJECTIVE The aim of this systematic review was to estimate the role of L-CMBs in cognitive performance. METHODS We selected, from the Cochrane Library, Embase, PubMed, and ScienceDirect databases, clinical studies, published from January 2000 to January 2020 and focused on the association between L-CMBs and cognitive functions. The inclusion criteria were: 1) participants grouped according to presence or absence of CMBs, 2) extensive neuropsychological examination, 3) CMBs differentiation according to topographical distribution, and 4) MRI-based CMB definition (< 10 mm and low signal in T2*/SWI). The impact of L-CMBs was separately assessed for executive functions, visuospatial skills, language, and memory. RESULTS Among 963 potentially eligible studies, six fulfilled the inclusion criteria. Four studies reported a greater reduction in executive performances in participants with L-CMB and two studies showed a statistically significant association between visuospatial dysfunction and L-CMBs. No association was found between hippocampal memory or language abilities and L-CMBs. CONCLUSION Lobar CMBs are associated with a reduction of processing speed and visuospatial performances, thus suggesting the contribution of vascular amyloid deposition to this cognitive profile. This occurrence enables us to suspect an underlying Alzheimer's disease pathology even in absence of typical hippocampal memory impairment.
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Affiliation(s)
- Lorenzo Cipriano
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dario Saracino
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau (ICM), INSERM U1127, CNRS UMR 7225 - Aramis Project Team, Inria Research Center of Paris - Reference Center for Rare or Early Dementias, IM2A, Department of Neurology, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France
| | - Mariano Oliva
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vito Campana
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gianfranco Puoti
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Renata Conforti
- Department of Medicine of Precision, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovica Fulgione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Elisabetta Signoriello
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Cinzia Coppola
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
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9
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Magnetic resonance imaging assessment of cerebral small vessel disease intensification in patients with severe aortic valve stenosis. Pol J Radiol 2021; 86:e564-e573. [PMID: 34820033 PMCID: PMC8607833 DOI: 10.5114/pjr.2021.110650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To assess the prevalence of the neuroradiological indices of cerebral small vessel disease (CSVD) in patients with severe aortic valve stenosis (AS) in magnetic resonance imaging (MRI). Material and methods 34 patients (age 60-90 years, 17 women and 17 men) with severe AS and 50 healthy controls (age 61-85 years, 29 women and 21 men) underwent MRI brain examinations, which were analysed for the neuroradiological indices of CSVD: hyperintensities in periventricular white matter (PVWM) and deep white matter (DWM), enlarged perivascular spaces (ePVS), lacunar strokes, and cerebral microbleeds (CMBs). Results PVWM hyperintensities were found in 46% of volunteers and was significantly lower (p = 0.027), corresponding to AS patients (80%), the density of lesions was higher in the AS group than in controls (p = 0.019). DWM hyperintensities were found more often in AS patients (76%) than in controls (66%) (p = 0.303), but the densities were similar in both groups. Lacunar strokes were found in 35% of AS patients and 16% of controls (p = 0.042). The average number of lacunar strokes per person was 0.9 in the AS group and 0.3 in the controls (p = 0.035). The AS group showed higher variance in the number of strokes: SD = 1.96 vs. SD = 1.06 in controls. Both prevalence and density of the ePVS and CMBs did not differ significantly between the groups. Conclusions Neuroradiological indices of the vascular disease do not provide an unequivocal clue to the pathogenesis of CSVD in patients with severe AS. Most observations imply that CSVD is primarily a consequence of cerebral hypoperfusion caused by AS.
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10
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Wang XY, Lyu JH, Zhang SH, Duan CH, Duan Q, Ma XX, Zhang TY, Zhang J, Tian CL, Lou X. Severity of Intracranial Large Artery Disease Correlates With Cerebral Small Vessel Disease. J Magn Reson Imaging 2021; 56:264-272. [PMID: 34797007 DOI: 10.1002/jmri.28004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Small vessel disease (SVD) shares common vascular risk factors with large artery disease (LAD). However, little is known about the relationship between intracranial artery stenosis and SVD burden. PURPOSE To investigate whether SVD burden correlates with severity of intracranial LAD. STUDY TYPE Retrospective. POPULATION Five hundred and sixteen patients with LAD of arterial circulation were enrolled from one hospital, including 384 males (59 ± 11 years) and 132 females (60 ± 12 years). FIELD STRENGTH/SEQUENCE 3 T. T1 -weighted fast spin echo (T1 W FSE), T2 W FSE, T2 fluid attenuated inversion recovery, diffusion-weighted imaging, susceptibility-weight imaging, and time-of-flight magnetic resonance angiography. ASSESSMENT The LAD was divided into mild stenosis (<30%), moderate stenosis (30%-69%), and severe stenosis (≥70%). The Standard for Reporting Vascular Changes on Neuroimaging criteria was used to rate the SVD burden according to the level of white matter hyperintensity (WMH), perivascular space (PVS), cerebral microbleed (CMB), and lacunes. STATISTICAL TESTS Lilliefors test, ANOVA, chi-squared test, Mann-Whitney U test, Wilcoxon signed rank test, Bonferroni test, Spearman's correlation, logistic regression, and Cohen's kappa test. RESULTS The grade scores for centrum semiovale PVS (CS-PVS) were positively correlated with the degree of stenosis (R = 0.413), whereas the presence of severe basal ganglia PVS (BG-PVS) was associated with CMB (R = 0.508), lacunes (R = 0.365), and severe WMH (R = 0.478). In multivariate analysis, severe CS-PVS (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.9-4.8) and lacunes (aOR, 2.1; 95% CI, 1.3-3.4) were associated with severe stenosis of LAD. In addition, CS-PVS was related to severe stenosis in a dose-dependent manner: when CS-PVS score was 3 and 4, the aORs of severe stenosis were 1.9 and 7.7, respectively. DATA CONCLUSION The severity of LAD in anterior circulation is associated with SVD burden, which suggests that different SVD burden may be used for risk stratification in LAD. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Xue-Yang Wang
- Medical School of Chinese PLA, Beijing, China.,Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jin-Hao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | | | - Cao-Hui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Qi Duan
- Medical School of Chinese PLA, Beijing, China
| | - Xiao-Xiao Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Ting-Yang Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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11
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Liu S, Hou B, You H, Zhang Y, Zhu Y, Ma C, Zuo Z, Feng F. The Association Between Perivascular Spaces and Cerebral Blood Flow, Brain Volume, and Cardiovascular Risk. Front Aging Neurosci 2021; 13:599724. [PMID: 34531732 PMCID: PMC8438293 DOI: 10.3389/fnagi.2021.599724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Basal ganglia perivascular spaces are associated with cognitive decline and cardiovascular risk factors. There is a lack of studies on the cardiovascular risk burden of basal ganglia perivascular spaces (BG-PVS) and their relationship with gray matter volume (GMV) and GM cerebral blood flow (CBF) in the aging brain. Here, we investigated these two issues in a large sample of cognitively intact older adults. Methods: A total of 734 volunteers were recruited. MRI was performed with 3.0 T using a pseudo-continuous arterial spin labeling (pCASL) sequence and a sagittal isotropic T1-weighted sequence for CBF and GMV analysis. The images obtained from 406 participants were analyzed to investigate the relationship between the severity of BG-PVS and GMV/CBF. False discovery rate-corrected P-values (PFDR) of <0.05 were considered significant. The images obtained from 254 participants were used to study the relationship between the severity of BG-PVS and cardiovascular risk burden. BG-PVS were rated using a 5-grade score. The severity of BG-PVS was classified as mild (grade <3) and severe (grade ≥3). Cardiovascular risk burden was assessed with the Framingham General Cardiovascular Risk Score (FGCRS). Results: Severe basal ganglia perivascular spaces were associated with significantly smaller GMV and CBF in multiple cortical regions (PFDR <0.05), and were associated with significantly larger volume in the bilateral caudate nucleus, pallidum, and putamen (PFDR <0.05). The participants with severe BG-PVS were more likely to have a higher cardiovascular risk burden than the participants with mild BG-PVS (60.71% vs. 42.93%; P =0.02). Conclusion: In cognitively intact older adults, severe BG-PVS are associated with smaller cortical GMV and CBF, larger subcortical GMV, and higher cardiovascular risk burden.
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Affiliation(s)
- Sirui Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwei Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Ma
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Sino-Danish College, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Wang Y, Yan X, Zhan J, Zhang P, Zhang G, Ge S, Wen H, Wang L, Xu N, Lu L. Neuroimaging Markers of Cerebral Small Vessel Disease on Hemorrhagic Transformation and Functional Outcome After Intravenous Thrombolysis in Patients With Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:692942. [PMID: 34326767 PMCID: PMC8315270 DOI: 10.3389/fnagi.2021.692942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to perform a systematic review and meta-analysis to assess whether cerebral small vessel disease (CSVD) on neuroimaging of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) is associated with an increased risk of hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), and poor functional outcome (PFO). Methods: A thorough search of several databases was carried out to identify relevant studies up to December 2020. We included studies of patients with AIS and neuroimaging markers of CSVD treated with IVT. The primary outcome was HT, and the secondary outcomes were sICH and 3-month PFO. The quality of the studies involved was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis with the fixed effects model was performed. Results: Twenty-four eligible studies (n = 9,419) were pooled in the meta-analysis. All included studies were regarded as high quality with the NOS scores of at least 6 points. The meta-analysis revealed associations between the presence of CSVD and HT, sICH, and the 3-month PFO after IVT. Compared with no CSVD, the presence of CSVD was associated with an increased risk of HT (OR: 1.81, 95% CI: 1.52-2.16), sICH (OR: 2.42, 95% CI: 1.76-3.33), and 3-month PFO (OR: 2.15, 95% CI: 1.89-2.44). For patients with AIS complicated with CSVD, compared with a CSVD score of 0-1, a CSVD score of 2-4 was associated with an increased risk of HT (OR: 3.10, 95% CI: 1.67-5.77), sICH (OR: 2.86, 95% CI: 1.26-6.49), and 3-month PFO (OR: 4.58, 95% CI: 2.97-7.06). Conclusion: Patients with AIS complicated with neuroimaging markers of CSVD are at increased risk of HT and 3-month PFO after IVT. However, it is still necessary to clarify the exact role of CSVD in the occurrence, development, and prognosis of AIS. Systematic Review Registration: www.ClinicalTrials.gov, identifier CRD4202123 3900.
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Affiliation(s)
- Yiqiao Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoting Yan
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Zhan
- Postdoctoral Programme, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peiming Zhang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guangming Zhang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuqi Ge
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hao Wen
- Department of Neurology, The Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lin Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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13
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Yu X, Yin X, Hong H, Wang S, Jiaerken Y, Zhang F, Pasternak O, Zhang R, Yang L, Lou M, Zhang M, Huang P. Increased extracellular fluid is associated with white matter fiber degeneration in CADASIL: in vivo evidence from diffusion magnetic resonance imaging. Fluids Barriers CNS 2021; 18:29. [PMID: 34193191 PMCID: PMC8247253 DOI: 10.1186/s12987-021-00264-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background White matter hyperintensities (WMHs) are one of the hallmarks of cerebral small vessel disease (CSVD), but the pathological mechanisms underlying WMHs remain unclear. Recent studies suggest that extracellular fluid (ECF) is increased in brain regions with WMHs. It has been hypothesized that ECF accumulation may have detrimental effects on white matter microstructure. To test this hypothesis, we used cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) as a unique CSVD model to investigate the relationships between ECF and fiber microstructural changes in WMHs. Methods Thirty-eight CADASIL patients underwent 3.0 T MRI with multi-model sequences. Parameters of free water (FW) and apparent fiber density (AFD) obtained from diffusion-weighted imaging (b = 0 and 1000 s/mm2) were respectively used to quantify the ECF and fiber density. WMHs were split into four subregions with four levels of FW using quartiles (FWq1 to FWq4) for each participant. We analyzed the relationships between FW and AFD in each subregion of WMHs. Additionally, we tested whether FW of WMHs were associated with other accompanied CSVD imaging markers including lacunes and microbleeds. Results We found an inverse correlation between FW and AFD in WMHs. Subregions of WMHs with high-level of FW (FWq3 and FWq4) were accompanied with decreased AFD and with changes in FW-corrected diffusion tensor imaging parameters. Furthermore, FW was also independently associated with lacunes and microbleeds. Conclusions Our study demonstrated that increased ECF was associated with WM degeneration and the occurrence of lacunes and microbleeds, providing important new insights into the role of ECF in CADASIL pathology. Improving ECF drainage might become a therapeutic strategy in future. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00264-1.
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Affiliation(s)
- Xinfeng Yu
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Xinzhen Yin
- Department of Neurology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Hong
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Shuyue Wang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Yeerfan Jiaerken
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Fan Zhang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ofer Pasternak
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruiting Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China
| | - Linglin Yang
- Department of Psychiatry, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
| | - Peiyu Huang
- Department of Radiology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Shangcheng District, Hangzhou, 310009, China.
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14
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Jäkel L, De Kort AM, Klijn CJM, Schreuder FHBM, Verbeek MM. Prevalence of cerebral amyloid angiopathy: A systematic review and meta-analysis. Alzheimers Dement 2021; 18:10-28. [PMID: 34057813 PMCID: PMC9290643 DOI: 10.1002/alz.12366] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 01/05/2023]
Abstract
Reported prevalence estimates of sporadic cerebral amyloid angiopathy (CAA) vary widely. CAA is associated with cognitive dysfunction and intracerebral hemorrhage, and linked to immunotherapy‐related side‐effects in Alzheimer's disease (AD). Given ongoing efforts to develop AD immunotherapy, accurate estimates of CAA prevalence are important. CAA can be diagnosed neuropathologically or during life using MRI markers including strictly lobar microbleeds. In this meta‐analysis of 170 studies including over 73,000 subjects, we show that in patients with AD, CAA prevalence based on pathology (48%) is twice that based on presence of strictly lobar cerebral microbleeds (22%); in the general population this difference is three‐fold (23% vs 7%). Both methods yield similar estimated prevalences of CAA in cognitively normal elderly (5% to 7%), in patients with intracerebral hemorrhage (19% to 24%), and in patients with lobar intracerebral hemorrhage (50% to 57%). However, we observed large heterogeneity among neuropathology and MRI protocols, which calls for standardized assessment and reporting of CAA.
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Affiliation(s)
- Lieke Jäkel
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Anna M De Kort
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands
| | - Marcel M Verbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Radboud University Medical Cente, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Chen H, Oliver BG, Pant A, Olivera A, Poronnik P, Pollock CA, Saad S. Particulate Matter, an Intrauterine Toxin Affecting Foetal Development and Beyond. Antioxidants (Basel) 2021; 10:antiox10050732. [PMID: 34066412 PMCID: PMC8148178 DOI: 10.3390/antiox10050732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 02/07/2023] Open
Abstract
Air pollution is the 9th cause of the overall disease burden globally. The solid component in the polluted air, particulate matters (PMs) with a diameter of 2.5 μm or smaller (PM2.5) possess a significant health risk to several organ systems. PM2.5 has also been shown to cross the blood–placental barrier and circulate in foetal blood. Therefore, it is considered an intrauterine environmental toxin. Exposure to PM2.5 during the perinatal period, when the foetus is particularly susceptible to developmental defects, has been shown to reduce birth weight and cause preterm birth, with an increase in adult disease susceptibility in the offspring. However, few studies have thoroughly studied the health outcome of foetuses due to intrauterine exposure and the underlying mechanisms. This perspective summarises currently available evidence, which suggests that intrauterine exposure to PM2.5 promotes oxidative stress and inflammation in a similar manner as occurs in response to direct PM exposure. Oxidative stress and inflammation are likely to be the common mechanisms underlying the dysfunction of multiple systems, offering potential targets for preventative strategies in pregnant mothers for an optimal foetal outcome.
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Affiliation(s)
- Hui Chen
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (B.G.O.); (A.O.)
- Correspondence: (H.C.); (S.S.)
| | - Brian G. Oliver
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (B.G.O.); (A.O.)
| | - Anushriya Pant
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (A.P.); (P.P.)
| | - Annabel Olivera
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW 2007, Australia; (B.G.O.); (A.O.)
| | - Philip Poronnik
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia; (A.P.); (P.P.)
| | - Carol A. Pollock
- Renal Research Laboratory, Kolling Institute of Medical Research, Sydney, NSW 2065, Australia;
| | - Sonia Saad
- Renal Research Laboratory, Kolling Institute of Medical Research, Sydney, NSW 2065, Australia;
- Correspondence: (H.C.); (S.S.)
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16
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Ikeda M, Kodaira S, Kasahara H, Takai E, Nagashima K, Fujita Y, Makioka K, Hirayanagi K, Furuta N, Furuta M, Sanada E, Kobayashi A, Harigaya Y, Nagamine S, Hattori N, Tashiro Y, Kishi K, Shimada H, Suto T, Tanaka H, Sakai Y, Yamazaki T, Tanaka Y, Aihara Y, Amari M, Yamaguchi H, Okamoto K, Takatama M, Ishii K, Higuchi T, Tsushima Y, Ikeda Y. Cerebral Microbleeds, Cerebrospinal Fluid, and Neuroimaging Markers in Clinical Subtypes of Alzheimer's Disease. Front Neurol 2021; 12:543866. [PMID: 33889121 PMCID: PMC8056016 DOI: 10.3389/fneur.2021.543866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Lobar cerebral microbleeds (CMBs) in Alzheimer's disease (AD) are associated with cerebral amyloid angiopathy (CAA) due to vascular amyloid beta (Aβ) deposits. However, the relationship between lobar CMBs and clinical subtypes of AD remains unknown. Here, we enrolled patients with early- and late-onset amnestic dominant AD, logopenic variant of primary progressive aphasia (lvPPA) and posterior cortical atrophy (PCA) who were compatible with the AD criteria. We then examined the levels of cerebrospinal fluid (CSF) biomarkers [Aβ1-42, Aβ1-40, Aβ1-38, phosphorylated tau 181 (P-Tau), total tau (T-Tau), neurofilament light chain (NFL), and chitinase 3-like 1 protein (YKL-40)], analyzed the number and localization of CMBs, and measured the cerebral blood flow (CBF) volume by 99mTc-ethyl cysteinate dimer single photon emission computerized tomography (99mTc ECD-SPECT), as well as the mean cortical standard uptake value ratio by 11C-labeled Pittsburgh Compound B-positron emission tomography (11C PiB-PET). Lobar CMBs in lvPPA were distributed in the temporal, frontal, and parietal lobes with the left side predominance, while the CBF volume in lvPPA significantly decreased in the left temporal area, where the number of lobar CMBs and the CBF volumes showed a significant inversely correlation. The CSF levels of NFL in lvPPA were significantly higher compared to the other AD subtypes and non-demented subjects. The numbers of lobar CMBs significantly increased the CSF levels of NFL in the total AD patients, additionally, among AD subtypes, the CSF levels of NFL in lvPPA predominantly were higher by increasing number of lobar CMBs. On the other hand, the CSF levels of Aβ1-38, Aβ1-40, Aβ1-42, P-Tau, and T-Tau were lower by increasing number of lobar CMBs in the total AD patients. These findings may suggest that aberrant brain hypoperfusion in lvPPA was derived from the brain atrophy due to neurodegeneration, and possibly may involve the aberrant microcirculation causing by lobar CMBs and cerebrovascular injuries, with the left side dominance, consequently leading to a clinical phenotype of logopenic variant.
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Affiliation(s)
- Masaki Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan.,Division of Common Education (Neurology), Faculty of Health and Medical Care, Saitama Medical University, Hidaka, Japan
| | - Sayaka Kodaira
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Eriko Takai
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kimitoshi Hirayanagi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsumi Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Minori Furuta
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Etsuko Sanada
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayumi Kobayashi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yasuo Harigaya
- Department of Neurology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Shun Nagamine
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noriaki Hattori
- Department of Neuropsychiatry, Jomo Hospital, Maebashi, Japan
| | - Yuichi Tashiro
- Department of Neurology, Mito Medical Center, Mito, Japan
| | - Kazuhiro Kishi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Hirotaka Shimada
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Hisashi Tanaka
- Department of Neuropsychiatry, Tanaka Hospital, Yoshioka, Japan
| | - Yasujiro Sakai
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Tsuneo Yamazaki
- Department of Occupational Therapy, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Yukiko Tanaka
- Department of Geriatric Medicine, Uchida Hospital, Numata, Japan
| | - Yuko Aihara
- Department of Neurology, Shinozuka Hospital, Fujioka, Japan
| | - Masakuni Amari
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Haruyasu Yamaguchi
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan.,Tokyo Center for Dementia Research and Practices, Tokyo, Japan
| | - Koichi Okamoto
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Masamitsu Takatama
- Department of Neurology, Geriatrics Research Institute and Hospital, Maebashi, Japan
| | - Kenji Ishii
- Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Wang Y. Predicting new silent cerebral infarction after intracerebral hemorrhage using serum white blood cell count. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:97-102. [PMID: 33680405 PMCID: PMC7919177 DOI: 10.22088/cjim.12.1.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background It has been confirmed that incidental silent cerebral infarctions (SCIs) found in healthy people may be risk factors for cerebrovascular diseases such as strokes and vascular dementia. The prospective study aimed to determine the utility of baseline serum white blood cell (WBC) counts to predict the emergence of new SCI after intracranial hemorrhage (ICH). Methods This is a prospective study. From January 2016 to December 2017, we recruited 171 patients admitted to the neurology department of the Affiliated Shuyang Hospital of Xuzhou Medical University with a first episode of ICH. Serum WBC count was measured on admission. SCI was detected by cranial magnetic resonance imaging (MRI) 14 days after the onset of the ICH. Receiver operating characteristic curve analysis was used to calculate the most appropriate cut-off values of the WBC count for differentiating patients with and without SCI at the end of the study period. Results New SCIs were detected in 28.07% of patients by cranial MRI. Multivariate logistic regression analysis showed that cerebral microbleeds (CMBs), raised WBC counts, and leukoaraiosis were independent risk factors for SCI. The most appropriate cut-off WBC count differentiating the two groups was 7.65×109/L (sensitivity: 77.08%, specificity: 63.41%). Conclusion Elevated levels of serum WBC counts in patients with ICH are associated with SCI. There is potential value in using serum WBC counts to predict new SCI after an acute hemorrhagic stroke.
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Affiliation(s)
- Yuanwei Wang
- 1. Department of Neurology, The Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang, Jiangsu, China
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18
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Bergeret S, Queneau M, Rodallec M, Landeau B, Chetelat G, Hong YT, Dumurgier J, Hugon J, Paquet C, Farid K, Baron JC. Brain Glucose Metabolism in Cerebral Amyloid Angiopathy: An FDG-PET Study. Stroke 2021; 52:1478-1482. [PMID: 33611942 DOI: 10.1161/strokeaha.120.032905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The in vivo diagnosis of cerebral amyloid angiopathy (CAA) is currently based on the Boston criteria, which largely rely on hemorrhagic features on brain magnetic resonance imaging. Adding to these criteria 18F-fluoro-deoxy-D-glucose (FDG) positron emission tomography, a widely available imaging modality, might improve their accuracy. Here we tested the hypothesis that FDG uptake is reduced in posterior cortical areas, particularly the primary occipital cortex, which pathologically bear the brunt of vascular Aβ deposition. METHODS From a large memory clinic database, we retrospectively included all patients in whom both brain magnetic resonance imaging and FDG positron emission tomography had been obtained as part of routine clinical care and who fulfilled the Boston criteria for probable CAA. None had a history of symptomatic intracerebral hemorrhage. FDG data processing involved (1) spatial normalization to the Montreal Neurology Institute/International Consortium for Brain Mapping 152 space and (2) generation of standardized FDG uptake (relative standardized uptake value; relative to the pons). The relative standardized uptake value data obtained in 13 regions of interest sampling key cortical areas and the cerebellum were compared between the CAA and age-matched control groups using 2 separate healthy subject databases and image-processing pipelines. The presence of significant hypometabolism (2-tailed P<0.05) was assessed for the bilaterally averaged regions-of-interest relative standardized uptake values. RESULTS Fourteen patients fulfilling the Boston criteria for probable CAA (≥2 exclusively lobar microbleeds) were identified. Significant hypometabolism (P range, 0.047 to <0.0001) consistently affected the posterior cortical areas, including the superior and inferior parietal, primary visual, lateral occipital, lateral temporal, precuneus, and posterior cingulate regions of interest. The anterior cortical areas were marginally or not significantly hypometabolic, and the cerebellum was spared. CONCLUSIONS Supporting our hypothesis, significant glucose hypometabolism predominantly affected posterior cortical regions, including the visual cortex. These findings from a small sample may have diagnostic implications but require replication in larger prospective studies. In addition, whether they generalize to CAA-related symptomatic intracerebral hemorrhage warrants specific studies.
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Affiliation(s)
- Sébastien Bergeret
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.)
| | - Mathieu Queneau
- Department of Nuclear Medicine (M.Q.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Mathieu Rodallec
- Department of Radiology (M.R.), Centre Cardiologique du Nord, Saint-Denis, France
| | - Brigitte Landeau
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Gaël Chetelat
- INSERM U1237, Université Caen Normandie, France (G.C., B.L.).,CYCERON Biomedical Imaging Platform, Caen, France (G.C., B.L.)
| | - Young T Hong
- Department of Clinical Neurosciences, Wolfson Brain Imaging Centre, University of Cambridge, United Kingdom (Y.T.H.)
| | - Julien Dumurgier
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jacques Hugon
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Claire Paquet
- INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France.,Assistance Publique-Hopitaux de Paris, Cognitive Neurology Center, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Paris, France (J.H., C.P.)
| | - Karim Farid
- Department of Nuclear Medicine, CHU de Martinique, Université des Antilles, Fort-de-France (S.B., K.F.).,INSERM U1144 (J.D., J.H., C.P., K.F.), Université de Paris, France
| | - Jean-Claude Baron
- Department of Neurology, Sainte-Anne Hospital (J.-C.B.), Université de Paris, France.,INSERM U1266 (J.-C.B.), Université de Paris, France
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19
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Lower cerebral perfusion is associated with tau-PET in the entorhinal cortex across the Alzheimer's continuum. Neurobiol Aging 2021; 102:111-118. [PMID: 33765424 DOI: 10.1016/j.neurobiolaging.2021.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/28/2022]
Abstract
Alzheimer's disease (AD) is associated with reduced temporo-parietal cerebral blood flow (CBF). However, a substantial variability in CBF across the clinical spectrum of AD has been reported, possibly due to differences in primary AD pathologies. Here, we assessed CBF (ASL-MRI), tau (AV1451-PET) and amyloid (AV45/FBB-PET) in 156 subjects across the AD continuum. Using mixed-effect regression analyses, we assessed the local associations between amyloid-PET, tau-PET and CBF in a hypothesis-driven way focusing on each pathology's predilection areas. The contribution of Apolipoprotein E (APOE) genotype, and MRI markers of small vessel disease (SVD) to alterations in CBF were assessed as well. Tau-PET was associated with lower CBF in the entorhinal cortex, independent of Aβ. Amyloid-PET was associated with lower CBF in temporo-parietal regions. No associations between MRI markers of SVD and CBF were observed. These results provide evidence that in addition to Aβ, pathologic tau is a major correlate of CBF in early Braak stages, independent of Aβ, APOE genotype and SVD markers.
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20
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Ferro DA, Mutsaerts HJ, Hilal S, Kuijf HJ, Petersen ET, Petr J, van Veluw SJ, Venketasubramanian N, Yeow TB, Biessels GJ, Chen C. Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion. J Cereb Blood Flow Metab 2020; 40:1869-1878. [PMID: 31558107 PMCID: PMC7430096 DOI: 10.1177/0271678x19877403] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = -.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.
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Affiliation(s)
- Doeschka A Ferro
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Henri Jjm Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Saima Hilal
- Department of Radiology and Nuclear Medicine & Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.,Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Esben T Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jan Petr
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Susanne J van Veluw
- Department of Neurology, J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston, USA
| | | | | | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore, Singapore
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21
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Yu C, Lu W, Qiu J, Wang F, Li J, Wang L. Alterations of the Whole Cerebral Blood Flow in Patients With Different Total Cerebral Small Vessel Disease Burden. Front Aging Neurosci 2020; 12:175. [PMID: 32655393 PMCID: PMC7324936 DOI: 10.3389/fnagi.2020.00175] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Cerebral small vessel disease (CSVD) is a common age-related vascular disease of the brain associated with slowly accumulating tissue damage. At present, total CSVD burden score is a commonly used method to evaluate the severity of the disease. Purpose To observe whether global and regional cerebral perfusion is related to total CSVD score and to explore global and regional cerebral blood flow (CBF) changes in patients with different degrees of CSVD. Methods We collected 130 subjects with different total burden score of CSVD (0 point: 33 subjects, 1 point: 39 subjects, 2 points: 24 subjects, 3 points: 24 subjects, 4 points: 10 subjects). Total CSVD burden score was evaluated by clinically routine sequences (T2WI, T2-FLAIR, T1WI, DWI, and SWAN sequence). Global and regional CBF were calculated and correlation analysis was used to investigate the relationship between total CSVD score and CBF of the whole brain and several brain regions. Results The analysis results showed that there was a negative correlation between total CSVD burden score and global CBF (r = −0.33, p = 0.001). Total CSVD burden score also had moderately negative correlations with CBF of almost all the brain regions. Conclusion CSVD is a disease that affects the whole brain. With the increase of total CSVD burden score, the global and regional CBF decreased. The CSVD total burden score could be used to evaluate the overall condition of brain perfusion.
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Affiliation(s)
- Chunyan Yu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Weizhao Lu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Jianfeng Qiu
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
| | - Feng Wang
- The Second Affiliated Hospital of Shandong First Medical University, Tai'an, China
| | | | - Liru Wang
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China
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22
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Cognitive Correlates of MRI-defined Cerebral Vascular Injury and Atrophy in Elderly American Indians: The Strong Heart Study. J Int Neuropsychol Soc 2020; 26:263-275. [PMID: 31791442 PMCID: PMC7083690 DOI: 10.1017/s1355617719001073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE American Indians experience substantial health disparities relative to the US population, including vascular brain aging. Poorer cognitive test performance has been associated with cranial magnetic resonance imaging findings in aging community populations, but no study has investigated these associations in elderly American Indians. METHODS We examined 786 American Indians aged 64 years and older from the Cerebrovascular Disease and its Consequences in American Indians study (2010-2013). Cranial magnetic resonance images were scored for cortical and subcortical infarcts, hemorrhages, severity of white matter disease, sulcal widening, ventricle enlargement, and volumetric estimates for white matter hyperintensities (WMHs), hippocampus, and brain. Participants completed demographic, medical history, and neuropsychological assessments including testing for general cognitive functioning, verbal learning and memory, processing speed, phonemic fluency, and executive function. RESULTS Processing speed was independently associated with the presence of any infarcts, white matter disease, and hippocampal and brain volumes, independent of socioeconomic, language, education, and clinical factors. Other significant associations included general cognitive functioning with hippocampal volume. Nonsignificant, marginal associations included general cognition with WMH and brain volume; verbal memory with hippocampal volume; verbal fluency and executive function with brain volume; and processing speed with ventricle enlargement. CONCLUSIONS Brain-cognition associations found in this study of elderly American Indians are similar to those found in other racial/ethnic populations, with processing speed comprising an especially strong correlate of cerebrovascular disease. These findings may assist future efforts to define opportunities for disease prevention, to conduct research on diagnostic and normative standards, and to guide clinical evaluation of this underserved and overburdened population.
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23
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Watanabe T, Kanzaki Y, Yamauchi Y, Ito T, Nishida Y, Yamamura K, Komori T, Sohmiya K, Hoshiga M. Increased prevalence of cerebral microbleeds in patients with low left ventricular systolic function. Heart Vessels 2020; 35:384-390. [PMID: 31535200 DOI: 10.1007/s00380-019-01503-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/06/2019] [Indexed: 01/05/2023]
Abstract
Gradient-echo T2-star (T2*)-weighted magnetic resonance imaging (MRI) is a sensitive method to detect cerebral microbleeds (CMBs). The presence of CMBs was reported to be a marker of future cardiovascular mortality and is associated with various cardiovascular risk factors, use of antithrombotic drugs, and cognitive dysfunction. However, the relationship between cardiac function and CMBs remains unclear. We investigated the association between cardiac function and presence of CMBs in patients with cardiovascular diseases. This single-center retrospective study included a total of 424 participants (mean age 70 ± 12 years; men 286 (67%); mean left ventricular ejection fraction (LVEF) 61% ± 12%] who underwent echocardiography and brain T2*-weighted MRI within 1 month without neurologic abnormality. CMBs were found in 118 (28%) patients. There was no significant relationship between CMBs and anticoagulant or antiplatelet therapy. LVEF was significantly lower in patients with CMBs than in those without CMBs (59% ± 13% vs. 62% ± 11%, P < 0.05). On multivariate logistic analysis, lower LVEF [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96-1.00; P < 0.05] and age (OR 1.02, 95% CI 1.00-1.05; P < 0.05) were significantly associated with CMBs. The presence of CMBs was frequently observed in the patients with cardiovascular disease and was significantly associated with age and LVEF.
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Affiliation(s)
- Tomohiko Watanabe
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan.
| | - Yohei Yamauchi
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Yusuke Nishida
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | | | - Tsuyoshi Komori
- Department of Radiology, Osaka Medical College, Takatsuki, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan
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24
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Comparison of perihematomal perfusion in deep and lobar intracerebral hemorrhage. Neuroradiology 2019; 62:257-261. [PMID: 31863142 DOI: 10.1007/s00234-019-02331-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Hypoperfusion in the perihematomal rim is common in acute intracerebral hemorrhage (ICH) but its determinants remain incompletely characterized. Despite known biological differences between deep and lobar ICH, the association between ICH location and cerebral perfusion has not been investigated. We tested the hypothesis that perihematomal perfusion differs between deep and lobar ICH. METHODS Prospectively collected cohort of subjects with primary spontaneous ICH undergoing CT perfusion on admission. Cerebral blood flow (CBF), blood volume (CBV), and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. The association between perihematomal perfusion and ICH location was explored with multivariable linear regression. RESULTS A total of 155 patients were enrolled (59 with a lobar bleeding). In univariate analysis, median perihematomal CBF and CBV were lower in lobar ICH compared with deep ICH (23.8 vs 33.4 mL/100 g/min, p = 0.001 and 1.7 vs 2.3 mL/100 g, p = 0.001, respectively). Lobar ICH location remained inversely associated with CBF (β = - 0.17, p = 0.038) and CBV (β = - 0.19, p = 0.023) after adjustment for confounders in linear regression. CONCLUSION Lobar ICH location is inversely related with perihematomal CBF and CBV. Further studies are needed to confirm this association and define the underlying biological mechanisms.
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25
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Reduced Cerebral Blood Flow in the Visual Cortex and Its Correlation With Glaucomatous Structural Damage to the Retina in Patients With Mild to Moderate Primary Open-angle Glaucoma. J Glaucoma 2019; 27:816-822. [PMID: 29952821 DOI: 10.1097/ijg.0000000000001017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Altered ocular and cerebral vascular autoregulation and vasoreactivity have been demonstrated in patients with primary open-angle glaucoma (POAG). In the present study, we investigated the correlations between reduced cerebral blood flow (CBF) in early and higher-tier visual cortical areas and glaucomatous changes in the retinas of patients with mild to moderate POAG. PATIENTS AND METHODS 3-dimensional pseudocontinuous arterial spin labelling magnetic resonance imaging at 3 T was performed in 20 normal controls and 15 mild to moderate POAG patients. Regions of interest were selected based on the Population-Average, Landmark- and Surface-based (PALS) atlas of the human cerebral cortex. Arterial spin labelling-measured CBF values were extracted in the early and higher-tier visual cortical areas and were compared between patients and controls using a 2-sample t test. Pearson correlation analyses were used to assess the correlations between reduced CBF and cup-to-disc ratio, retinal nerve fiber layer thickness, and ganglion cell complex thickness. RESULTS Reduced CBF in early visual cortical areas (V1, V2, and ventral posterior area) and in the higher-tier visual left lateral occipital cortex was presented in mild to moderate POAG patients compared with controls. Furthermore, reduced CBF of the right areas V2 and ventral posterior area was correlated with cup-to-disc ratio, total ganglion cell complex thickness, and average retinal nerve fiber layer thickness. CONCLUSIONS In conclusion, the complex pathologic progress of POAG includes abnormal cerebral perfusion within the visual cortex since the mild to moderate disease stages. The association of cerebral perfusion changes with alterations of the optic disc and the retina may contribute to the early diagnosis of POAG.
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Schreiber S, Wilisch-Neumann A, Schreiber F, Assmann A, Scheumann V, Perosa V, Jandke S, Mawrin C, Carare RO, Werring DJ. Invited Review: The spectrum of age-related small vessel diseases: potential overlap and interactions of amyloid and nonamyloid vasculopathies. Neuropathol Appl Neurobiol 2019; 46:219-239. [PMID: 31386773 DOI: 10.1111/nan.12576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022]
Abstract
Deep perforator arteriopathy (DPA) and cerebral amyloid angiopathy (CAA) are the commonest known cerebral small vessel diseases (CSVD), which cause ischaemic stroke, intracebral haemorrhage (ICH) and vascular cognitive impairment (VCI). While thus far mainly considered as separate entities, we here propose that DPA and CAA share similarities, overlap and interact, so that 'pure' DPA or CAA are extremes along a continuum of age-related small vessel pathologies. We suggest blood-brain barrier (BBB) breakdown, endothelial damage and impaired perivascular β-amyloid (Aβ) drainage are hallmark common mechanisms connecting DPA and CAA. We also suggest a need for new biomarkers (e.g. high-resolution imaging) to deepen understanding of the complex relationships between DPA and CAA.
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Affiliation(s)
- S Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany.,Center for behavioral brain sciences (CBBS), Magdeburg, Germany
| | - A Wilisch-Neumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - F Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - A Assmann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - V Scheumann
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - V Perosa
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - S Jandke
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Germany
| | - C Mawrin
- Department of Neuropathology, Otto-von-Guericke University, Magdeburg, Germany
| | - R O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Abe T, Takao M, Kimura H, Akaji K, Mihara B, Tanahashi N, Kanda T. Cerebral Microbleeds Detected Using 3.0T Magnetic Resonance Imaging in 2,003 Patients with Ischemic or Hemorrhagic Stroke. JMA J 2019; 2:164-173. [PMID: 33615027 PMCID: PMC7889836 DOI: 10.31662/jmaj.2019-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction: Compared with 1.5T magnetic resonance imaging (MRI), using 3.0T MRI makes it easier to detect cerebral microbleeds (CMBs). We used 3.0T MRI to investigate the backgrounds, risk factors, and number and location of CMBs in patients with ischemic or hemorrhagic stroke. Methods: We extracted data on clinical characteristics, risk factors, and number and location of CMBs in 2,003 patients treated between January 2010 and December 2014 within one week of stroke occurrence. We then carried out multivariate analysis of the data. Results: CMBs were present in 1,025 patients. The numbers of CMBs in ischemic stroke and hemorrhagic stroke patients were 9,410 and 6,419, respectively. Patients with CMBs showed significantly higher rates of cognitive impairment (p < 0.001, odds ratio [OR] = 1.514), hypertension (p < 0.001, OR = 3.145), previous history of stroke (p < 0.001, OR = 1.782), and presence of hemorrhagic stroke (p < 0.001, OR = 2.066). The use of antithrombotic medication before the stroke did not affect the incidence of CMBs. In ischemic stroke patients, patients with small vessel occlusion had a significantly greater rate of previous history of hemorrhagic stroke (p = 0.046) and number of patients with CMBs (p < 0.001) than those with cardioembolism. Conclusions: CMBs were well observed in patients with small vessel disease, and hypertension was an important factor in ischemic and hemorrhagic stroke. Antithrombotic medication is not associated with the development of CMBs if adequate antihypertensive therapy is provided.
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Affiliation(s)
- Tetsuya Abe
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masaki Takao
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan.,Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Hiroaki Kimura
- Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Mihara Memorial Hospital, Isesaki, Japan
| | - Ban Mihara
- Department of Neurology, Mihara Memorial Hospital, Isesaki, Japan
| | - Norio Tanahashi
- Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Su N, Liang X, Yao M, Zhou LX, Wang Q, Jin ZY, Zhang SY, Cui LY, Gong G, Zhu YC, Ni J. Cerebral Microbleeds Correlated with White Matter and Hippocampal Volumes in Community-Dwelling Populations. J Alzheimers Dis 2019; 71:559-567. [PMID: 31424402 DOI: 10.3233/jad-190454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Few studies have investigated the correlation between cerebral microbleeds (CMBs), a hemorrhagic imaging marker of cerebral small vessel disease (CSVD), and brain volume. OBJECTIVE We investigated the association between the burden and locations of CMBs and brain volume in community-dwelling populations. METHODS Data were obtained from 1,029 participants who underwent brain magnetic resonance imaging (MRI) and APOE genotyping. Volumes of the whole brain, subcortical white matter (WM), cortical gray matter (GM), and hippocampus were extracted. Linear regression models were used to investigate the relationship between the CMB burden and their location with structural changes. RESULTS Regarding burden, participants with≥3 CMBs had significantly lower whole brain (β= -1.124, p = 0.0133), subcortical WM (β= -1.020, p = 0.0043), and hippocampus (β= -0.015, p = 0.0088) volumes than those without CMBs. Regarding location and burden, the presence of≥3 strictly lobar CMBs was negatively associated with whole brain volume (β= -2.838, p = 0.0088). Additionally, higher CMB burdens in strictly lobar locations or deep/mixed locations were associated with lower subcortical WM volume (β= -1.689, p = 0.0482; β= -0.872, p = 0.0464, respectively). Finally, the presence of≥3 deep/mixed CMBs was associated with lower hippocampus volume (β= -0.018, p = 0.0088), and these associations were independent of other ischemic markers of CSVD. However, the CMB burden and distributional pattern did not correlate with cortical GM volumes. CONCLUSION A higher CMB burden, in specific locations, is associated with decreased brain volumes in community-dwelling populations.
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Affiliation(s)
- Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Liang
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Xin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Wang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gaolang Gong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Staffaroni AM, Cobigo Y, Elahi FM, Casaletto KB, Walters SM, Wolf A, Lindbergh CA, Rosen HJ, Kramer JH. A longitudinal characterization of perfusion in the aging brain and associations with cognition and neural structure. Hum Brain Mapp 2019; 40:3522-3533. [PMID: 31062904 PMCID: PMC6693488 DOI: 10.1002/hbm.24613] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 01/01/2023] Open
Abstract
Cerebral perfusion declines across the lifespan and is altered in the early stages of several age-related neuropathologies. Little is known, however, about the longitudinal evolution of perfusion in healthy older adults, particularly when perfusion is quantified using magnetic resonance imaging with arterial spin labeling (ASL). The objective was to characterize longitudinal perfusion in typically aging adults and elucidate associations with cognition and brain structure. Adults who were functionally intact at baseline (n = 161, ages 47-89) underwent ASL imaging to quantify whole-brain gray matter perfusion; a subset (n = 136) had repeated imaging (average follow-up: 2.3 years). Neuropsychological testing at each visit was summarized into executive function, memory, and processing speed composites. Global gray matter volume, white matter microstructure (mean diffusivity), and white matter hyperintensities were also quantified. We assessed baseline associations among perfusion, cognition, and brain structure using linear regression, and longitudinal relationships using linear mixed effects models. Greater baseline perfusion, particularly in the left dorsolateral prefrontal cortex and right thalamus, was associated with better executive functions. Greater whole-brain perfusion loss was associated with worsening brain structure and declining processing speed. This study helps validate noninvasive MRI-based perfusion imaging and underscores the importance of cerebral blood flow in cognitive aging.
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Affiliation(s)
- Adam M. Staffaroni
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Yann Cobigo
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Fanny M. Elahi
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Kaitlin B. Casaletto
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Samantha M. Walters
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Amy Wolf
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Cutter A. Lindbergh
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Howard J. Rosen
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
| | - Joel H. Kramer
- Department of Neurology, Memory and Aging CenterUniversity of California at San Francisco (UCSF)San FranciscoCalifornia
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30
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Chen YC, Wei XE, Lu J, Qiao RH, Shen XF, Li YH. Correlation Between the Number of Lenticulostriate Arteries and Imaging of Cerebral Small Vessel Disease. Front Neurol 2019; 10:882. [PMID: 31456742 PMCID: PMC6699475 DOI: 10.3389/fneur.2019.00882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/30/2019] [Indexed: 01/22/2023] Open
Abstract
Background and purpose: Hypoperfusion plays an important role in the pathophysiology of cerebral small vessel disease (SVD). Lenticulostriate arteries (LSAs) are some of the most important cerebral arterial small vessels. This study aimed to investigate whether the number of LSAs was associated with the cerebral perfusion in SVD patients and determine the correlation between the number of LSAs and SVD severity. Methods: Five hundred and ninety-four consecutive patients who underwent digital subtraction angiography were enrolled in this study. The number of LSAs was determined. Computed tomography perfusion (CTP) was used to calculate the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). Magnetic resonance imaging (MRI) was performed to assess cerebral infarct, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), enlarged perivascular spaces (EPVSs), and lacunes. An SVD compound score was calculated to express the level of cerebral SVD load. Results: The SVD scores were negatively correlated with the number of the LSAs (P < 0.001, rs = −0.44). The number of LSAs was inversely associated with the presence of any type of SVD (P < 0.001). The adjusted ORs of the SVD severity were 0.31 for LSA group 1 (LSA > 20) vs. group 2 (LSA = 10–20) and 0.47 for LSA group 2 (LSA = 10–20) vs. group 3 (LSA < 10). MTT and TTP were significantly higher and CBF was significantly lower when the number of LSAs was between 5 and 10 on each side of the basal ganglia (P < 0.001, <0.001, and <0.001, respectively). The CBV was slightly lower when the number of LSAs was between 5 and 10, while it was significantly lower when the number was <5 on each side of the basal ganglia (P < 0.05, <0.0001, respectively). Conclusion: LSA count was lower in SVD patients than the non-SVD participants and there was a positive correlation between the cerebral perfusion and the number of LSAs. The LSA number was negatively associated with SVD severity, hypoperfusion might play an important role. This finding may have potentially important clinical implications for monitoring LSA in SVD patients.
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Affiliation(s)
- Yuan-Chang Chen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Er Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Lu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui-Hua Qiao
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xue-Feng Shen
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Hua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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31
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Graff-Radford J, Arenaza-Urquijo EM, Knopman DS, Schwarz CG, Brown RD, Rabinstein AA, Gunter JL, Senjem ML, Przybelski SA, Lesnick T, Ward C, Mielke MM, Lowe VJ, Petersen RC, Kremers WK, Kantarci K, Jack CR, Vemuri P. White matter hyperintensities: relationship to amyloid and tau burden. Brain 2019; 142:2483-2491. [PMID: 31199475 PMCID: PMC6658846 DOI: 10.1093/brain/awz162] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/02/2019] [Accepted: 04/18/2019] [Indexed: 01/10/2023] Open
Abstract
Although white matter hyperintensities have traditionally been viewed as a marker of vascular disease, recent pathology studies have found an association between white matter hyperintensities and Alzheimer's disease pathologies. The objectives of this study were to investigate the topographic patterns of white matter hyperintensities associated with Alzheimer's disease biomarkers measured using PET. From the population-based Mayo Clinic Study of Aging, 434 participants without dementia (55% male) with FLAIR and gradient recall echo MRI, tau-PET (AV-1451) and amyloid-PET scans were identified. A subset had cerebral microbleeds detected on T2* gradient recall echo scans. White matter hyperintensities were semi-automatically segmented using FLAIR MRI in participant space and normalized to a custom template. We used statistical parametric mapping 12-based, voxel-wise, multiple-regression analyses to detect white matter hyperintense regions associated with Alzheimer's biomarkers (global amyloid from amyloid-PET and meta-regions of interest tau uptake from tau-PET) after adjusting for age, sex and hypertension. For amyloid associations, we additionally adjusted for tau and vice versa. Topographic patterns of amyloid-associated white matter hyperintensities included periventricular white matter hyperintensities (frontal and parietal lobes). White matter hyperintense volumes in the detected topographic pattern correlated strongly with lobar cerebral microbleeds (P < 0.001, age and sex adjusted Cohen's d = 0.703). In contrast, there were no white matter hyperintense regions significantly associated with increased tau burden using voxel-based analysis or region-specific analysis. Among non-demented elderly, amyloid load correlated with a topographic pattern of white matter hyperintensities. Further, the amyloid-associated, white matter hyperintense regions strongly correlated with lobar cerebral microbleeds suggesting that cerebral amyloid angiopathy contributes to the relationship between amyloid and white matter hyperintensities. The study did not support an association between increased tau burden and white matter hyperintense burden.
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Affiliation(s)
| | | | - David S Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Scott A Przybelski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Timothy Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Chadwick Ward
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
Purpose of Review This review summarizes recent literature linking Alzheimer's disease (AD) and late life depression (LLD). It describes shared neurobiological features associated with both conditions, as well as factors that may increase resilience to onset and severity of cognitive decline and AD. Finally, we pose a number of future research directions toward improving detection, management, and treatment of both conditions. Recent Findings Epidemiological studies have consistently shown a significant relationship between LLD and AD, with support for depression as a prodromal feature of AD, a risk factor for AD, and observation of some shared risk factors underlying both disease processes. Three major neurobiological features shared by LLD and AD include neurodegeneration, disruption to cerebrovascular functioning, and increased levels of neuroinflammation. There are also potentially modifiable factors that can increase resilience to AD and LLD, including social support, physical and cognitive engagement, and cognitive reserve. Summary We propose that, in the context of depression, neurobiological events, such as neurodegeneration, cerebrovascular disease, and neuroinflammation result in a brain that is more vulnerable to the consequences of the pathophysiological features of AD, lowering the threshold for the onset of the behavioral presentation of AD (i.e., cognitive decline and dementia). We discuss factors that can increase resilience to AD and LLD, including social support, physical and cognitive engagement, and cognitive reserve. We conclude with a discussion of future research directions.
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Bergeron S, Chen Y, Auger F, Deguil J, Durieux N, Skrobala E, Barus R, Potey C, Cordonnier C, Pasquier F, Ravasi L, Bordet R, Gautier S. Role of cortical microbleeds in cognitive impairment: In vivo behavioral and imaging characterization of a novel murine model. J Cereb Blood Flow Metab 2019; 39:1015-1025. [PMID: 29333917 PMCID: PMC6547192 DOI: 10.1177/0271678x17752765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral microbleeds (CMBs) could contribute to cognitive impairment in the general population and in patients with dementia. We designed a study to (i) develop a murine model of CMBs, (ii) assess whether CMBs affect cognition in this model and (iii) assess whether this model is sensitive to pharmacological modulation. Male C57Bl6/J mice were stereotactically administered collagenase to induce cortical lesion analysed by MRI at 24 h. CMB-mice were assessed at six weeks post-lesion for cognitive performances (Barnes maze and Touchscreen automated paired-associated learning (PAL) task) and for cerebral metabolism (in vivo PET/CT with fluorodeoxyglucose (FDG)). CMB-model sensitivity to pharmacological modulation was assessed by administering atorvastatin (5 mg/kg/day) over the follow-up period. CMB mice were compared to naïve littermates. Collagenase at 0.8 µU/µl appeared suitable to induce reproducible and reliable CMBs. At six weeks, a decline in learning, spatial and visuospatial memory was significantly observed in CMB-mice. Brain metabolism was impaired in all cortex, striatum and the ipsilateral dentate gyrus. A significant improvement in cognition performances was depicted under atorvastatin. In this novel murine model of CMBs, we validated that CMBs lowered cognitive performances and affected regional metabolism. We also proved that this CMB-model is sensitive to pharmacological modulation.
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Affiliation(s)
- Sandrine Bergeron
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Yaohua Chen
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Florent Auger
- 2 Univ. Lille, Inserm, CHU Lille, In Vivo Imaging Core Facility, Lille, France
| | - Julie Deguil
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Nicolas Durieux
- 2 Univ. Lille, Inserm, CHU Lille, In Vivo Imaging Core Facility, Lille, France
| | - Emilie Skrobala
- 3 Univ. Lille Labex DISTALZ, CHU Lille, Biostatistics Platform, and memory clinic, Lille, France
| | - Romain Barus
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Camille Potey
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Charlotte Cordonnier
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Florence Pasquier
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Laura Ravasi
- 2 Univ. Lille, Inserm, CHU Lille, In Vivo Imaging Core Facility, Lille, France
| | - Régis Bordet
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Sophie Gautier
- 1 Univ. Lille, Inserm, CHU Lille, Degenerative and Vascular Cognitive Disorders, Lille, France
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Wang YW, Zhang GM. New Silent Cerebral Infarction in Patients with Acute Non-Cerebral Amyloid Angiopathy Intracerebral Hemorrhage as a Predictor of Recurrent Cerebrovascular Events. Med Sci Monit 2019; 25:418-426. [PMID: 30640895 PMCID: PMC6342061 DOI: 10.12659/msm.914423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the incidence and related risk factors of new silent cerebral infarction in patients with acute non-cerebral amyloid angiopathy (non-CAA) intracerebral hemorrhage (ICH) and to explore clinical cerebrovascular event recurrence within 1 year. MATERIAL AND METHODS This prospective study observed 152 patients with non-CAA ICH diagnosed by computed tomography within 3 days after onset. All patients underwent magnetic resonance imaging on day 14 to identify silent cerebral infarction, and their subsequent clinical cerebrovascular events were followed up regularly within 1 year. RESULTS Of the 152 patients, 46 (30.26%) had silent cerebral infarctions. Multiple logistic regression analysis revealed that the white blood cell (WBC) count, cerebral microbleeds (CMBs), and leukoaraiosis were silent cerebral infarction risk factors. At 1-year follow-up, 34 (22.37%) had clinical cerebrovascular events, with 8 (23.53%) having vascular-related deaths. Multiple logistic regression analysis showed that silent cerebral infarction was the only independent predictor of future clinical cerebrovascular events. CONCLUSIONS Silent cerebral infarction is common during acute non-CAA ICH and is independently related to WBC counts, CMBs, and leukoaraiosis. The risk of clinical cerebrovascular events in non-CAA ICH patients with silent cerebral infarction increases in the following year; thus, silent cerebral infarction may be a useful predictor of recurrent cerebrovascular events.
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Affiliation(s)
- Yuan-Wei Wang
- Department of Neurology, Shuyang People's Hospital, Shuyang Hospital Affiliated to Xuzhou Medical University, Shuyang, Jiangsu, China (mainland)
| | - Guo-Ming Zhang
- Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang Hospital Affiliated to Xuzhou Medical University, Shuyang, Jiangsu, China (mainland)
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35
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Woodward NC, Haghani A, Johnson RG, Hsu TM, Saffari A, Sioutas C, Kanoski SE, Finch CE, Morgan TE. Prenatal and early life exposure to air pollution induced hippocampal vascular leakage and impaired neurogenesis in association with behavioral deficits. Transl Psychiatry 2018; 8:261. [PMID: 30498214 PMCID: PMC6265287 DOI: 10.1038/s41398-018-0317-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/08/2018] [Accepted: 11/13/2018] [Indexed: 01/12/2023] Open
Abstract
Exposure to traffic-related air pollution (TRAP) is associated with a range of neurodevelopmental disorders in human populations. In rodent models, prenatal TRAP exposure increased depressive behaviors and increased brain microglial activity. To identify cellular mechanisms, we examined adult neurogenesis and the blood-brain barrier (BBB) in relation to cognition and motivated behaviors in rats that were exposed to a nano-sized TRAP subfraction from gestation into adulthood. At age 5 months, exposed male rats had 70% fewer newly generated neurons in the dentate gyrus (DG) of the hippocampus. Microglia were activated in DG and CA1 subfields (35% more Iba1). The BBB was altered, with a 75% decrease of the tight junction protein ZO-1 in the CA1 layer, and twofold more iron deposits, a marker of microhemorrhages. The exposed rats had impaired contextual memory (novel object in context), reduced food-seeking behavior, and increased depressive behaviors (forced swim). Deficits of de novo neurogenesis were inversely correlated with depressive behavior, whereas increased microbleeds were inversely correlated with deficits in contextual memory. These findings give the first evidence that prenatal and early life exposure to TRAP impairs adult hippocampal neurogenesis and increases microbleeds in association with behavioral deficits.
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Affiliation(s)
- N. C. Woodward
- 0000 0001 2156 6853grid.42505.36Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA
| | - A. Haghani
- 0000 0001 2156 6853grid.42505.36Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA
| | - R. G. Johnson
- 0000 0001 2156 6853grid.42505.36Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA
| | - T. M. Hsu
- 0000 0001 2156 6853grid.42505.36Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA USA ,0000 0001 2156 6853grid.42505.36Neuroscience Program, University of Southern California, Los Angeles, CA USA
| | - A. Saffari
- 0000 0001 2156 6853grid.42505.36Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA
| | - C. Sioutas
- 0000 0001 2156 6853grid.42505.36Viterbi School of Engineering, University of Southern California, Los Angeles, CA USA
| | - S. E. Kanoski
- 0000 0001 2156 6853grid.42505.36Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, CA USA ,0000 0001 2156 6853grid.42505.36Neuroscience Program, University of Southern California, Los Angeles, CA USA
| | - C. E. Finch
- 0000 0001 2156 6853grid.42505.36Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA ,0000 0001 2156 6853grid.42505.36Dornsife College, University of Southern California, Los Angeles, CA USA
| | - T. E. Morgan
- 0000 0001 2156 6853grid.42505.36Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA
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Chen X, Wang J, Shan Y, Cai W, Liu S, Hu M, Liao S, Huang X, Zhang B, Wang Y, Lu Z. Cerebral small vessel disease: neuroimaging markers and clinical implication. J Neurol 2018; 266:2347-2362. [PMID: 30291424 DOI: 10.1007/s00415-018-9077-3] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 12/28/2022]
Abstract
Cerebral small vessel disease (CSVD) is a broad category of cerebrovascular diseases which primarily affect the perforating arterioles, capillaries and venules with multiple distinct etiologies. In spite of distinctive pathogenesis, CSVD shares similar neuroimaging markers, including recent small subcortical infarct, lacune of presumed vascular origin, white matter hyperintensity of presumed vascular origin, perivascular space and cerebral microbleeds. The radiological features of neuroimaging markers are indicative for etiological analysis. Furthermore, in sporadic arteriosclerotic pathogenesis associated CSVD, the total CSVD burden is a significant predictor for stroke events, global cognitive impairment, psychiatric disorders and later life quality. This review aims to summarize the radiological characteristics as well as the clinical implication of CSVD markers and neuroimaging interpretation for CSVD symptomatology.
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Affiliation(s)
- Xiaodong Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Jihui Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tian He Road, Guangzhou, 510630, Guangdong, China
| | - Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Sanxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Mengyan Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Siyuan Liao
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Xuehong Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, 510630, Guangdong, China.
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The presence of cerebral microbleeds is associated with cognitive impairment in Parkinson's disease. J Neurol Sci 2018; 393:39-44. [DOI: 10.1016/j.jns.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 01/08/2023]
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Wang R, Laveskog A, Laukka EJ, Kalpouzos G, Bäckman L, Fratiglioni L, Qiu C. MRI load of cerebral microvascular lesions and neurodegeneration, cognitive decline, and dementia. Neurology 2018; 91:e1487-e1497. [PMID: 30232255 PMCID: PMC6202944 DOI: 10.1212/wnl.0000000000006355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/12/2018] [Indexed: 12/03/2022] Open
Abstract
Objective To explore the differential associations of neurodegeneration and microvascular lesion load with cognitive decline and dementia in older people and the modifying effect of the APOE genotype on these associations. Methods A sample of 436 participants (age ≥ 60 years) was derived from the population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, and clinically examined at baseline (2001–2003) and 3 occasions during the 9-year follow-up. At baseline, we assessed microvascular lesion load using a summary score for MRI markers of lacunes, white matter hyperintensities (WMHs), and perivascular spaces and neurodegeneration load for markers of enlarged ventricles, smaller hippocampus, and smaller gray matter. We assessed cognitive function using the Mini-Mental State Examination (MMSE) test and diagnosed dementia following the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. We analyzed data using linear mixed-effects, mediation, and random-effects Cox models. Results During the follow-up, 46 participants were diagnosed with dementia. Per 1-point increase in microvascular lesion and neurodegeneration score (range 0–3) was associated with multiple adjusted β-coefficients of −0.35 (95% confidence interval, −0.51 to −0.20) and −0.44 (−0.56 to −0.32), respectively, for the MMSE score and multiple adjusted hazard ratios of 1.68 (1.12–2.51) and 2.35 (1.58–3.52), respectively, for dementia; carrying APOE ε4 reinforced the associations with MMSE decline. WMH volume changes during the follow-up mediated 66.9% and 12.7% of the total association of MMSE decline with the baseline microvascular score and neurodegeneration score, respectively. Conclusions Both cerebral microvascular lesion and neurodegeneration loads are strongly associated with cognitive decline and dementia. The cognitive decline due to microvascular lesions is exacerbated by APOE ε4 and is largely attributed to progression and development of microvascular lesions.
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Affiliation(s)
- Rui Wang
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden.
| | - Anna Laveskog
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Erika J Laukka
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Grégoria Kalpouzos
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Lars Bäckman
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Laura Fratiglioni
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden
| | - Chengxuan Qiu
- From the Department of Neurobiology (R.W., E.J.L., G.K., L.B., L.F., C.Q.), Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University; Division of Radiology (A.L.), Department of Clinical Science, Intervention and Technology, Karolinska University Hospital at Huddinge; Department of Neuroradiology (A.L.), Karolinska University Hospital, Stockholm; and Stockholm Gerontology Research Center (L.F.), Stockholm, Sweden.
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Zhang N, Gordon ML, Ma Y, Chi B, Gomar JJ, Peng S, Kingsley PB, Eidelberg D, Goldberg TE. The Age-Related Perfusion Pattern Measured With Arterial Spin Labeling MRI in Healthy Subjects. Front Aging Neurosci 2018; 10:214. [PMID: 30065646 PMCID: PMC6056623 DOI: 10.3389/fnagi.2018.00214] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/25/2018] [Indexed: 01/12/2023] Open
Abstract
Aim: To analyze age-related cerebral blood flow (CBF) using arterial spin labeling (ASL) MRI in healthy subjects with multivariate principal component analysis (PCA). Methods: 50 healthy subjects (mean age 45.8 ± 18.5 years, range 21-85) had 3D structural MRI and pseudo-continuous ASL MRI at resting state. The relationship between CBF and age was examined with voxel-based univariate analysis using multiple regression and two-sample t-test (median age 41.8 years as a cut-off). An age-related CBF pattern was identified using multivariate PCA. Results: Age correlated negatively with CBF especially anteriorly and in the cerebellum. After adjusting by global value, CBF was relatively decreased with aging in certain regions and relatively increased in others. The age-related CBF pattern showed relative reductions in frontal and parietal areas and cerebellum, and covarying increases in temporal and occipital areas. Subject scores of this pattern correlated negatively with age (R2 = 0.588; P < 0.001) and discriminated between the older and younger subgroups (P < 0.001). Conclusion: A distinct age-related CBF pattern can be identified with multivariate PCA using ASL MRI.
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Affiliation(s)
- Nan Zhang
- The Litwin-Zucker Research Center, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Marc L. Gordon
- The Litwin-Zucker Research Center, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hofstra University, Hepstead, NY, United States
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Bradley Chi
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hofstra University, Hepstead, NY, United States
| | - Jesus J. Gomar
- The Litwin-Zucker Research Center, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Shichun Peng
- Center for Neurosciences, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Peter B. Kingsley
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hofstra University, Hepstead, NY, United States
- Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, NY, United States
| | - David Eidelberg
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hofstra University, Hepstead, NY, United States
- Center for Neurosciences, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Terry E. Goldberg
- The Litwin-Zucker Research Center, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hofstra University, Hepstead, NY, United States
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Joris PJ, Mensink RP, Adam TC, Liu TT. Cerebral Blood Flow Measurements in Adults: A Review on the Effects of Dietary Factors and Exercise. Nutrients 2018; 10:nu10050530. [PMID: 29693564 PMCID: PMC5986410 DOI: 10.3390/nu10050530] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
Improving cerebrovascular function may be a key mechanism whereby a healthy lifestyle, of which a healthy diet combined with increased physical activity levels is a cornerstone, protects against cognitive impairments. In this respect, effects on cerebral blood flow (CBF)—a sensitive physiological marker of cerebrovascular function—are of major interest. This review summarizes the impact of specific dietary determinants and physical exercise on CBF in adults and discusses the relation between these effects with potential changes in cognitive function. A limited number of randomized controlled trials have already demonstrated the beneficial effects of an acute intake of nitrate and polyphenols on CBF, but evidence for a relationship between these effects as well as improvements in cognitive functioning is limited. Moreover, long-term trans-resveratrol supplementation has been shown to increase CBF in populations at increased risk of accelerated cognitive decline. Long-term supplementation of n-3 long-chain polyunsaturated fatty acids may also increase CBF, but related effects on cognitive performance have not yet been found. Significant decreases in cerebral perfusion were observed by commonly consumed amounts of caffeine, while alcohol intake was shown to increase CBF in a dose-dependent way. However, the long-term effects are not clear. Finally, long-term exercise training may be a promising approach to improve CBF, as increases in perfusion may contribute to the beneficial effects on cognitive functioning observed following increased physical activity levels.
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Affiliation(s)
- Peter J Joris
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands.
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands.
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands.
| | - Thomas T Liu
- Center for Functional Magnetic Resonance Imaging (MRI), University of California San Diego, La Jolla, CA 92093-0677, USA.
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Tang J, Zhen Y, Yu L, Lv C, Zheng J, Liang H. Analyzing the neuropsychological characteristics and changes in serum markers of patients with chronic cerebral circulation insufficiency. Rev Assoc Med Bras (1992) 2018; 64:41-46. [PMID: 29561941 DOI: 10.1590/1806-9282.64.01.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/16/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the neuropsychological characteristics and changes in CRP, S100B, MBP, HSP-7, and NSE in serum. METHOD Sixty-six (66) patients treated in our hospital as CCCI group were chosen for our study, and 90 patients with depression were selected as the depression group. The patients in both groups were examined with CT perfusion, depression, anxiety and cognition evaluation. Their serum CRP, S100B, MBP, HSP-70 and NSE levels were detected. Neuropsychological and serum markers characteristics were compared. RESULTS The CBF and CBV in bilateral basal ganglia, frontal lobes, greater oval center, brain stem, and left and right regions of occipital lobes of the patients in CCCI group were significantly lower than in the depression group. The HAMD and HAMA scores of CCCI group patients were significantly lower than in the depression group; CCCI group performed better regarding attention, memory, abstract terms and delayed recall. CCCI also had significantly higher total scores than the depression group. Serum CRP, S100B, MBP, HSP-70 and NSE levels in CCCI group were significantly higher than in the depression group. The differences reach statistical significance (p<0.05). CONCLUSION CCCI patients who are accompanied by minor depressive disorder have different degrees of cognitive impairment and experience a significant rise in serum CRP, S100B, MBP, HSP-70 and NSE.
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Affiliation(s)
- Jianhua Tang
- Department of Neurology, Yantaishan Hospital, Yantai, China
| | - Yuqing Zhen
- Department of Neurology, Yantaishan Hospital, Yantai, China
| | - Ling Yu
- Department of Neurology, Yantaishan Hospital, Yantai, China
| | - Cui Lv
- Department of Neurology, Yantaishan Hospital, Yantai, China
| | - Juan Zheng
- Department of Neurology, Yantaishan Hospital, Yantai, China
| | - Hui Liang
- Department of Neurology, Yantaishan Hospital, Yantai, China
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Zhu H, Li Z, Lv J, Zhao R. Effects of cerebral small vessel disease on the outcome of patients with ischemic stroke caused by large artery atherosclerosis. Neurol Res 2018. [PMID: 29543130 DOI: 10.1080/01616412.2018.1446283] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Hui Zhu
- Medical College, Qingdao University, Qingdao, China
| | - Zhixing Li
- Medical College, Qingdao University, Qingdao, China
| | - Jinglei Lv
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Renliang Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Daou MAZ, Boyd BD, Donahue MJ, Albert K, Taylor WD. Anterior-posterior gradient differences in lobar and cingulate cortex cerebral blood flow in late-life depression. J Psychiatr Res 2018; 97:1-7. [PMID: 29156413 PMCID: PMC5742550 DOI: 10.1016/j.jpsychires.2017.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/10/2017] [Accepted: 11/10/2017] [Indexed: 02/08/2023]
Abstract
Vascular pathology is common in late-life depression, contributing to changes in cerebral function. We examined whether late-life depression was associated with differences in cerebral blood flow (CBF) and whether such differences were related to vascular risk and cerebrovascular pathology, specifically white matter hyperintensity (WMH) volumes. Twenty-three depressed elders and 20 age- and sex-matched elders with no psychiatric history completed cranial 3T MRI. MRI procedures included a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition obtained while on room air and during a hypercapnia challenge allowing for calculation of cerebrovascular reactivity (CVR). Brain segmentation identified frontal, temporal, parietal and cingulate sub-regions in which CBF and CVR were calculated. The depressed group exhibited an anterior-posterior gradient in CBF, with lower CBF throughout the frontal lobe but higher CBF in the parietal lobe, temporal lobe, thalamus and hippocampus. A similar anterior to posterior gradient was observed in the cingulate cortex, with anterior regions exhibiting lower CBF and posterior regions exhibiting higher CBF. We did not observe any group differences in CVR measures. We did not observe significant relationships between CBF and CVR with vascular risk or WMH volumes, aside from an isolated finding associating higher WMH volumes with lower CBF in the rostral anterior cingulate cortex. Decreased anterior CBF in depressed elders might reflect decreased metabolic activity in these regions, while increased posterior CBF may represent either compensatory processes or different activity of posterior intrinsic functional networks. Future work should examine how these findings are related to compensatory changes with aging.
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Affiliation(s)
- Margarita Abi Zeid Daou
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Brian D. Boyd
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Manus J. Donahue
- The Department of Radiology and Radiological Science, Vanderbilt
University Medical Center, Nashville, TN, 37212, USA
| | - Kimberly Albert
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Warren D. Taylor
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA,Geriatric Research, Education and Clinical Center, Department of
Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN,
37212, USA
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Akoudad S, Gurol ME, Fotiadis P, Koudstaal PJ, Hofman A, Ikram MA, Greenberg SM, Vernooij MW. Cerebral Microbleeds and Cerebrovascular Reactivity in the General Population: The EDAN Study. J Alzheimers Dis 2018; 53:497-503. [PMID: 27163807 DOI: 10.3233/jad-151130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND In patients with symptomatic cerebral amyloid angiopathy (CAA), cerebrovascular reactivity to visual stimuli is reduced. Lobar microbleeds are a diagnostic hallmark of CAA, but are also highly prevalent in asymptomatic individuals. Recent data suggest that the latter group might have CAA. OBJECTIVE We investigated whether cerebrovascular reactivity is impaired in asymptomatic individuals with lobar microbleeds. METHODS From the population-based Rotterdam Study, we invited 35 participants with lobar microbleeds and 15 age-matched controls (all≥55 years) for functional MRI (fMRI) as part of the Early Detection of Angiopathy Network (EDAN) Study. Cerebrovascular reactivity parameters (i.e., amplitude and time to peak responses) were assessed in response to visual stimulation using fMRI. Student's t-test and linear regression were used to compare fMRI parameters in participants with and without microbleeds. RESULTS Amplitude and time to peak responses did not differ between participants with and without microbleeds (respectively, p = 0.179 and p = 0.555). Participants with microbleeds had slightly higher amplitude responses compared to participants without microbleeds. After excluding individuals with mixed microbleeds (i.e., lobar and non-lobar microbleeds), we found no significant difference in cerebrovascular reactivity for persons with a single microbleed or multiple microbleeds compared to persons without microbleeds. CONCLUSIONS In the general population, lobar microbleeds may not relate to impaired cerebrovascular reactivity. In asymptomatic individuals, lobar microbleeds may either reflect less advanced CAA pathology insufficient to cause functional vascular impairment, or reflect vascular pathology other than CAA.
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Affiliation(s)
- Saloua Akoudad
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M Edip Gurol
- Department of Neurology, Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Panagiotis Fotiadis
- Department of Neurology, Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Steven M Greenberg
- Department of Neurology, Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, the Netherlands.,Department of Radiology, Erasmus MC University Medical Center Rotterdam, the Netherlands
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Ding J, Sigurðsson S, Jónsson PV, Eiriksdottir G, Charidimou A, Lopez OL, van Buchem MA, Guðnason V, Launer LJ. Large Perivascular Spaces Visible on Magnetic Resonance Imaging, Cerebral Small Vessel Disease Progression, and Risk of Dementia: The Age, Gene/Environment Susceptibility-Reykjavik Study. JAMA Neurol 2017; 74:1105-1112. [PMID: 28715552 DOI: 10.1001/jamaneurol.2017.1397] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance With advancing age, an increased visibility of perivascular spaces (PVSs) on magnetic resonance imaging (MRI) is hypothesized to represent impaired drainage of interstitial fluid from the brain and may reflect underlying cerebral small vessel disease (SVD). However, whether large perivascular spaces (L-PVSs) (>3 mm in diameter) visible on MRI are associated with SVD and cognitive deterioration in older individuals is unknown. Objective To examine whether L-PVSs are associated with the progression of the established MRI markers of SVD, cognitive decline, and increased risk of dementia. Design, Setting, and Participants The prospective, population-based Age, Gene/Environment Susceptibility-Reykjavik Study assessed L-PVSs at baseline (September 1, 2002, through February 28, 2006) on MRI studies of the brain in 2612 participants. Participants returned for additional MRI from April 1, 2007, through September 30, 2011, and underwent neuropsychological testing at the 2 time points a mean (SD) of 5.2 (0.2) years apart. Data analysis was conducted from August 1, 2016, to May 4, 2017. Exposures The presence, number, and location of L-PVSs. Main Outcomes and Measures Incident subcortical infarcts, cerebral microbleeds, and progression of white matter hyperintensities detected on MRI; cognitive decline defined as composite score changes between baseline and follow-up in the domains of memory, information processing speed, and executive function; and adjudicated incident dementia cases diagnosed according to international guidelines. Results Of the 2612 study patients (mean [SD] age, 74.6 [4.8] years; 1542 [59.0%] female), 424 had L-PVSs and 2188 did not. The prevalence of L-PVSs was 16.2% (median number of L-PVSs, 1; range, 1-17). After adjusting for age, sex, and interval between baseline and follow-up scanning, the presence of L-PVSs was significantly associated with an increased risk of incident subcortical infarcts (adjusted risk ratio, 2.54; 95% CI, 1.76-3.68) and microbleeds (adjusted risk ratio, 1.43; 95% CI, 1.18-1.72) and a greater 5-year progression of white matter hyperintensity volume. The presence of L-PVSs was also associated with a steeper decline in information processing speed and more than quadrupled the risk of vascular dementia. All associations persisted when further adjusted for genetic and cerebrovascular risk factors. The associations with cognitive outcomes were independent of educational level, depression, and other SVD MRI markers. Conclusions and Relevance Large PVSs are an MRI marker of SVD and associated with the pathogenesis of vascular-related cognitive impairment in older individuals. Large PVSs should be included in assessments of vascular cognitive impairment in the older population and as potential targets for interventions.
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Affiliation(s)
- Jie Ding
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
| | | | - Pálmi V Jónsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Vilmundur Guðnason
- Icelandic Heart Association, Kopavogur, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
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Williams RJ, Goodyear BG, Peca S, McCreary CR, Frayne R, Smith EE, Pike GB. Identification of neurovascular changes associated with cerebral amyloid angiopathy from subject-specific hemodynamic response functions. J Cereb Blood Flow Metab 2017; 37:3433-3445. [PMID: 28145796 PMCID: PMC5624392 DOI: 10.1177/0271678x17691056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cerebral amyloid angiopathy (CAA) is a small-vessel disease preferentially affecting posterior brain regions. Recent evidence has demonstrated the efficacy of functional MRI in detecting CAA-related neurovascular injury, however, it is unknown whether such perturbations are associated with changes in the hemodynamic response function (HRF). Here we estimated HRFs from two different brain regions from block design activation data, in light of recent findings demonstrating how block designs can accurately reflect HRF parameter estimates while maximizing signal detection. Patients with a diagnosis of probable CAA and healthy controls performed motor and visual stimulation tasks. Time-to-peak (TTP), full-width at half-maximum (FWHM), and area under the curve (AUC) of the estimated HRFs were compared between groups and to MRI features associated with CAA including cerebral microbleed (CMB) count. Motor HRFs in CAA patients showed significantly wider FWHM ( P = 0.006) and delayed TTP ( P = 0.03) compared to controls. In the patient group, visual HRF FWHM was positively associated with CMB count ( P = 0.03). These findings indicate that hemodynamic abnormalities in patients with CAA may be reflected in HRFs estimated from block designs across different brain regions. Moreover, visual FWHM may be linked to structural MR indications associated with CAA.
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Affiliation(s)
- Rebecca J Williams
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada
| | - Bradley G Goodyear
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Stefano Peca
- 5 Tom Baker Cancer Centre, University of Calgary, Calgary, Canada
| | - Cheryl R McCreary
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Richard Frayne
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Eric E Smith
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - G Bruce Pike
- 1 Department of Radiology, University of Calgary, Calgary, Canada.,2 Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,3 Seaman Family MR Research Centre, Alberta Health Services, Calgary, Canada.,4 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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47
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Li X, Yuan J, Yang L, Qin W, Yang S, Li Y, Fan H, Hu W. The significant effects of cerebral microbleeds on cognitive dysfunction: An updated meta-analysis. PLoS One 2017; 12:e0185145. [PMID: 28934304 PMCID: PMC5608335 DOI: 10.1371/journal.pone.0185145] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 09/07/2017] [Indexed: 01/15/2023] Open
Abstract
Objective Accumulated data suggests that cerebral microbleeds (CMBs) play an important role in the decline of cognitive function, but the results remain inconsistent. In the current study, we aimed to investigate the association between CMBs and cognitive function, as well as the various effects of CMBs on different domains of cognition. Methods We searched through the databases of PubMed, Embase, Cochrane Library, and ScienceDirect. After a consistency test, the publication bias was evaluated and a sensitivity analysis was performed with combined odds ratios (OR) and standardized mean difference (SMD) of CMBs. Results A meta-analysis of 25 studies with 9343 participants total was conducted. Patients with CMBs had higher incidence of cognitive impairment (OR:3.5410; 95% confidence interval [CI] [2.2979, 5.4567], p<0.05) and lower scores of cognitive functions (SMD: -0.2700 [-0.4267, -0.1133], p<0.05 in Mini-Mental State Examination [MMSE] group and -0.4869 [-0.8902, -0.0818], p<0.05 in Montreal Cognitive Assessment [MoCA] group). Our results also indicated that patients with CMBs had obvious decline in cognitive functions, for instance, orientation (SMD: -0.9565 [-1.7260, -0.1869], p<0.05), attention and calculation (SMD: -1.1518 [-1.9553, -0.3484], p<0.05) and delayed recall (SMD: -0.5527 [-1.1043, -0.0011], p = 0.05). Conclusions Our data suggested that CMBs might be an important risk factor for cognitive dysfunction, especially in the domains of orientation, attention and calculation and delayed recall functions. Prospective cohort studies with further investigations will be needed in larger samples.
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Affiliation(s)
- Xuanting Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junliang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Qin
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuna Yang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yue Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huimin Fan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- * E-mail:
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48
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Planton M, Raposo N, Danet L, Albucher JF, Péran P, Pariente J. Impact of spontaneous intracerebral hemorrhage on cognitive functioning: An update. Rev Neurol (Paris) 2017; 173:481-489. [PMID: 28838790 DOI: 10.1016/j.neurol.2017.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/26/2017] [Accepted: 06/16/2017] [Indexed: 12/22/2022]
Abstract
Intracerebral hemorrhage (ICH) accounts for 15% of all strokes and approximately 50% of stroke-related mortality and disability worldwide. Patients who have experienced ICH are at high risk of negative outcome, including stroke and cognitive disorders. Vascular cognitive impairment are frequently seen after brain hemorrhage, yet little is known about them, as most studies have focused on neuropsychological outcome in ischemic stroke survivors, using well-documented acute and chronic cognitive scores. However, recent evidence supports the notion that ICH and dementia are closely related and each increases the risk of the other. The location of the lesion also plays a significant role as regards the neuropsychological profile, while the pathophysiology of ICH can indicate a specific pattern of dysfunction. Several cognitive domains may be affected, such as language, memory, executive function, processing speed and gnosis.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France.
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - L Danet
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - P Péran
- Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, place Dr-Baylac, pavillon Baudot, 31024 Toulouse cedex 3, France; Toulouse NeuroImaging Centre, université de Toulouse, Inserm, UPS, 31000 Toulouse, France
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Abstract
Cerebral amyloid angiopathy is a condition of the cerebral arterioles and to a lesser extent capillaries and veins, wherein beta-amyloid is deposited. In arterioles, this preferentially targets vascular smooth muscle cells and in the later stages undermines the stability of the vessel. This condition is frequently comorbid with Alzheimer's disease and its role in cognitive impairment and dementia is a topic of considerable recent research. This article reviews recent literature which confirms that CAA independently contributes to cognitive impairment by potentiating the neurodegeneration of Alzheimer's disease, by predisposing to microhemorrhagic and microischemic injury to the brain parenchyma, and by interfering with the autoregulation of CNS blood flow. In this review, we discuss the clinical presentation of cerebral amyloid angiopathy, with a focus on the neuropsychological manifestations of this vasculopathy.
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Affiliation(s)
- Matthew Schrag
- Dept of Neurology, Vanderbilt University School of Medicine, 1301 Medical Center Dr, TVC Neurology Suite, Nashville, TN, 37232, USA
| | - Howard Kirshner
- Dept of Neurology, Vanderbilt University School of Medicine, 1301 Medical Center Dr, TVC Neurology Suite, Nashville, TN, 37232, USA.
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50
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Wolters FJ, Zonneveld HI, Hofman A, van der Lugt A, Koudstaal PJ, Vernooij MW, Ikram MA. Cerebral Perfusion and the Risk of Dementia: A Population-Based Study. Circulation 2017; 136:719-728. [PMID: 28588075 DOI: 10.1161/circulationaha.117.027448] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/02/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cerebral hypoperfusion has previously been associated with mild cognitive impairment and dementia in various cross-sectional studies, but whether hypoperfusion precedes neurodegeneration is unknown. We prospectively determined the association of cerebral perfusion with subsequent cognitive decline and development of dementia. METHODS Between 2005 and 2012, we measured cerebral blood flow by 2-dimensional phase-contrast magnetic resonance imaging in participants of the population-based Rotterdam Study without dementia. We determined the association of cerebral perfusion (mL/100mL/min) with risk of dementia (until 2015) using a Cox model, adjusting for age, sex, demographics, cardiovascular risk factors, and apolipoprotein E genotype. We repeated analyses for Alzheimer disease and accounting for stroke. We used linear regression to determine change in cognitive performance during 2 consecutive examination rounds in relation to perfusion. Finally, we investigated whether associations were modified by baseline severity of white matter hyperintensities. RESULTS Of 4759 participants (median age 61.3 years, 55.2% women) with a median follow-up of 6.9 years, 123 participants developed dementia (97 Alzheimer disease). Lower cerebral perfusion was associated with higher risk of dementia (adjusted hazard ratio, 1.31; 95% confidence interval per standard deviation decrease, 1.07-1.61), similar for Alzheimer disease only, and unaltered by accounting for stroke. Risk of dementia with hypoperfusion was higher with increasing severity of white matter hyperintensities (with severe white matter hyperintensities; hazard ratio, 1.54; 95% confidence interval, 1.11-2.14). At cognitive reexamination after on average 5.7 years, lower baseline perfusion was associated with accelerated decline in cognition (global cognition: β=-0.029, P=0.003), which was similar after excluding those with incident dementia, and again most profound in individuals with higher volume of white matter hyperintensities (P value for interaction=0.019). CONCLUSIONS Cerebral hypoperfusion is associated with accelerated cognitive decline and an increased risk of dementia in the general population.
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Affiliation(s)
- Frank J Wolters
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - Hazel I Zonneveld
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - Albert Hofman
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - Aad van der Lugt
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - Peter J Koudstaal
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - Meike W Vernooij
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.)
| | - M Arfan Ikram
- From Department of Epidemiology (F.J.W., H.I.Z., A.H., M.W.V., M.A.I.), Department of Neurology (F.J.W., P.J.K., M.A.I.), Department of Radiology and Nuclear Medicine (H.I.Z., A.v.d.L., M.W.V., M.A.I.), Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (F.J.W., A.H.).
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