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Kapoor A, Dutt S, Alitin JPM, Sible IJ, Marshall A, Shenasa F, Engstrom AC, Gaubert A, Shao X, Bradford DR, Rodgers K, Mather M, Wang DJJ, Nation DA. Older adults with reduced cerebrovascular reactivity exhibit high white matter hyperintensity burden. Neurobiol Aging 2024; 139:5-10. [PMID: 38579393 DOI: 10.1016/j.neurobiolaging.2024.03.006] [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: 12/12/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
Cerebrovascular reactivity (CVR) deficits may contribute to small vessel disease, such as white matter hyperintensities (WMH). Moreover, apolipoprotein-e4 (APOE4) carriers at genetic risk for Alzheimer's disease exhibit cerebrovascular dysfunction relative to non-carriers. We examined whether older adults, and APOE4 carriers specifically, with diminished CVR would exhibit higher WMH burden. Independently living older adults (N = 125, mean age = 69.2 years; SD = 7.6; 31.2% male) free of dementia or clinical stroke underwent brain MRI to quantify cerebral perfusion during CVR to hypercapnia and hypocapnia and determine WMH volume. Adjusting for age, sex and intracranial volume, hierarchical regression analysis revealed a significant association between whole brain CVR to hypercapnia and WMH overall [B = -.02, 95% CI (-.04, -.008), p =.003] and in APOE4 carriers [B = -.03, 95% CI (-.06, -.009), p =.009]. Findings suggest deficits in cerebral vasodilatory capacity are associated with WMH burden in older adults and future studies are warranted to further delineate the effect of APOE4 on precipitating WMH.
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Affiliation(s)
- Arunima Kapoor
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Shubir Dutt
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - John Paul M Alitin
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Isabel J Sible
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Anisa Marshall
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Fatemah Shenasa
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Allison C Engstrom
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Aimée Gaubert
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Xingfeng Shao
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - David Robert Bradford
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, Department of Pharmacology, University of Arizona, Tucson, AZ, USA
| | - Mara Mather
- University of Southern California Leonard Davis School of Gerontology, USA
| | - Danny J J Wang
- Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- University of Southern California Leonard Davis School of Gerontology, USA; Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, University of Southern California Keck School of Medicine, USA.
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Dupré N, Drieu A, Joutel A. Pathophysiology of cerebral small vessel disease: a journey through recent discoveries. J Clin Invest 2024; 134:e172841. [PMID: 38747292 PMCID: PMC11093606 DOI: 10.1172/jci172841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
Cerebral small vessel disease (cSVD) encompasses a heterogeneous group of age-related small vessel pathologies that affect multiple regions. Disease manifestations range from lesions incidentally detected on neuroimaging (white matter hyperintensities, small deep infarcts, microbleeds, or enlarged perivascular spaces) to severe disability and cognitive impairment. cSVD accounts for approximately 25% of ischemic strokes and the vast majority of spontaneous intracerebral hemorrhage and is also the most important vascular contributor to dementia. Despite its high prevalence and potentially long therapeutic window, there are still no mechanism-based treatments. Here, we provide an overview of the recent advances in this field. We summarize recent data highlighting the remarkable continuum between monogenic and multifactorial cSVDs involving NOTCH3, HTRA1, and COL4A1/A2 genes. Taking a vessel-centric view, we discuss possible cause-and-effect relationships between risk factors, structural and functional vessel changes, and disease manifestations, underscoring some major knowledge gaps. Although endothelial dysfunction is rightly considered a central feature of cSVD, the contributions of smooth muscle cells, pericytes, and other perivascular cells warrant continued investigation.
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Affiliation(s)
- Nicolas Dupré
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Antoine Drieu
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Anne Joutel
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, Paris, France
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Pacholko A, Iadecola C. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension 2024; 81:991-1007. [PMID: 38426329 PMCID: PMC11023809 DOI: 10.1161/hypertensionaha.123.21356] [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] [Indexed: 03/02/2024]
Abstract
Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.
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Affiliation(s)
- Anthony Pacholko
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
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Van Den Brink H, Pham S, Siero JC, Arts T, Onkenhout L, Kuijf H, Hendrikse J, Wardlaw JM, Dichgans M, Zwanenburg JJ, Biessels GJ. Assessment of Small Vessel Function Using 7T MRI in Patients With Sporadic Cerebral Small Vessel Disease: The ZOOM@SVDs Study. Neurology 2024; 102:e209136. [PMID: 38497722 PMCID: PMC11067699 DOI: 10.1212/wnl.0000000000209136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/07/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral small vessel disease (cSVD) is a major cause of stroke and dementia, but little is known about disease mechanisms at the level of the small vessels. 7T-MRI allows assessing small vessel function in vivo in different vessel populations. We hypothesized that multiple aspects of small vessel function are altered in patients with cSVD and that these abnormalities relate to disease burden. METHODS Patients and controls participated in a prospective observational cohort study, the ZOOM@SVDs study. Small vessel function measures on 7T-MRI included perforating artery blood flow velocity and pulsatility index in the basal ganglia and centrum semiovale, vascular reactivity to visual stimulation in the occipital cortex, and reactivity to hypercapnia in the gray and white matter. Lesion load on 3T-MRI and cognitive function were used to assess disease burden. RESULTS Forty-six patients with sporadic cSVD (mean age ± SD 65 ± 9 years) and 22 matched controls (64 ± 7 years) participated in the ZOOM@SVDs study. Compared with controls, patients had increased pulsatility index (mean difference 0.09, p = 0.01) but similar blood flow velocity in basal ganglia perforating arteries and similar flow velocity and pulsatility index in centrum semiovale perforating arteries. The duration of the vascular response to brief visual stimulation in the occipital cortex was shorter in patients than in controls (mean difference -0.63 seconds, p = 0.02), whereas reactivity to hypercapnia was not significantly affected in the gray and total white matter. Among patients, reactivity to hypercapnia was lower in white matter hyperintensities compared with normal-appearing white matter (blood-oxygen-level dependent mean difference 0.35%, p = 0.001). Blood flow velocity and pulsatility index in basal ganglia perforating arteries and reactivity to brief visual stimulation correlated with disease burden. DISCUSSION We observed abnormalities in several aspects of small vessel function in patients with cSVD indicative of regionally increased arteriolar stiffness and decreased reactivity. Worse small vessel function also correlated with increased disease burden. These functional measures provide new mechanistic markers of sporadic cSVD.
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Affiliation(s)
- Hilde Van Den Brink
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Stanley Pham
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jeroen C Siero
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Tine Arts
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Laurien Onkenhout
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Hugo Kuijf
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jeroen Hendrikse
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Joanna M Wardlaw
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Martin Dichgans
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Jaco J Zwanenburg
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
| | - Geert Jan Biessels
- From the Department of Neurology and Neurosurgery (H.V.D.B., L.O., G.J.B.), UMC Utrecht Brain Center; Department of Radiology (S.P., J.C.S., T.A., J.H., J.J.Z.), Center for Image Sciences, University Medical Center Utrecht; Spinoza Centre for Neuroimaging Amsterdam (J.C.S.); Image Sciences Institute (H.K.), University Medical Center Utrecht, the Netherlands; Brain Research Imaging Centre (J.M.W.), Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre at the University of Edinburgh, United Kingdom; Institute for Stroke and Dementia Research (M.D.), University Hospital, LMU Munich; Munich Cluster for Systems Neurology (SyNergy) (M.D.); and German Center for Neurodegenerative Disease (DZNE) (M.D.), Germany
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Hoogeveen ES, Pelzer N, Ghariq E, van Osch MJP, Dahan A, Terwindt GM, Kruit MC. Cerebrovascular reactivity to hypercapnia in patients with migraine: A dual-echo arterial spin labeling MRI study. Headache 2024; 64:276-284. [PMID: 38429974 DOI: 10.1111/head.14680] [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: 05/31/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE This study aimed to compare cerebrovascular reactivity between patients with migraine and controls using state-of-the-art magnetic resonance imaging (MRI) techniques. BACKGROUND Migraine is associated with an increased risk of cerebrovascular disease, but the underlying mechanisms are still not fully understood. Impaired cerebrovascular reactivity has been proposed as a link. Previous studies have evaluated cerebrovascular reactivity with different methodologies and results are conflicting. METHODS In this single-center, observational, case-control study, we included 31 interictal patients with migraine without aura (aged 19-66 years, 17 females) and 31 controls (aged 22-64 years, 18 females) with no history of vascular disease. Global and regional cerebrovascular reactivities were assessed with a dual-echo arterial spin labeling (ASL) 3.0 T MRI scan of the brain which measured the change in cerebral blood flow (CBF) and BOLD (blood oxygen level dependent) signal to inhalation of 5% carbon dioxide. RESULTS When comparing patients with migraine to controls, cerebrovascular reactivity values were similar between the groups, including mean gray matter CBF-based cerebrovascular reactivity (3.2 ± 0.9 vs 3.4 ± 1% ΔCBF/mmHg CO2 ; p = 0.527), mean gray matter BOLD-based cerebrovascular reactivity (0.18 ± 0.04 vs 0.18 ± 0.04% ΔBOLD/mmHg CO2 ; p = 0.587), and mean white matter BOLD-based cerebrovascular reactivity (0.08 ± 0.03 vs 0.08 ± 0.02% ΔBOLD/mmHg CO2 ; p = 0.621).There was no association of cerebrovascular reactivity with monthly migraine days or migraine disease duration (all analyses p > 0.05). CONCLUSION Cerebrovascular reactivity to carbon dioxide seems to be preserved in patients with migraine without aura.
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Affiliation(s)
- E S Hoogeveen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N Pelzer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Ghariq
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology and Nuclear Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M J P van Osch
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M C Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Johnson BJ, Lipford ME, Barcus RA, Olson JD, Schaaf GW, Andrews RN, Kim J, Dugan GO, Deycmar S, Reed CA, Whitlow CT, Cline JM. Assessing cerebrovascular reactivity (CVR) in rhesus macaques (Macaca mulatta) using a hypercapnic challenge and pseudo-continuous arterial spin labeling (pCASL). Neuroimage 2024; 285:120491. [PMID: 38070839 PMCID: PMC10842457 DOI: 10.1016/j.neuroimage.2023.120491] [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: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
Cerebrovascular reactivity (CVR) is a measure of cerebral small vessels' ability to respond to changes in metabolic demand and can be quantified using magnetic resonance imaging (MRI) coupled with a vasoactive stimulus. Reduced CVR occurs with neurodegeneration and is associated with cognitive decline. While commonly measured in humans, few studies have evaluated CVR in animal models. Herein, we describe methods to induce hypercapnia in rhesus macaques (Macaca mulatta) under gas anesthesia to measure cerebral blood flow (CBF) and CVR using pseudo-continuous arterial spin labeling (pCASL). Fifteen (13 M, 2 F) adult rhesus macaques underwent pCASL imaging that included a baseline segment (100% O2) followed by a hypercapnic challenge (isoflurane anesthesia with 5% CO2, 95% O2 mixed gas). Relative hypercapnia was defined as an end-tidal CO2 (ETCO2) ≥5 mmHg above baseline ETCO2. The mean ETCO2 during the baseline segment of the pCASL sequence was 34 mmHg (range: 23-48 mmHg). During this segment, mean whole-brain CBF was 51.48 ml/100g/min (range: 21.47-77.23 ml/100g/min). Significant increases (p<0.0001) in ETCO2 were seen upon inspiration of the mixed gas (5% CO2, 95% O2). The mean increase in ETCO2 was 8.5 mmHg and corresponded with a mean increase in CBF of 37.1% (p<0.0001). The mean CVR measured was 4.3%/mmHg. No anesthetic complications occurred as a result of the CO2 challenge. Our methods were effective at inducing a state of relative hypercapnia that corresponds with a detectable increase in whole brain CBF using pCASL MRI. Using these methods, a CO2 challenge can be performed in conjunction with pCASL imaging to evaluate CBF and CVR in rhesus macaques. The measured CVR in rhesus macaques is comparable to human CVR highlighting the translational utility of rhesus macaques in neuroscience research. These methods present a feasible means to measure CVR in comparative models of neurodegeneration and cerebrovascular dysfunction.
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Affiliation(s)
- Brendan J Johnson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States.
| | - Megan E Lipford
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biomedical Engineering, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Richard A Barcus
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - John D Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - George W Schaaf
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Rachel N Andrews
- Department of Radiation Oncology, Section on Radiation Biology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Jeongchul Kim
- Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Greg O Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Simon Deycmar
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Colin A Reed
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - Christopher T Whitlow
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Radiology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biomedical Engineering, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Biostatistics and Data Science, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
| | - J Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States; Department of Radiation Oncology, Section on Radiation Biology, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, United States
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7
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Scheuermann BC, Parr SK, Schulze KM, Kunkel ON, Turpin VG, Liang J, Ade CJ. Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032616. [PMID: 37930079 PMCID: PMC10727345 DOI: 10.1161/jaha.123.032616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta-analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS). METHODS AND RESULTS MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta-analyses performed using inverse-variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta-analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta-analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99-5.14]; P=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15-1.33]; P<0.01). Meta-regression adjusted for comorbidities accounted for one-third of the AS model variance (R2=29.4%, Pmoderators=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18-1.70]; P<0.01). CONCLUSIONS The collective findings of the present systematic review and meta-analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
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Affiliation(s)
| | - Shannon K. Parr
- Department of KinesiologyKansas State UniversityManhattanKSUSA
| | | | | | | | - Jia Liang
- Department of Biostatistics, St. Jude Children’s Research HospitalMemphisTNUSA
| | - Carl J. Ade
- Department of KinesiologyKansas State UniversityManhattanKSUSA
- Department of Physician’s Assistant Studies, Kansas State UniversityManhattanKSUSA
- Johnson Cancer Research CenterKansas State UniversityManhattanKSUSA
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Adeniyi PA, Gong X, MacGregor E, Degener-O’Brien K, McClendon E, Garcia M, Romero O, Russell J, Srivastava T, Miller J, Keene CD, Back SA. Ferroptosis of Microglia in Aging Human White Matter Injury. Ann Neurol 2023; 94:1048-1066. [PMID: 37605362 PMCID: PMC10840747 DOI: 10.1002/ana.26770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Because the role of white matter (WM) degenerating microglia (DM) in remyelination failure is unclear, we sought to define the core features of this novel population of aging human microglia. METHODS We analyzed postmortem human brain tissue to define a population of DM in aging WM lesions. We used immunofluorescence staining and gene expression analysis to investigate molecular mechanisms related to the degeneration of DM. RESULTS We found that DM, which accumulated myelin debris were selectively enriched in the iron-binding protein light chain ferritin, and accumulated PLIN2-labeled lipid droplets. DM displayed lipid peroxidation injury and enhanced expression for TOM20, a mitochondrial translocase, and a sensor of oxidative stress. DM also displayed enhanced expression of the DNA fragmentation marker phospho-histone H2A.X. We identified a unique set of ferroptosis-related genes involving iron-mediated lipid dysmetabolism and oxidative stress that were preferentially expressed in WM injury relative to gray matter neurodegeneration. INTERPRETATION Ferroptosis appears to be a major mechanism of WM injury in Alzheimer's disease and vascular dementia. WM DM are a novel therapeutic target to potentially reduce the impact of WM injury and myelin loss on the progression of cognitive impairment. ANN NEUROL 2023;94:1048-1066.
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Affiliation(s)
- Philip A. Adeniyi
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Xi Gong
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Ellie MacGregor
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Kiera Degener-O’Brien
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Evelyn McClendon
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Mariel Garcia
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Oscar Romero
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Joshua Russell
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Taasin Srivastava
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeremy Miller
- Allen Institute for Brain Science, Seattle, Washington, USA
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Stephen A. Back
- Departments of Pediatrics and, Oregon Health & Science University, Portland, Oregon, USA
- Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Gorelick PB, Sorond FA. Advancing our knowledge about cerebral small vessel diseases. Lancet Neurol 2023; 22:972-973. [PMID: 37863595 DOI: 10.1016/s1474-4422(23)00318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Philip B Gorelick
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Farzaneh A Sorond
- Division of Stroke and Neurocritical Care, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Kopczak A, Stringer MS, van den Brink H, Kerkhofs D, Blair GW, van Dinther M, Reyes CA, Garcia DJ, Onkenhout L, Wartolowska KA, Thrippleton MJ, Kampaite A, Duering M, Staals J, Lesnik-Oberstein S, Muir KW, Middeke M, Norrving B, Bousser MG, Mansmann U, Rothwell PM, Doubal FN, van Oostenbrugge R, Biessels GJ, Webb AJS, Wardlaw JM, Dichgans M. Effect of blood pressure-lowering agents on microvascular function in people with small vessel diseases (TREAT-SVDs): a multicentre, open-label, randomised, crossover trial. Lancet Neurol 2023; 22:991-1004. [PMID: 37863608 DOI: 10.1016/s1474-4422(23)00293-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Hypertension is the leading risk factor for cerebral small vessel disease. We aimed to determine whether antihypertensive drug classes differentially affect microvascular function in people with small vessel disease. METHODS We did a multicentre, open-label, randomised crossover trial with blinded endpoint assessment at five specialist centres in Europe. We included participants aged 18 years or older with symptomatic sporadic small vessel disease or cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and an indication for antihypertensive treatment. Participants were randomly assigned (1:1:1) to one of three sequences of antihypertensive treatment using a computer-generated multiblock randomisation, stratified by study site and patient group. A 2-week washout period was followed by three 4-week periods of oral monotherapy with amlodipine, losartan, or atenolol at approved doses. The primary endpoint was change in cerebrovascular reactivity (CVR) determined by blood oxygen level-dependent MRI response to hypercapnic challenge in normal-appearing white matter from the end of washout to the end of each treatment period. Efficacy analyses were done by intention-to-treat principles in all randomly assigned participants who had at least one valid assessment for the primary endpoint, and analyses were done separately for participants with sporadic small vessel disease and CADASIL. This trial is registered at ClinicalTrials.gov, NCT03082014, and EudraCT, 2016-002920-10, and is terminated. FINDINGS Between Feb 22, 2018, and April 28, 2022, 75 participants with sporadic small vessel disease (mean age 64·9 years [SD 9·9]) and 26 with CADASIL (53·1 years [7·0]) were enrolled and randomly assigned to treatment. 79 participants (62 with sporadic small vessel disease and 17 with CADASIL) entered the primary efficacy analysis. Change in CVR did not differ between study drugs in participants with sporadic small vessel disease (mean change in CVR 1·8 × 10-4%/mm Hg [SE 20·1; 95% CI -37·6 to 41·2] for amlodipine; 16·7 × 10-4%/mm Hg [20·0; -22·3 to 55·8] for losartan; -7·1 × 10-4%/mm Hg [19·6; -45·5 to 31·1] for atenolol; poverall=0·39) but did differ in patients with CADASIL (15·7 × 10-4%/mm Hg [SE 27·5; 95% CI -38·3 to 69·7] for amlodipine; 19·4 × 10-4%/mm Hg [27·9; -35·3 to 74·2] for losartan; -23·9 × 10-4%/mm Hg [27·5; -77·7 to 30·0] for atenolol; poverall=0·019). In patients with CADASIL, pairwise comparisons showed that CVR improved with amlodipine compared with atenolol (-39·6 × 10-4%/mm Hg [95% CI -72·5 to -6·6; p=0·019) and with losartan compared with atenolol (-43·3 × 10-4%/mm Hg [-74·3 to -12·3]; p=0·0061). No deaths occurred. Two serious adverse events were recorded, one while taking amlodipine (diarrhoea with dehydration) and one while taking atenolol (fall with fracture), neither of which was related to study drug intake. INTERPRETATION 4 weeks of treatment with amlodipine, losartan, or atenolol did not differ in their effects on cerebrovascular reactivity in people with sporadic small vessel disease but did result in differential treatment effects in patients with CADASIL. Whether antihypertensive drug classes differentially affect clinical outcomes in people with small vessel diseases requires further research. FUNDING EU Horizon 2020 programme.
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Affiliation(s)
- Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Michael S Stringer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hilde van den Brink
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Danielle Kerkhofs
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gordon W Blair
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Maud van Dinther
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Carmen Arteaga Reyes
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Laurien Onkenhout
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karolina A Wartolowska
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Julie Staals
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | | | - Keith W Muir
- School of Psychology and Neuroscience, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Martin Middeke
- Hypertoniezentrum München, Excellence Centre of the European Society of Hypertension, Munich, Germany
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | | | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Robert van Oostenbrugge
- Department of Neurology and School for Cardiovascular Diseases, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alastair J S Webb
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; German Centre for Cardiovascular Research, Munich, Germany.
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11
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Hannawi Y. Cerebral Small Vessel Disease: a Review of the Pathophysiological Mechanisms. Transl Stroke Res 2023:10.1007/s12975-023-01195-9. [PMID: 37864643 DOI: 10.1007/s12975-023-01195-9] [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: 06/02/2023] [Revised: 06/02/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
Cerebral small vessel disease (cSVD) refers to the age-dependent pathological processes involving the brain small vessels and leading to vascular cognitive impairment, intracerebral hemorrhage, and acute lacunar ischemic stroke. Despite the significant public health burden of cSVD, disease-specific therapeutics remain unavailable due to the incomplete understanding of the underlying pathophysiological mechanisms. Recent advances in neuroimaging acquisition and processing capabilities as well as findings from cSVD animal models have revealed critical roles of several age-dependent processes in cSVD pathogenesis including arterial stiffness, vascular oxidative stress, low-grade systemic inflammation, gut dysbiosis, and increased salt intake. These factors interact to cause a state of endothelial cell dysfunction impairing cerebral blood flow regulation and breaking the blood brain barrier. Neuroinflammation follows resulting in neuronal injury and cSVD clinical manifestations. Impairment of the cerebral waste clearance through the glymphatic system is another potential process that has been recently highlighted contributing to the cognitive decline. This review details these mechanisms and attempts to explain their complex interactions. In addition, the relevant knowledge gaps in cSVD mechanistic understanding are identified and a systematic approach to future translational and early phase clinical research is proposed in order to reveal new cSVD mechanisms and develop disease-specific therapeutics.
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Affiliation(s)
- Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University, 333 West 10th Ave, Graves Hall 3172C, Columbus, OH, 43210, USA.
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12
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Zhang Y, Chang P, Liu N, Jiang Y, Chu Y, Du W, Lin L, Gao B, Li Y, Qu M, Yang C, Miao Y. Correlation between lenticulostriate arteries and white matter microstructure changes in patients with cerebral small vessel disease. Front Neurosci 2023; 17:1202538. [PMID: 37817799 PMCID: PMC10560852 DOI: 10.3389/fnins.2023.1202538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 10/12/2023] Open
Abstract
To explore the correlation between the number of lenticulostriate arteries (LSAs) and the white matter features in cerebral small vessel diseases (CSVD) by 3T magnetic resonance imaging (MRI). Seventy-one patients with diagnoses of CSVD were prospectively enrolled to undergo 3T MRI examination, including high-resolution vascular wall imaging (VWI) and diffusion tensor imaging (DTI). The LSAs were observed and counted on VWI, and the patients were divided into three groups according to the LSA counts. The presence of white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS) was assessed in each patient, and a composite CSVD score was calculated. Periventricular and deep white matter hyperintensity (PVWMH, DWMH) volume ratios were obtained based on automatic segmentation. Fractional anisotropy (FA) and mean diffusivity (MD) were processed by using tract-based spatial statistics (TBSS) analysis. These parameters were compared among the three groups. Correlations between the LSA counts and white matter features were also analyzed. There were differences in WMHs (P = 0.001), CMBs (P < 0.001), EPVS (P = 0.017), composite CSVD scores (P < 0.001), PVWMH volume ratios (P = 0.001), DWMH volume ratios (P < 0.001), global FA (P = 0.001), and global MD (P = 0.002) among the three groups. There were correlations between the LSA counts and WMHs (r = -0.45, P < 0.001), CMBs (r = -0.44, P < 0.001), EPVS (r = -0.28, P = 0.020), the composite CSVD score (r = -0.52, P < 0.001), DWMH volume ratio (r = -0.47, P < 0.001), PWMH volume ratio (r = -0.34, P = 0.004), global FA (r = 0.36, P = 0.002), and global MD (r = -0.33, P = 0.005). Diabetes mellitus (OR 3.36, 95% CI 1.06-10.63; P = 0.039) and increased DWMH volume ratios (OR 1.04, 95% CI 1.00-1.08; P = 0.048) were independent risk factors for a decrease in LSA counts. TBSS analysis showed differences among the three groups in global FA and MD after adjusting for age and sex (P < 0.05). The LSA counts was associated with white matter microstructure changes in CSVD and has the potential to represent the extent of subcortical microvascular damage in CSVD patients.
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Affiliation(s)
- Yukun Zhang
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Peipei Chang
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Na Liu
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yuhan Jiang
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Ying Chu
- Department of Neurology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Wei Du
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | | | - Bingbing Gao
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yuan Li
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Mingrui Qu
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Chao Yang
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - YanWei Miao
- Department of Radiology, The First Affiliated Hospital, Dalian Medical University, Dalian, China
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13
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Marchena-Romero KJ, Ji X, Sommer R, Centen A, Ramirez J, Poulin JM, Mikulis D, Thrippleton M, Wardlaw J, Lim A, Black SE, MacIntosh BJ. Examining temporal features of BOLD-based cerebrovascular reactivity in clinical populations. Front Neurol 2023; 14:1199805. [PMID: 37396759 PMCID: PMC10310960 DOI: 10.3389/fneur.2023.1199805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background Conventional cerebrovascular reactivity (CVR) estimation has demonstrated that many brain diseases and/or conditions are associated with altered CVR. Despite the clinical potential of CVR, characterization of temporal features of a CVR challenge remains uncommon. This work is motivated by the need to develop CVR parameters that characterize individual temporal features of a CVR challenge. Methods Data were collected from 54 adults and recruited based on these criteria: (1) Alzheimer's disease diagnosis or subcortical Vascular Cognitive Impairment, (2) sleep apnea, and (3) subjective cognitive impairment concerns. We investigated signal changes in blood oxygenation level dependent (BOLD) contrast images with respect to hypercapnic and normocapnic CVR transition periods during a gas manipulation paradigm. We developed a model-free, non-parametric CVR metric after considering a range of responses through simulations to characterize BOLD signal changes that occur when transitioning from normocapnia to hypercapnia. The non-parametric CVR measure was used to examine regional differences across the insula, hippocampus, thalamus, and centrum semiovale. We also examined the BOLD signal transition from hypercapnia back to normocapnia. Results We found a linear association between isolated temporal features of successive CO2 challenges. Our study concluded that the transition rate from hypercapnia to normocapnia was significantly associated with the second CVR response across all regions of interest (p < 0.001), and this association was highest in the hippocampus (R2 = 0.57, p < 0.0125). Conclusion This study demonstrates that it is feasible to examine individual responses associated with normocapnic and hypercapnic transition periods of a BOLD-based CVR experiment. Studying these features can provide insight on between-subject differences in CVR.
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Affiliation(s)
- Kayley-Jasmin Marchena-Romero
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Xiang Ji
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Rosa Sommer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Andrew Centen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Joel Ramirez
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Joshua M. Poulin
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - David Mikulis
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Michael Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute Centre, The University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Lim
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
| | - Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Toronto, ON, Canada
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14
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Wang L, Lin H, Zhao Z, Chen L, Wu L, Liu T, Li J, Huang CC, Peng Y, Lo CYZ, Gao X. Sex disparity of cerebral white matter hyperintensity in the hypertensive elderly: The Shanghai Changfeng study. Hum Brain Mapp 2023; 44:2099-2108. [PMID: 36583389 PMCID: PMC9980881 DOI: 10.1002/hbm.26196] [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: 04/22/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 12/31/2022] Open
Abstract
White matter hyperintensity (WMH) is associated with vascular hemodynamic alterations and reflects white matter injury. To date, the sex difference of tract-specific WMH and the relationship between high blood pressure (BP) and tract-specific WMH remain unclear. We recruited 515 subjects from the Shanghai Changfeng study (range 53-89 years, mean age 67.33 years). Systolic and diastolic blood pressure (SBP and DBP) were collected and used to calculate pulse pressure (PP). Magnetic resonance T1 and T2 FLAIR images were acquired to measure WMH and calculate WMH index. The ANCOVA test was performed to test the difference between sexes, and the linear regression model was used to examine the associations between BP and WMH index. Men showed higher WMH index than women in all white matter tracts (p < .001, respectively) except for the bilateral superior longitudinal fasciculus (SLF) and its left temporal part (tSLF). High SBP and PP was associated with a lower WMH index on the left corticospinal tract (CST), SLF, tSLF and right cingulum in hippocampus (p ≤ .001, respectively) in women, while high DBP was associated with a higher WMH index on the bilateral CST (left p < .001; right p = .001), left inferior longitudinal fasciculus (p < .001) and inferior fronto-occipital fasciculus (p = .002) in men. Men tend to have more WMH compared to women. A high SBP/PP relates to a lower WMH burden in women. This suggests that women could benefit from higher blood pressure in older age.
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Affiliation(s)
- Liangqi Wang
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,School of Life Sciences, Fudan University, Shanghai, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Zehua Zhao
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lingyan Chen
- Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Wu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Ting Liu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chu-Chung Huang
- School of Psychology and Cognitive Science, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
| | - Yifeng Peng
- Department of Radiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain Inspired Intelligence, Fudan University, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.,Human Phenome Institute, Fudan University, Shanghai, China.,Institute for Metabolic Diseases, Fudan University, Shanghai, China
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15
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He Y, Li Z, Shi X, Ding J, Wang X. Roles of NG2 Glia in Cerebral Small Vessel Disease. Neurosci Bull 2023; 39:519-530. [PMID: 36401147 PMCID: PMC10043141 DOI: 10.1007/s12264-022-00976-w] [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: 04/09/2022] [Accepted: 09/02/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is one of the most prevalent pathologic processes affecting 5% of people over 50 years of age and contributing to 45% of dementia cases. Increasing evidence has demonstrated the pathological roles of chronic hypoperfusion, impaired cerebral vascular reactivity, and leakage of the blood-brain barrier in CSVD. However, the pathogenesis of CSVD remains elusive thus far, and no radical treatment has been developed. NG2 glia, also known as oligodendrocyte precursor cells, are the fourth type of glial cell in addition to astrocytes, microglia, and oligodendrocytes in the mammalian central nervous system. Many novel functions for NG2 glia in physiological and pathological states have recently been revealed. In this review, we discuss the role of NG2 glia in CSVD and the underlying mechanisms.
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Affiliation(s)
- Yixi He
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhenghao Li
- Institute of Neuroscience, MOE Key Laboratory of Molecular Neurobiology, NMU, Shanghai, 200433, China
| | - Xiaoyu Shi
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Xin Wang
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
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Abstract
Cerebral small vessel disease (CSVD) has emerged as a common factor driving age-dependent diseases, including stroke and dementia. CSVD-related dementia will affect a growing fraction of the aging population, requiring improved recognition, understanding, and treatments. This review describes evolving criteria and imaging biomarkers for the diagnosis of CSVD-related dementia. We describe diagnostic challenges, particularly in the context of mixed pathologies and the absence of highly effective biomarkers for CSVD-related dementia. We review evidence regarding CSVD as a risk factor for developing neurodegenerative disease and potential mechanisms by which CSVD leads to progressive brain injury. Finally, we summarize recent studies on the effects of major classes of cardiovascular medicines relevant to CSVD-related cognitive impairment. Although many key questions remain, the increased attention to CSVD has resulted in a sharper vision for what will be needed to meet the upcoming challenges imposed by this disease.
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Affiliation(s)
- Fanny M. Elahi
- Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY
- Neurology Service, VA Bronx Healthcare System, Bronx, NY
| | - Michael M. Wang
- Departments of Neurology and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI
- Neurology Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
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17
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Lee WJ, Jung KH, Song H, Lee H, Park HE, Koh Y, Choi SY, Park KI. Clonal hematopoiesis with DNMT3A mutation is associated with lower white matter hyperintensity volume. CNS Neurosci Ther 2023; 29:1243-1253. [PMID: 36807865 PMCID: PMC10068463 DOI: 10.1111/cns.14114] [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: 06/17/2022] [Revised: 12/22/2022] [Accepted: 01/20/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Clonal hematopoiesis of indeterminate potential (CHIP) increases the risk of cerebrovascular events, while its association with cerebral white matter hyperintensity (WMH) is undemonstrated. We evaluated the effect of CHIP and its major driving mutations on cerebral WMH severity. METHODS From an institutional cohort of a routine health check-up program with a DNA repository database, subjects who were ≥50 years of age, with one or more cardiovascular risk factors but no central nervous system disorder, and performed brain MRI were included. Along with the presence of CHIP and its major driving mutations, clinical and laboratory data were obtained. WMH volume was measured in total, periventricular, and subcortical regions. RESULTS Among the total 964 subjects, 160 subjects were classified as CHIP positive group. CHIP was most frequently associated with DNMT3A mutation (48.8%), followed by TET2 (11.9%) and ASXL1 (8.1%) mutations. Linear regression analysis adjusting for age, sex, and conventional cerebrovascular risk factors suggested that CHIP with DNMT3A mutation was associated with the lower log-transformed total WMH volume, unlike other CHIP mutations. When classified according to variant allele fraction (VAF) value of DNMT3A mutation, higher VAF classes were associated with the lower log-transformed total WMH and the lower log-transformed periventricular WMH volume, but not with the log-transformed subcortical WMH volumes. CONCLUSIONS Clonal hematopoiesis with DNMT3A mutation is quantitatively associated with a lower volume of cerebral WMH, especially in the periventricular region. CHIP with DNMT3A mutation might have a protective role in the endothelial pathomechanism of WMH.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Han Song
- Genome Opinion Inc., Seoul, South Korea
| | - Heesun Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo Eun Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Youngil Koh
- Genome Opinion Inc., Seoul, South Korea.,Division of Hemato-oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Su-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Neurology, Seoul National University Healthcare System Gangnam Center, Seoul, South Korea
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18
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Abstract
Hypertension affects a significant proportion of the adult and aging population and represents an important risk factor for vascular cognitive impairment and late-life dementia. Chronic high blood pressure continuously challenges the structural and functional integrity of the cerebral vasculature, leading to microvascular rarefaction and dysfunction, and neurovascular uncoupling that typically impairs cerebral blood supply. Hypertension disrupts blood-brain barrier integrity, promotes neuroinflammation, and may contribute to amyloid deposition and Alzheimer pathology. The mechanisms underlying these harmful effects are still a focus of investigation, but studies in animal models have provided significant molecular and cellular mechanistic insights. Remaining questions relate to whether adequate treatment of hypertension may prevent deterioration of cognitive function, the threshold for blood pressure treatment, and the most effective antihypertensive drugs. Recent advances in neurovascular biology, advanced brain imaging, and detection of subtle behavioral phenotypes have begun to provide insights into these critical issues. Importantly, a parallel analysis of these parameters in animal models and humans is feasible, making it possible to foster translational advancements. In this review, we provide a critical evaluation of the evidence available in experimental models and humans to examine the progress made and identify remaining gaps in knowledge.
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Affiliation(s)
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Daniela Carnevale
- Department of Molecular Medicine, “Sapienza” University of Rome, Italy
- Research Unit of Neuro and Cardiovascular Pathophysiology, IRCCS Neuromed, Pozzilli, Italy
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19
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Zhang W, Cheng Z, Fu F, Zhan Z. Prevalence and clinical characteristics of white matter hyperintensities in Migraine: A meta-analysis. Neuroimage Clin 2023; 37:103312. [PMID: 36610309 PMCID: PMC9827384 DOI: 10.1016/j.nicl.2023.103312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND Current evidences show an increased risk of white matter hyperintensities (WMHs) in migraineurs compared to age-matched controls. However, WMHs prevalence and the associations between WMHs and clinical characteristics in migraineurs have not been systematically evaluated using a meta-analytical approach. This study explored the pooled prevalence of WMHs and the associations of WMHs with the clinical characteristics in patients with migraine. METHODS A systematic review and meta-analysis of observational studies reporting the occurrence and clinical characteristics of patients with WMHs attributed to migraine was performed. We searched the PubMed, Web of Science, and Embase databases. Random-effects models were used to calculate the pooled prevalence rate, odds ratio (OR), or mean difference (MD) with corresponding 95% confidence intervals (CIs). RESULTS Thirty eligible studies were identified including 3,502 migraineurs aged 37.2 (mean) years. The pooled WMHs prevalence was 44 %, 45 %, and 38 % in migraine, migraine with aura, and migraine without aura groups, respectively. In migraineurs with WMHs, the frontal lobe and subcortical white matter were the most susceptible area. Compared with non-migraine controls, patients with migraine had increased odds for WMHs (OR 4.32, 95 % CI = 2.56-7.28, I2 = 67 %). According to reported univariable results from included studies, pooled analysis showed that clinical characteristics including age, presence of aura, disease duration, hypertension, diabetes mellitus and right-to-left shunt were associated with the presence of WMHs. Migraine pain and aura characteristics were not related to WMHs. CONCLUSIONS These data suggest that WMHs are common in migraine, especially in those who are older or have aura, hypertension, diabetes mellitus, or right-to-left shunt. A better understanding of the WMHs attributed to migraine is needed in future studies.
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Affiliation(s)
- Wenyuan Zhang
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China.
| | - Zicheng Cheng
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenxiang Zhan
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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20
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Hayes G, Pinto J, Sparks SN, Wang C, Suri S, Bulte DP. Vascular smooth muscle cell dysfunction in neurodegeneration. Front Neurosci 2022; 16:1010164. [PMID: 36440263 PMCID: PMC9684644 DOI: 10.3389/fnins.2022.1010164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/24/2022] [Indexed: 09/01/2023] Open
Abstract
Vascular smooth muscle cells (VSMCs) are the key moderators of cerebrovascular dynamics in response to the brain's oxygen and nutrient demands. Crucially, VSMCs may provide a sensitive biomarker for neurodegenerative pathologies where vasculature is compromised. An increasing body of research suggests that VSMCs have remarkable plasticity and their pathophysiology may play a key role in the complex process of neurodegeneration. Furthermore, extrinsic risk factors, including environmental conditions and traumatic events can impact vascular function through changes in VSMC morphology. VSMC dysfunction can be characterised at the molecular level both preclinically, and clinically ex vivo. However the identification of VSMC dysfunction in living individuals is important to understand changes in vascular function at the onset and progression of neurological disorders such as dementia, Alzheimer's disease, and Parkinson's disease. A promising technique to identify changes in the state of cerebral smooth muscle is cerebrovascular reactivity (CVR) which reflects the intrinsic dynamic response of blood vessels in the brain to vasoactive stimuli in order to modulate regional cerebral blood flow (CBF). In this work, we review the role of VSMCs in the most common neurodegenerative disorders and identify physiological systems that may contribute to VSMC dysfunction. The evidence collected here identifies VSMC dysfunction as a strong candidate for novel therapeutics to combat the development and progression of neurodegeneration, and highlights the need for more research on the role of VSMCs and cerebrovascular dynamics in healthy and diseased states.
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Affiliation(s)
- Genevieve Hayes
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Joana Pinto
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Sierra N. Sparks
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Congxiyu Wang
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Sana Suri
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, United Kingdom
| | - Daniel P. Bulte
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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21
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Lee MJ, Park BY, Cho S, Kim S, Park H, Kim ST, Chung CS. Cerebrovascular reactivity and deep white matter hyperintensities in migraine: A prospective CO 2 targeting study. J Cereb Blood Flow Metab 2022; 42:1879-1889. [PMID: 35607990 PMCID: PMC9536123 DOI: 10.1177/0271678x221103006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several studies suggested the association of migraine with deep white matter hyperintensities (WMHs). We aimed to explore the cerebrovascular reactivity (CVR), deep WMH burden, and their association in patients with migraine using a state-of-the-art methodology. A total of 31 patients with migraine without aura and 31 age/sex-matched controls underwent 3T MRI with prospective end-tidal carbon dioxide (CO2) targeting. We quantified deep WMH clusters using an automated segmentation tool and measured voxel-wise CVR by changes in blood oxygen level-dependent signal fitted to subjects' end-tidal CO2. The association of migraine and CVR with the presence of WMH in each voxel and interaction of migraine and CVR on WMH were analysed. Patients had a higher number of deep WMHs than controls (p = 0.015). Migraine and reduced CVR were associated with increased probability of having WMHs in each voxel (adjusted OR 30.78 [95% CI 1.89-500.53], p = 0.016 and adjusted OR 0.30 [0.29-0.32], p < 0.001, respectively). Migraine had an effect modification on CVR on deep WMHs (p for interaction <0.001): i.e. the association between CVR and WMH was greater in patients than in controls. We suggest that the migraine-WMH association can be explained by the effect modification on the CVR.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Bo-Yong Park
- Department of Data Science, Inha University, Incheon, South Korea
| | - Soohyun Cho
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, South Korea.,School of Electronic and Electrical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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22
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Voss MW, Jain S. Getting Fit to Counteract Cognitive Aging: Evidence and Future Directions. Physiology (Bethesda) 2022; 37:0. [PMID: 35001656 PMCID: PMC9191193 DOI: 10.1152/physiol.00038.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Physical activity has shown tremendous promise for counteracting cognitive aging, but also tremendous variability in cognitive benefits. We describe evidence for how exercise affects cognitive and brain aging, and whether cardiorespiratory fitness is a key factor. We highlight a brain network framework as a valuable paradigm for the mechanistic insight needed to tailor physical activity for cognitive benefits.
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Affiliation(s)
- Michelle W. Voss
- 1Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa,2Interdisciplinary Graduate Program in Neuroscience, University of Iowa, Iowa City, Iowa,3Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa
| | - Shivangi Jain
- 1Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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23
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Kuipers S, Overmars LM, van Es B, de Bresser J, Bron EE, Hoefer IE, Kappelle LJ, Teunissen CE, Biessels GJ, Haitjema S. A cluster of blood-based protein biomarkers reflecting coagulation relates to the burden of cerebral small vessel disease. J Cereb Blood Flow Metab 2022; 42:1282-1293. [PMID: 35086368 PMCID: PMC9207498 DOI: 10.1177/0271678x221077339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Biological processes underlying cerebral small vessel disease (cSVD) are largely unknown. We hypothesized that identification of clusters of inter-related bood-based biomarkers that are associated with the burden of cSVD provides leads on underlying biological processes. In 494 participants (mean age 67.6 ± 8.7 years; 36% female; 75% cardiovascular diseases; 25% reference participants) we assessed the relation between 92 blood-based biomarkers from the OLINK cardiovascular III panel and cSVD, using cluster-based analyses. We focused particularly on white matter hyperintensities (WMH). Nineteen biomarkers individually correlated with WMH ratio (r range: 0.16-0.27, Bonferroni corrected p-values <0.05), of which sixteen biomarkers formed one biomarker cluster. Pathway analysis showed that this biomarker cluster predominantly reflected coagulation processes. This cluster related also significantly to other cSVD manifestations (lacunar infarcts, microbleeds, and enlarged perivascular spaces), which supports generalizability beyond WMHs. To study possible causal effects of biological processes reflected by the cluster we performed a mediation analysis that showed a mediation effect of the cluster on the relation between age and WMH ratio (proportion mediated 17%), and hypertension and WMH-volume (proportion mediated 21%). In conclusion, we identified a cluster of blood-based biomarkers reflecting coagulation, that is related to manifestations of cSVD, corroborating involvement of coagulation abnormalities in the etiology of cSVD.
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Affiliation(s)
- Sanne Kuipers
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L Malin Overmars
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Bram van Es
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther E Bron
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Imo E Hoefer
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, VrijeUniversiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Saskia Haitjema
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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24
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DuBose LE, Weng TB, Pierce GL, Wharff C, Reist L, Hamilton C, O’Deen A, Dubishar K, Lane-Cordova A, Voss MW. Association between cardiorespiratory fitness and cerebrovascular reactivity to a breath-hold stimulus in older adults: influence of aerobic exercise training. J Appl Physiol (1985) 2022; 132:1468-1479. [PMID: 35482329 PMCID: PMC9208436 DOI: 10.1152/japplphysiol.00599.2021] [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: 11/22/2022] Open
Abstract
Cerebrovascular reactivity (CVR) to a physiological stimulus is a commonly used surrogate of cerebrovascular health. Cross-sectional studies using blood oxygen level dependent (BOLD) neuroimaging demonstrated lower BOLD-CVR to hypercapnia among adults with high compared with lower cardiorespiratory fitness (CRF) in contrast to transcranial Doppler studies. However, whether BOLD-CVR changes following chronic aerobic exercise in older, cognitively intact adults is unclear. This study evaluated relations between BOLD-CVR with CRF (V̇o2peak) using a cross-sectional and interventional study design. We hypothesized that 1) greater CRF would be associated with lower BOLD-CVR in older adults (n = 114; 65 ± 6.5 yr) with a wide range of CRF and 2) BOLD-CVR would be attenuated after exercise training in a subset (n = 33) randomized to 3-mo of moderate- or light-intensity cycling. CVR was quantified as the change in the BOLD signal in response to acute hypercapnia using a blocked breath-hold design from a region-of-interest analysis for cortical networks. In the cross-sectional analysis, there was a quadratic relation between V̇o2peak (P = 0.03), but not linear (P = 0.87) and cortical BOLD-CVR. BOLD-CVR increased until a V̇o2peak ∼28 mL/kg/min after which BOLD-CVR declined. The nonlinear trend was consistent across all networks (P = 0.04-0.07). In the intervention, both the active and light-intensity exercise groups improved CRF similarly (6% vs. 10.8%, P = 0.28). The percent change in CRF was positively associated with change in BOLD-CVR in the default mode network only. These data suggest that BOLD-CVR is nonlinearly associated with CRF and that in lower-fit adults default mode network may be most sensitive to CRF-related increases in BOLD-CVR.NEW & NOTEWORTHY Earlier studies evaluating associations between cardiorespiratory fitness (CRF) and cerebrovascular reactivity (CVR) have demonstrated conflicting findings dependent on imaging modality or subject characteristics in individuals across a narrow range of CRF. This study demonstrates that CRF is nonlinearly associated with CVR measured by blood oxygen level dependent (BOLD) fMRI in a large sample of middle-aged and older adults across a wide range of CRF, suggesting that conflicting prior findings are related to the range of CRFs studied.
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Affiliation(s)
- Lyndsey E. DuBose
- 1Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - Timothy B. Weng
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Gary L. Pierce
- 1Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa,3Department Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Conner Wharff
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Lauren Reist
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Chase Hamilton
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Abby O’Deen
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Kaitlyn Dubishar
- 1Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - Abbi Lane-Cordova
- 1Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - Michelle W. Voss
- 2Department Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa,4Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa
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25
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Beaudin AE, McCreary CR, Mazerolle EL, Gee M, Sharma B, Subotic A, Zwiers AM, Cox E, Nelles K, Charlton A, Frayne R, Ismail Z, Beaulieu C, Jickling G, Camicioli RM, Pike GB, Smith E. Cerebrovascular Reactivity Across the Entire Brain in Cerebral Amyloid Angiopathy. Neurology 2022; 98:e1716-e1728. [PMID: 35210294 PMCID: PMC9071369 DOI: 10.1212/wnl.0000000000200136] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Reduced cerebrovascular reactivity is proposed to be a feature of cerebral amyloid angiopathy (CAA) but has not been measured directly. Employing a global vasodilatory stimulus (hypercapnia), this study assessed the relationships between cerebrovascular reactivity and MRI markers of CAA and cognitive function. Methods In a cross-sectional study, individuals with probable CAA, mild cognitive impairment, or dementia due to Alzheimer disease and healthy controls underwent neuropsychological testing and an MRI that included a 5% carbon dioxide challenge. Cerebrovascular reactivity was compared across groups controlling for age, sex, and the presence of hypertension, and its associations with MRI markers of CAA in participants with CAA and with cognition across all participants were determined using multivariable linear regression adjusting for group, age, sex, education, and the presence of hypertension. Results Cerebrovascular reactivity data (mean ± SD) were available for 26 participants with CAA (9 female; 74.4 ± 7.7 years), 19 participants with mild cognitive impairment (5 female; 72.1 ± 8.5 years), 12 participants with dementia due to Alzheimer disease (4 female; 69.4 ± 6.6 years), and 39 healthy controls (30 female; 68.8 ± 5.4 years). Gray and whiter matter reactivity averaged across the entire brain was lower in participants with CAA and Alzheimer disease dementia compared to healthy controls, with a predominantly posterior distribution of lower reactivity in both groups. Higher white matter hyperintensity volume was associated with lower white matter reactivity (standardized coefficient [β], 95% CI −0.48, −0.90 to −0.01). Higher gray matter reactivity was associated with better global cognitive function (β 0.19, 0.03–0.36), memory (β 0.21, 0.07–0.36), executive function (β 0.20, 0.02–0.39), and processing speed (β 0.27, 0.10–0.45) and higher white matter reactivity was associated with higher memory (β 0.22, 0.08–0.36) and processing speed (β 0.23, 0.06–0.40). Conclusions Reduced cerebrovascular reactivity is a core feature of CAA and its assessment may provide an additional biomarker for disease severity and cognitive impairment.
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Affiliation(s)
- Andrew E Beaudin
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada .,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Erin L Mazerolle
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada
| | - Myrlene Gee
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Breni Sharma
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Arsenije Subotic
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Angela M Zwiers
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Emily Cox
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Nelles
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anna Charlton
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Zahinoor Ismail
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Glen Jickling
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard M Camicioli
- Division of Neurology and Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
| | - Eric Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health Services, Calgary, AB, Canada
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26
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Connectomic-genetic signatures in the cerebral small vessel disease. Neurobiol Dis 2022; 167:105671. [DOI: 10.1016/j.nbd.2022.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/31/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
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27
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Chen WT, Chi NF, Cheng HM, Ko YT, Chuang SY, Pan WH, Chen CH, Chung CP, Wang PN. Associations Between Cerebral Vasoreactivity and Cognitive Function in the Middle-Aged Non-Demented Population. J Alzheimers Dis 2022; 86:679-690. [DOI: 10.3233/jad-215317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Increasing evidence shows early vascular dysregulation in the pathophysiology of Alzheimer’s disease (AD) in elderly population. Objective: We wondered about the relationship between vascular health and cognitive performance in middle-aged adults. The present study aims to evaluate whether and which brain vascular hemodynamic parameters are associated with cognitive functions in a middle-aged, non-demented population. Methods: We recruited 490 middle-aged community-based participants (30–60 years). Transcranial color-coded sonography was used to measure cerebral vascular hemodynamics, including mean flow velocity, pulsatility index, and breath-holding index (BHI) in the middle cerebral arteries (MCAs). Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA). A multivariate linear regression model was used to determine the association between the MoCA scores and each intracranial hemodynamic parameter. Results: In 369 participants (median age 52 years [IQR 47–56], 48.8% men) with robust acoustic windows, the factors related to poorer MoCA scores were older age, less education extent, and the habitats of cigarette smoking or alcohol consumption. Multivariate analyses did not show a significant association between any intracranial hemodynamic parameters in both MCAs and MoCA scores in the total study population. Left MCA BHI was found to be significantly and independently correlated with the MoCA scores only in people aged 55–60 years (n = 111, B = 0.70, 95% confidence interval, 0.13–1.26, p = 0.017), however, not in people younger than 55 years. Conclusion: Our results emphasize the role of neurovascular abnormalities in the early pathophysiology of cognitive impairment and suggest cerebral vasoreactivity as the earliest detectable cognition-associated hemodynamic parameter.
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Affiliation(s)
- Wan-Ting Chen
- Division of Neurology, Taipei City Hospital, Zhongxiao Branch, Taiwan
| | - Nai-Fang Chi
- Neurological Institute, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
| | - Hao-Min Cheng
- School of Medicine, National Yang-Ming University, Taiwan
- Institute of Public Health, National Yang-Ming University, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taiwan
- Center for Evidence-based Medicine and Department of Medical Education, Taipei Veterans General Hospital, Taiwan
| | - Yu-Ting Ko
- Division of Cardiology, Taipei Veterans General Hospital, Taiwan
| | - Shao-Yuan Chuang
- Division of Health Services and Preventive Medicine, Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Wen-Harn Pan
- Division of Health Services and Preventive Medicine, Institute of Population Health Sciences, National Health Research Institutes, Taiwan
| | - Chen-Huan Chen
- School of Medicine, National Yang-Ming University, Taiwan
- Institute of Public Health, National Yang-Ming University, Taiwan
- Division of Cardiology, Taipei Veterans General Hospital, Taiwan
- Center for Evidence-based Medicine and Department of Medical Education, Taipei Veterans General Hospital, Taiwan
| | - Chih-Ping Chung
- Neurological Institute, Taipei Veterans General Hospital, Taiwan
- School of Medicine, National Yang-Ming University, Taiwan
| | - Pei-Ning Wang
- Neurological Institute, Taipei Veterans General Hospital, Taiwan
- Brain Research Center, National Yang Ming University, Taiwan
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28
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Fixel based analysis of white matter alterations in early stage cerebral small vessel disease. Sci Rep 2022; 12:1581. [PMID: 35091684 PMCID: PMC8799636 DOI: 10.1038/s41598-022-05665-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
Cerebral small vessel disease (CSVD) is a common cause of morbidity and cognitive decline in the elderly population. However, characterizing the disease pathophysiology and its association with potential clinical sequelae in early stages is less well explored. We applied fixel-based analysis (FBA), a novel framework of investigating microstructural white matter integrity by diffusion-weighted imaging, to data of 921 participants of the Hamburg City Health Study, comprising middle-aged individuals with increased cerebrovascular risk in early stages of CSVD. In individuals in the highest quartile of white matter hyperintensity loads (n = 232, median age 63 years; IQR 15.3 years), FBA detected significantly reduced axonal density and increased atrophy of transcallosal fiber tracts, the bilateral superior longitudinal fasciculus, and corticospinal tracts compared to participants in the lowest quartile of white matter hyperintensities (n = 228, mean age 55 years; IQR 10 years). Analysis of all participants (N = 921) demonstrated a significant association between reduced fiber density and worse executive functions operationalized by the Trail Making Test. Findings were confirmed by complementary analysis of diffusion tensor metrics.
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29
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Bhogal AA. Medullary vein architecture modulates the white matter BOLD cerebrovascular reactivity signal response to CO 2: Observations from high-resolution T2* weighted imaging at 7T. Neuroimage 2021; 245:118771. [PMID: 34861395 DOI: 10.1016/j.neuroimage.2021.118771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 11/29/2021] [Indexed: 01/24/2023] Open
Abstract
Brain stress testing using blood oxygenation level-dependent (BOLD) MRI to evaluate changes in cerebrovascular reactivity (CVR) is of growing interest for evaluating white matter integrity. However, even under healthy conditions, the white matter BOLD-CVR response differs notably from that observed in the gray matter. In addition to actual arterial vascular control, the venous draining topology may influence the WM-CVR response leading to signal delays and dispersions. These types of alterations in hemodynamic parameters are sometimes linked with pathology, but may also arise from differences in normal venous architecture. In this work, high-resolution T2*weighted anatomical images combined with BOLD imaging during a hypercapnic breathing protocol were acquired using a 7 tesla MRI system. Hemodynamic parameters including base CVR, hemodynamic lag, lag-corrected CVR, response onset and signal dispersion, and finally ΔCVR (corrected CVR minus base CVR) were calculated in 8 subjects. Parameter maps were spatially normalized and correlated against an MNI-registered white matter medullary vein atlas. Moderate correlations (Pearson's rho) were observed between medullary vessel frequency (MVF) and ΔCVR (0.52; 0.58 for total WM), MVF and hemodynamic lag (0.42; 0.54 for total WM), MVF and signal dispersion (0.44; 0.53 for total WM), and finally MVF and signal onset (0.43; 0.52 for total WM). Results indicate that, when assessed in the context of the WM venous architecture, changes in the response shape may only be partially reflective of the actual vascular reactivity response occurring further upstream by control vessels. This finding may have implications when attributing diseases mechanisms and/or progression to presumed impaired WM BOLD-CVR.
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Affiliation(s)
- Alex A Bhogal
- Radiology, University Medical Center Utrecht, Heidelberglaan 100, , Utrecht 3584 CX, the Netherland.
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30
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Kang P, Ying C, Chen Y, Ford AL, An H, Lee JM. Oxygen Metabolic Stress and White Matter Injury in Patients With Cerebral Small Vessel Disease. Stroke 2021; 53:1570-1579. [PMID: 34886686 PMCID: PMC9038643 DOI: 10.1161/strokeaha.121.035674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Chronic hypoxia-ischemia is a putative mechanism underlying the development of white matter hyperintensities (WMH) and microstructural disruption in cerebral small vessel disease. WMH fall primarily within deep white matter (WM) watershed regions. We hypothesized that elevated oxygen extraction fraction (OEF), a signature of hypoxia-ischemia, would be detected in the watershed where WMH density is highest. We further hypothesized that OEF would be elevated in regions immediately surrounding WMH, at the leading edge of growth. METHODS In this cross-sectional study conducted from 2016 to 2019 at an academic medical center in St Louis, MO, participants (age >50) with a range of cerebrovascular risk factors underwent brain magnetic resonance imaging using pseudocontinuous arterial spin labeling, asymmetric spin echo, fluid-attenuated inversion recovery and diffusion tensor imaging to measure cerebral blood flow (CBF), OEF, WMH, and WM integrity, respectively. We defined the physiologic watershed as a region where CBF was below the 10th percentile of mean WM CBF in a young healthy cohort. We conducted linear regression to evaluate the relationship between CBF and OEF with structural and microstructural WM injury defined by fluid-attenuated inversion recovery WMH and diffusion tensor imaging, respectively. We conducted ANOVA to determine if OEF was increased in proximity to WMH lesions. RESULTS In a cohort of 42 participants (age 50-80), the physiologic watershed region spatially overlapped with regions of highest WMH lesion density. As CBF decreased and OEF increased, WMH density increased. Elevated watershed OEF was associated with greater WMH burden and microstructural disruption, after adjusting for vascular risk factors. In contrast, WM and watershed CBF were not associated with WMH burden or microstructural disruption. Moreover, OEF progressively increased while CBF decreased, in concentric contours approaching WMH lesions. CONCLUSIONS Chronic hypoxia-ischemia in the watershed region may contribute to cerebral small vessel disease pathogenesis and development of WMH. Watershed OEF may hold promise as an imaging biomarker to identify individuals at risk for cerebral small vessel disease progression.
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Affiliation(s)
- Peter Kang
- Department of Neurology, Washington University School of Medicine. (P.K., Y.C., A.L.F., H.A., J.-M.L.)
| | - Chunwei Ying
- Department of Biomedical Engineering, Washington University (C.Y., H.A., J.-M.L.)
| | - Yasheng Chen
- Department of Neurology, Washington University School of Medicine. (P.K., Y.C., A.L.F., H.A., J.-M.L.)
| | - Andria L Ford
- Department of Neurology, Washington University School of Medicine. (P.K., Y.C., A.L.F., H.A., J.-M.L.).,Mallinckrodt Institute of Radiology, Washington University School of Medicine. (A.L.F., H.A., J.-M.L.)
| | - Hongyu An
- Department of Neurology, Washington University School of Medicine. (P.K., Y.C., A.L.F., H.A., J.-M.L.).,Mallinckrodt Institute of Radiology, Washington University School of Medicine. (A.L.F., H.A., J.-M.L.).,Department of Biomedical Engineering, Washington University (C.Y., H.A., J.-M.L.)
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine. (P.K., Y.C., A.L.F., H.A., J.-M.L.).,Mallinckrodt Institute of Radiology, Washington University School of Medicine. (A.L.F., H.A., J.-M.L.).,Department of Biomedical Engineering, Washington University (C.Y., H.A., J.-M.L.)
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31
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Wu X, Ya J, Zhou D, Ding Y, Ji X, Meng R. Pathogeneses and Imaging Features of Cerebral White Matter Lesions of Vascular Origins. Aging Dis 2021; 12:2031-2051. [PMID: 34881084 PMCID: PMC8612616 DOI: 10.14336/ad.2021.0414] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/14/2021] [Indexed: 01/10/2023] Open
Abstract
White matter lesion (WML), also known as white matter hyperintensities or leukoaraiosis, was first termed in 1986 to describe the hyperintense signals on T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) maps. Over the past decades, a growing body of pathophysiological findings regarding WMLs have been discovered and discussed. Currently, the generally accepted WML pathogeneses mainly include hypoxia-ischemia, endothelial dysfunction, blood-brain barrier disruption, and infiltration of inflammatory mediators or cytokines. However, none of them can explain the whole dynamics of WML formation. Herein, we primarily focus on the pathogeneses and neuroimaging features of vascular WMLs. To achieve this goal, we searched papers with any type published in PubMed from 1950 to 2020 and cross-referenced the keywords including “leukoencephalopathy”, “leukoaraiosis”, “white matter hyperintensity”, “white matter lesion”, “pathogenesis”, “pathology”, “pathophysiology”, and “neuroimaging”. Moreover, references of the selected articles were browsed and searched for additional pertinent articles. We believe this work will supply the robust references for clinicians to further understand the different WML patterns of varying vascular etiologies and thus make customized treatment.
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Affiliation(s)
- Xiaoqin Wu
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyuan Ya
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Division of Clinical Neuroscience, Queen's Medical Center School of Medicine, the University of Nottingham, Nottingham NG7 2UH, UK
| | - Da Zhou
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Xunming Ji
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,3Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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32
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Ren T, Sun S, Li B, Chen Y, Qu X, Li C, Deng X, Ni C. Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion. Neurologist 2021; 27:1-5. [PMID: 34842568 DOI: 10.1097/nrl.0000000000000350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS. MATERIALS AND METHODS Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences. RESULTS The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091). CONCLUSIONS Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.
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Affiliation(s)
- Taojie Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Shifu Sun
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Bo Li
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Yuan Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Xiaofeng Qu
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Chunxing Li
- Department of Neurology, Yancheng City No. 1 People's Hospital, Yancheng, Jiangsu Province, People's Republic of China
| | - Xiaowen Deng
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Caifang Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou
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33
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Huang H, Zhao K, Zhu W, Li H, Zhu W. Abnormal Cerebral Blood Flow and Functional Connectivity Strength in Subjects With White Matter Hyperintensities. Front Neurol 2021; 12:752762. [PMID: 34744987 PMCID: PMC8564178 DOI: 10.3389/fneur.2021.752762] [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: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
White matter hyperintensities (WMHs) are common neuroimaging findings in the aging population and are associated with various clinical symptoms, especially cognitive impairment. Abnormal global cerebral blood flow (CBF) and specific functional connections have been reported in subjects with higher WMH loads. Nevertheless, the comprehensive functional mechanisms underlying WMH are yet to be established. In this study, by combining resting-state functional magnetic resonance imaging and arterial spin labeling, we investigated the neurovascular dysfunction in subjects with WMH in CBF, functional connectivity strength (FCS), and CBF–FCS coupling. The whole-brain alterations of all these measures were explored among non-dementia subjects with different WMH loads using a fine-grained Human Brainnetome Atlas. In addition, exploratory mediation analyses were conducted to further determine the relationships between these neuroimaging indicators, WMH load, and cognition. The results showed that subjects with higher WMH loads displayed decreased CBF and FCS mainly in regions involving the cognitive- and emotional-related brain networks, including the default mode network, salience network, and central executive network. Notably, subjects with higher WMH loads also showed an abnormal regional CBF–FCS coupling in several regions of the thalamus, posterior cingulate cortex, and parahippocampal gyrus involving the default mode network. Furthermore, regional CBF in the right inferior temporal gyrus and right dorsal caudate may mediate the relationship between WMH load and cognition in WMH subjects. These findings indicated characteristic changes in cerebral blood supply, brain activity, and neurovascular coupling in regions involving specific brain networks with the development of WMH, providing further information on pathophysiology underpinnings of the WMH and related cognitive impairment.
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Affiliation(s)
- Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Zhao
- School of Biological Science & Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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34
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Staszewski J, Dȩbiec A, Skrobowska E, Stȩpień A. Cerebral Vasoreactivity Changes Over Time in Patients With Different Clinical Manifestations of Cerebral Small Vessel Disease. Front Aging Neurosci 2021; 13:727832. [PMID: 34744687 PMCID: PMC8563577 DOI: 10.3389/fnagi.2021.727832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives: Endothelial dysfunction (ED) has been linked to the pathogenesis of cerebral small vessel disease (SVD). We aimed to assess ED and cerebrovascular reactivity (CVR) in the patients with a diverse manifestation of SVD, with similar and extensive white matter lesions (WMLs, modified Fazekas scale grade ≥2), compared with a control group (CG) without the MRI markers of SVD, matched for age, gender, hypertension, diabetes, and to evaluate the change of CVR following 24 months. Methods: We repeatedly measured the vasomotor reactivity reserve (VMRr) and breath-holding index (BHI) of the middle cerebral artery (MCA) by the transcranial Doppler ultrasound (TCD) techniques in 60 subjects above 60 years with a history of lacunar stroke (LS), vascular dementia (VaD), or parkinsonism (VaP) (20 in each group), and in 20 individuals from a CG. Results: The mean age, frequency of the main vascular risk factors, and sex distribution were similar in the patients with the SVD groups and a CG. The VMRr and the BHI were more severely impaired at baseline (respectively, 56.7 ± 18% and 0.82 ± 0.39) and at follow-up (respectively, 52.3 ± 16.7% and 0.71 ± 0.38) in the patients with SVD regardless of the clinical manifestations (ANOVA, p > 0.1) than in the CG (respectively, baseline VMRr 77.2 ± 15.6%, BHI 1.15 ± 0.47, p < 0.001; follow-up VMRr 74.3 ± 17.6%, BHI 1.11 ± 0.4, p < 0.001). All the assessed CVR measures (VMRr and BHI) significantly decreased over time in the subjects with SVD (Wilcoxon's signed-rank test p = 0.01), but this was not observed in the CG (p > 0.1) and the decrease of CVR measures was not related to the SVD radiological progression (p > 0.1). Conclusions: This study provided evidence that the change in CVR measures is detectable over a 24-month period in patients with different clinical manifestations of SVD. Compared with the patients in CG with similar atherothrombotic risk factors, all the CVR measures (BMRr and BHI) significantly declined over time in the subjects with SVD. The reduction in CVR was not related to the SVD radiological progression.
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Affiliation(s)
- Jacek Staszewski
- Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland
| | | | - Ewa Skrobowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stȩpień
- Military Institute of Medicine, Clinic of Neurology, Warsaw, Poland
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35
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Smirnov M, Destrieux C, Maldonado IL. Cerebral white matter vasculature: still uncharted? Brain 2021; 144:3561-3575. [PMID: 34718425 DOI: 10.1093/brain/awab273] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/17/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
White matter vasculature plays a major role in the pathophysiology of permanent neurological deficits following a stroke or progressive cognitive alteration related to small vessel disease. Thus, knowledge of the complex vascularization and functional aspects of the deep white matter territories is paramount to comprehend clinical manifestations of brain ischemia. This review provides a structured presentation of the existing knowledge of the vascularization of the human cerebral white matter from seminal historical studies to the current literature. First, we revisit the highlights of prenatal development of the endoparenchymal telencephalic vascular system that are crucial for the understanding of vessel organization in the adult. Second, we reveal the tangled history of debates on the existence, clinical significance, and physiological role of leptomeningeal anastomoses. Then, we present how conceptions on white matter vascularization transitioned from the mixed ventriculopetal/ventriculofugal theory, in which a low-flow area was interposed in between concurrent arterial flows, to the purely ventriculopetal theory. The latter model explains variable white matter sensitivity to ischemia by various organizations of ventriculopetal vessel terminals having different origin/length properties and interconnection patterns. Next, arteries supplying primarily the white matter are described according to their length and overall structure. Furthermore, the known distribution territories, to date, are studied in relation to primary anatomical structures of the human cerebral white matter, emphasizing the sparsity of the "ground-truth" data available in the literature. Finally, the implications for both large vessel occlusion and chronic small vessel disease are discussed, as well as the insights from neuroimaging. All things considered, we identify the need for further research on deep white matter vascularization, especially regarding the arterial supply of white matter fiber tracts.
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Affiliation(s)
- Mykyta Smirnov
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
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36
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Monteiro A, Castro P, Pereira G, Ferreira C, Sorond F, Milstead A, Higgins JP, Polónia J, Azevedo E. Neurovascular Coupling Is Impaired in Hypertensive and Diabetic Subjects Without Symptomatic Cerebrovascular Disease. Front Aging Neurosci 2021; 13:728007. [PMID: 34690741 PMCID: PMC8526560 DOI: 10.3389/fnagi.2021.728007] [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: 06/20/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023] Open
Abstract
The mechanistic link between hypertension, diabetes and cerebral small vessel disease (CSVD) is still poorly understood. We hypothesized that hypertension and diabetes could impair cerebrovascular regulation prior to irreversibly established cerebrovascular disease. In this study, 52 hypertensive patients [54% males; age 64 ± 11 years; 58% with comorbid diabetes mellitus (DM)] without symptomatic cerebrovascular disease underwent transcranial Doppler (TCD) monitoring in the middle (MCA) and posterior (PCA) cerebral arteries, to assess vasoreactivity to carbon dioxide (VRCO2) and neurovascular coupling (NVC). 1.5T magnetic resonance imaging was also performed and white matter hyperintensity volume was automatically segmented from FLAIR sequences. TCD data from 17 healthy controls were obtained for comparison (47% males; age 60 ± 16 years). Hypertensive patients showed significant impairment of NVC in the PCA, with reduced increment in cerebral blood flow velocity during visual stimulation (22.4 ± 9.2 vs. 31.6 ± 5.7, p < 0.001), as well as disturbed NVC time-varying properties, with slower response (lower rate time: 0.00 ± 0.02 vs. 0.03 ± 6.81, p = 0.001), and reduced system oscillation (reduced natural frequency: 0.18 ± 0.08 vs. 0.22 ± 0.06, p < 0.001), when compared to controls. VRCO2 remained relatively preserved in MCA and PCA. These results were worse in hypertensive diabetic patients, with lower natural frequency (p = 0.043) than non-diabetic patients. White matter disease burden did not predict worse NVC. These findings suggest that hypertensive diabetic patients may have a precocious impairment of NVC, already occurring without symptomatic CSVD. Future research is warranted to evaluate whether NVC assessment could be useful as an early, non-invasive, surrogate marker for CSVD.
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Affiliation(s)
- Ana Monteiro
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.,Department of Neurology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Pedro Castro
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.,Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Gilberto Pereira
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.,Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmen Ferreira
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.,Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Farzaneh Sorond
- Department of Neurology, Division of Stroke and Neurocritical, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrew Milstead
- Department of Neurology, Division of Stroke and Neurocritical, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - James P Higgins
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jorge Polónia
- Hypertension Unit, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Department of Medicine, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal.,Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Carotid revascularization and cognitive impairment: the neglected role of cerebral small vessel disease. Neurol Sci 2021; 43:139-152. [PMID: 34596778 DOI: 10.1007/s10072-021-05629-w] [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: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Carotid atherosclerosis is a pathological process that leads to narrowing of the vessel lumen and a consequent risk of stroke. Revascularization procedures such as carotid endarterectomy (CEA) and carotid stenting aim to reduce occurrence of stroke in selected patients. Due to the proven benefit and low intraoperative risk, CEA is currently the preferred choice in candidates for carotid revascularization. However, the risk of cognitive impairment subsequent to CEA has not been fully elucidated and is unclear whether certain conditions, such as frailty, may increase this risk. There is consistent evidence that shows that frail patients have higher risk of cognitive impairment after surgical procedure. Moreover, brain pre-existing conditions may play a role in cognitive impairment after CEA. Cerebral small vessel disease (SVD) is a pathology that involves microcirculation and is detectable with computed tomography or magnetic resonance. SVD shares common vascular risk factors with carotid atherosclerosis, is a major contributor to vascular cognitive impairment and vascular dementia, and has been proposed as a marker of brain frailty. In this review, we discuss the current evidence about the link between carotid revascularization and cognitive impairment and advance the hypothesis that SVD may play a relevant role in development of cognitive impairment after carotid revascularization.
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Rastogi A, Weissert R, Bhaskar SMM. Emerging role of white matter lesions in cerebrovascular disease. Eur J Neurosci 2021; 54:5531-5559. [PMID: 34233379 DOI: 10.1111/ejn.15379] [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: 05/14/2021] [Revised: 06/26/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision-making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.
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Affiliation(s)
- Aarushi Rastogi
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert Weissert
- Department of Neurology, Regensburg University Hospital, University of Regensburg, Regensburg, Germany
| | - Sonu Menachem Maimonides Bhaskar
- South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.,Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,NSW Brain Clot Bank, NSW Health Pathology, Sydney, New South Wales, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Chan ST, Mercaldo ND, Kwong KK, Hersch SM, Rosas HD. Impaired Cerebrovascular Reactivity in Huntington's Disease. Front Physiol 2021; 12:663898. [PMID: 34366879 PMCID: PMC8334185 DOI: 10.3389/fphys.2021.663898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
There is increasing evidence that impairments of cerebrovascular function and/or abnormalities of the cerebral vasculature might contribute to early neuronal cell loss in Huntington's disease (HD). Studies in both healthy individuals as well as in patients with other neurodegenerative disorders have used an exogenous carbon dioxide (CO2) challenge in conjunction with functional magnetic resonance imaging (fMRI) to assess regional cerebrovascular reactivity (CVR). In this study, we explored potential impairments of CVR in HD. Twelve gene expanded HD individuals, including both pre-symptomatic and early symptomatic HD and eleven healthy controls were administered a gas mixture targeting a 4-8 mmHg increase in CO2 relative to the end-tidal partial pressure of CO2 (P ET CO2) at rest. A Hilbert Transform analysis was used to compute the cross-correlation between the time series of regional BOLD signal changes (ΔBOLD) and increased P ET CO2, and to estimate the response delay of ΔBOLD relative to P ET CO2. After correcting for age, we found that the cross-correlation between the time series for regional ΔBOLD and for P ET CO2 was weaker in HD subjects than in controls in several subcortical white matter regions, including the corpus callosum, subcortical white matter adjacent to rostral and caudal anterior cingulate, rostral and caudal middle frontal, insular, middle temporal, and posterior cingulate areas. In addition, greater volume of dilated perivascular space (PVS) was observed to overlap, primarily along the periphery, with the areas that showed greater ΔBOLD response delay. Our preliminary findings support that alterations in cerebrovascular function occur in HD and may be an important, not as yet considered, contributor to early neuropathology in HD.
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Affiliation(s)
- Suk Tak Chan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Nathaniel D Mercaldo
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Kenneth K Kwong
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Steven M Hersch
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Herminia D Rosas
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Imaging neurovascular, endothelial and structural integrity in preparation to treat small vessel diseases. The INVESTIGATE-SVDs study protocol. Part of the SVDs@Target project. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100020. [PMID: 36324725 PMCID: PMC9616332 DOI: 10.1016/j.cccb.2021.100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/25/2021] [Accepted: 06/20/2021] [Indexed: 12/30/2022]
Abstract
Background Sporadic cerebral small vessel disease (SVD) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) share clinical and neuroimaging features and possibly vascular dysfunction(s). However few studies have included both conditions, assessed more than one vascular dysfunction simultaneously, or included more than one centre. The INVESTIGATE-SVDs study will assess several cerebrovascular dysfunctions with MRI in participants with sporadic SVD or CADASIL at three European centres. Methods We will recruit participants with sporadic SVDs (ischaemic stroke or vascular cognitive impairment) and CADASIL in Edinburgh, Maastricht and Munich. We will perform detailed clinical and neuropsychological phenotyping of the participants, and neuroimaging including structural MRI, cerebrovascular reactivity MRI (CVR: using carbon dioxide challenge), phase contrast MRI (arterial, venous and CSF flow and pulsatility), dynamic contrast-enhanced MRI (blood brain barrier (BBB) leakage) and multishell diffusion imaging. Participants will measure their blood pressure (BP) and its variability over seven days using a telemetric device. Discussion INVESTIGATE-SVDs will assess the relationships of BBB integrity, CVR, pulsatility and CSF flow in sporadic SVD and CADASIL using a multisite, multimodal MRI protocol. We aim to establish associations between these measures of vascular function, risk factors particularly BP and its variability, and brain parenchymal lesions in these two SVD phenotypes. Additionally we will test feasibility of complex multisite MRI, provide reliable intermediary outcome measures and sample size estimates for future trials.
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Key Words
- BBB, blood brain barrier
- BOLD, blood oxygen level dependent
- BP, blood pressure
- BPv, blood pressure variability
- Blood-brain barrier permeability
- CADASIL
- CADASIL, cerebral autosomal dominant arteriopathy with leukoencephalopathy and subcortical infarcts
- CBF, cerebral blood flow
- CERAD+, consortium to establish a disease registry for Alzheimer's disease plus battery
- CO2, carbon dioxide
- CSF, cerebrospinal fluid
- CVR, cerebrovascular reactivity
- Cerebral small vessel disease
- Cerebrovascular reactivity
- DCE, dynamic contrast enhanced
- EtCO2, end-tidal carbon dioxide
- GM, grey matter
- MMSE, mini-mental state examination
- MRI
- MoCA, Montreal cognitive exam
- NIHSS, national institute for health stroke scale
- PI, pulsatility index
- PVS, perivascular space
- RSSI, recent small subcortical infarct
- SVDs, small vessel diseases
- WM, white matter
- WMH, white matter hyperintensity
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Amyot F, Lynch CE, Ollinger J, Werner JK, Silverman E, Moore C, Davis C, Turtzo LC, Diaz-Arrastia R, Kenney K. Cerebrovascular Reactivity Measures Are Associated With Post-traumatic Headache Severity in Chronic TBI; A Retrospective Analysis. Front Physiol 2021; 12:649901. [PMID: 34054569 PMCID: PMC8155500 DOI: 10.3389/fphys.2021.649901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To characterize the relationship between persistent post-traumatic headache (pPTH) and traumatic cerebrovascular injury (TCVI) in chronic traumatic brain injury (TBI). Cerebrovascular reactivity (CVR), a measure of the cerebral microvasculature and endothelial cell function, is altered both in individuals with chronic TBI and migraine headache disorder (Amyot et al., 2017; Lee et al., 2019b). The pathophysiologies of pPTH and migraine are believed to be associated with chronic microvascular dysfunction. We therefore hypothesize that TCVI may contribute to the underlying migraine-like mechanism(s) of pPTH. MATERIALS AND METHODS 22 moderate/severe TBI participants in the chronic stage (>6 months) underwent anatomic and functional magnetic resonance imaging (fMRI) scanning with hypercapnia gas challenge to measure CVR as well as the change in CVR (ΔCVR) after single-dose treatment of a specific phosphodiesterase-5 (PDE-5) inhibitor, sildenafil, which potentiates vasodilation in response to hypercapnia in impaired endothelium, as part of a Phase2a RCT of sildenafil in chronic TBI (NCT01762475). CVR and ΔCVR measures of each participant were compared with the individual's pPTH severity measured by the headache impact test-6 (HIT-6) survey. RESULTS There was a moderate correlation between HIT-6 and both CVR and ΔCVR scores [Spearman's correlation = -0.50 (p = 0.018) and = 0.46 (p = 0.03), respectively], indicating that a higher headache burden is associated with decreased endothelial function in our chronic TBI population. CONCLUSION There is a correlation between PTH and CVR in chronic moderate-severe TBI. This relationship suggests that chronic TCVI may underlie the pathobiology of pPTH. Further, our results suggest that novel treatment strategies that target endothelial function and vascular health may be beneficial in refractory pPTH.
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Affiliation(s)
- Franck Amyot
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Cillian E. Lynch
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John Ollinger
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - J. Kent Werner
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - E. Silverman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Carol Moore
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Cora Davis
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - L. Christine Turtzo
- National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Ramon Diaz-Arrastia
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Eikermann-Haerter K, Huang SY. White Matter Lesions in Migraine. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1955-1962. [PMID: 33636178 DOI: 10.1016/j.ajpath.2021.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
Migraine, the third most common disease worldwide, is a well-known independent risk factor for subclinical focal deep white matter lesions (WMLs), even in young and otherwise healthy individuals with no cardiovascular risk factors. These WMLs are more commonly seen in migraine patients with transient neurologic symptoms preceding their headaches, the so-called aura, and those with a high attack frequency. The pathophysiology of migraine-related deep white matter hyperintensities remains poorly understood despite their prevalence. Characteristic differences in their distribution related to chronic small vessel ischemic disease compared with that of common periventricular WMLs in the elderly suggest a different underlying mechanism. Both ischemic and inflammatory mechanisms have been proposed, as there is increased cerebral vulnerability to ischemia in migraineurs, whereas there is also evidence of blood-brain barrier disruption with associated release of proinflammatory substances during migraine attacks. An enhanced susceptibility to spreading depolarization, the electrophysiological event underlying migraine, may be the mechanism that causes repetitive episodes of cerebral hypoperfusion and neuroinflammation during migraine attacks. WMLs can negatively affect both physical and cognitive function, underscoring the public health importance of migraine, and suggesting that migraine is an important contributor to neurologic deficits in the general population.
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Affiliation(s)
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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43
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Champagne AA, Bhogal AA. Insights Into Cerebral Tissue-Specific Response to Respiratory Challenges at 7T: Evidence for Combined Blood Flow and CO 2-Mediated Effects. Front Physiol 2021; 12:601369. [PMID: 33584344 PMCID: PMC7876301 DOI: 10.3389/fphys.2021.601369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/06/2021] [Indexed: 11/16/2022] Open
Abstract
Cerebrovascular reactivity (CVR) mapping is finding increasing clinical applications as a non-invasive probe for vascular health. Further analysis extracting temporal delay information from the CVR response provide additional insight that reflect arterial transit time, blood redistribution, and vascular response speed. Untangling these factors can help better understand the (patho)physiology and improve diagnosis/prognosis associated with vascular impairments. Here, we use hypercapnic (HC) and hyperoxic (HO) challenges to gather insight about factors driving temporal delays between gray-matter (GM) and white-matter (WM). Blood Oxygen Level Dependent (BOLD) datasets were acquired at 7T in nine healthy subjects throughout BLOCK- and RAMP-HC paradigms. In a subset of seven participants, a combined HC+HO block, referred as the “BOOST” protocol, was also acquired. Tissue-based differences in Rapid Interpolation at Progressive Time Delays (RIPTiDe) were compared across stimulus to explore dynamic (BLOCK-HC) versus progressive (RAMP-HC) changes in CO2, as well as the effect of bolus arrival time on CVR delays (BLOCK-HC versus BOOST). While GM delays were similar between the BLOCK- (21.80 ± 10.17 s) and RAMP-HC (24.29 ± 14.64 s), longer WM lag times were observed during the RAMP-HC (42.66 ± 17.79 s), compared to the BLOCK-HC (34.15 ± 10.72 s), suggesting that the progressive stimulus may predispose WM vasculature to longer delays due to the smaller arterial content of CO2 delivered to WM tissues, which in turn, decreases intravascular CO2 gradients modulating CO2 diffusion into WM tissues. This was supported by a maintained ∼10 s offset in GM (11.66 ± 9.54 s) versus WM (21.40 ± 11.17 s) BOOST-delays with respect to the BLOCK-HC, suggesting that the vasoactive effect of CO2 remains constant and that shortening of BOOST delays was be driven by blood arrival reflected through the non-vasodilatory HO contrast. These findings support that differences in temporal and magnitude aspects of CVR between vascular networks reflect a component of CO2 sensitivity, in addition to redistribution and steal blood flow effects. Moreover, these results emphasize that the addition of a BOOST paradigm may provide clinical insights into whether vascular diseases causing changes in CVR do so by way of severe blood flow redistribution effects, alterations in vascular properties associated with CO2 diffusion, or changes in blood arrival time.
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Affiliation(s)
- Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,School of Medicine, Queen's University, Kingston, ON, Canada
| | - Alex A Bhogal
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
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Yang Z, Rong Y, Cao Z, Wu Y, Zhao X, Xie Q, Luo M, Liu Y. Microstructural and Cerebral Blood Flow Abnormalities in Subjective Cognitive Decline Plus: Diffusional Kurtosis Imaging and Three-Dimensional Arterial Spin Labeling Study. Front Aging Neurosci 2021; 13:625843. [PMID: 33597860 PMCID: PMC7882515 DOI: 10.3389/fnagi.2021.625843] [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: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: To explore microstructural and cerebral blood flow (CBF) abnormalities in individuals with subjective cognitive decline plus (SCD plus) using diffusional kurtosis imaging (DKI) and three-dimensional (3D) arterial spin labeling (ASL). Methods: Twenty-seven patients with SCD plus, 31 patients with amnestic mild cognitive impairment (aMCI), and 33 elderly controls (ECs) were recruited and underwent DKI and 3D ASL using a GE 3.0-T MRI. Mean kurtosis (MK), fractional anisotropy (FA), mean diffusivity (MD), and CBF values were acquired from 24 regions of interest (ROIs) in the brain, including the bilateral hippocampal (Hip) subregions (head, body, and tail), posterior cingulate cortex (PCC), precuneus, dorsal thalamus subregions (anterior nucleus, ventrolateral nucleus, and medial nucleus), lenticular nucleus, caput nuclei caudati, white matter (WM) of the frontal lobe, and WM of the occipital lobe. Pearson's correlation analysis was performed to assess the relationships among the DKI-derived parameters, CBF values, and key neuropsychological tests for SCD plus. Results: Compared with ECs, participants with SCD plus showed a significant decline in MK and CBF values, mainly in the Hip head and PCC, and participants with aMCI exhibited more significant abnormalities in the MK and CBF values than individuals with ECs and SCD plus in multiple regions. Combined MK values showed better discrimination between patients with SCD plus and ECs than that obtained using CBF levels, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.874 and 0.837, respectively. Similarly, the AUC in discriminating SCD plus from aMCI patients obtained using combined MK values was 0.823, which was also higher than the combined AUC of 0.779 obtained using CBF values. Moreover, MK levels in the left Hip (h) and left PCC positively correlated with the auditory verbal learning test-delayed recall (AVLT-DR) score in participants with SCD plus. By contrast, only the CBF value in the left Hip head positively correlated with the AVLT-DR score. Conclusions: Our results provide new evidence of microstructural and CBF changes in patients with SCD plus. MK may be used as an early potential neuroimaging biomarker and may be a more sensitive DKI parameter than CBF at the very early stage of Alzheimer's disease (AD).
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Affiliation(s)
- Zhongxian Yang
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.,Medical Imaging Center, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Yu Rong
- Medical Imaging Center, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China.,Department of Neurology, The People's Hospital of Gaozhou City, Maoming, China
| | - Zhen Cao
- Medical Imaging Center, The Second Affiliated Hospital, Medical College of Shantou University, Shantou, China
| | - Yi Wu
- Department of Neurology, Shantou Central Hospital and Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Xinzhu Zhao
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Qiuxia Xie
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Min Luo
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yubao Liu
- Medical Imaging Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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Ni L, Zhang B, Yang D, Qin R, Xu H, Ma J, Shao P, Xu Y. Lower Cerebrovascular Reactivity Contributed to White Matter Hyperintensity-Related Cognitive Impairment: A Resting-State Functional MRI Study. J Magn Reson Imaging 2020; 53:703-711. [PMID: 32996183 DOI: 10.1002/jmri.27376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Impaired cerebrovascular reactivity (CVR) plays an important role in the pathophysiology of white matter hyperintensities (WMHs). The pathogenesis of CVR in the development of WMH-related cognitive impairment (CI) remains poorly understood. PURPOSE To detect the CVR status in WMH subjects with/without CI by using a resting-state blood oxygenation level-dependent (BOLD) approach and to explore the mediating relationships among CVR, WMH, and cognitive level. STUDY TYPE Prospective. SUBJECTS Subjects with moderate to severe WMH (with CI [WMH-CI], n = 68; without CI [WMH-no-CI, n = 63) as well as normal controls (NCs, n = 87). FIELD STRENGTH/SEQUENCE 3.0T with gradient-recalled echoplanar imaging and 3D fluid-attenuated inversion recovery. ASSESSMENT The CVR, WMH volume, and cognitive level were assessed. The CVR map was derived using BOLD signal obtained from resting-state functional MRI data. STATISTICAL TESTS CVR maps were compared among the three groups. Partial correlation analyses were performed to correlate impaired CVR with WMH volume and cognitive test scores. Mediation analysis was conducted to determine whether WMH acted as a mediating factor between CVR and cognitive function. RESULTS Compared with the NC group, both WMH groups showed reduced CVR in the left hemisphere (P < 0.05). The WMH-CI group showed further decreased CVR in the left frontal area, when compared with the WMH-no-CI group (P < 0.05). In the WMH-CI group, the lower CVR in left frontal area was a strong indicator of poor performance on general cognition (r = 0.311), executive function (r = 0.362), and information processing speed (r = 0.399) (all P < 0.05). Periventricular WMH (PWMH) volume mediated these correlations, the β and 95% bootstrap confidence intervals were (0.5097, [0.1498,1.1385]), (-0.4081, [-1.0256,-0.1363]), and (-0.5576, [-1.4666,-0.1538]), respectively. DATA CONCLUSION WMH-CI subjects showed a greater reduction of CVR derived from a resting-state BOLD approach in the left frontal area than WMH-no-CI subjects. Cognition was highly dependent on the integrity of cerebrovascular reactivity and mediated by PWMH burden. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ling Ni
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Dan Yang
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruomeng Qin
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hengheng Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Junyi Ma
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Pengfei Shao
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Liu L, Kurgan L, Wu FX, Wang J. Attention convolutional neural network for accurate segmentation and quantification of lesions in ischemic stroke disease. Med Image Anal 2020; 65:101791. [PMID: 32712525 DOI: 10.1016/j.media.2020.101791] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 06/26/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Ischemic stroke lesion and white matter hyperintensity (WMH) lesion appear as regions of abnormally signal intensity on magnetic resonance image (MRI) sequences. Ischemic stroke is a frequent cause of death and disability, while WMH is a risk factor for stroke. Accurate segmentation and quantification of ischemic stroke and WMH lesions are important for diagnosis and prognosis. However, radiologists have a difficult time distinguishing these two types of similar lesions. A novel deep residual attention convolutional neural network (DRANet) is proposed to accurately and simultaneously segment and quantify ischemic stroke and WMH lesions in the MRI images. DRANet inherits the advantages of the U-net design and applies a novel attention module that extracts high-quality features from the input images. Moreover, the Dice loss function is used to train DRANet to address data imbalance in the training data set. DRANet is trained and evaluated on 742 2D MRI images which are produced from the sub-acute ischemic stroke lesion segmentation (SISS) challenge. Empirical tests demonstrate that DRANet outperforms several other state-of-the-art segmentation methods. It accurately segments and quantifies both ischemic stroke lesion and WMH. Ablation experiments reveal that attention modules improve the predictive performance of DRANet.
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Affiliation(s)
- Liangliang Liu
- School of Computer Science and Engineering, Central South University, Changsha, 410083, P.R. China; Hunan Provincial Key Lab on Bioinformatics, Central South University, Changsha, 410083, P.R. China; Department of Network Center, Pingdingshan University, Pingdingshan, 467000, P.R. China
| | - Lukasz Kurgan
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Fang-Xiang Wu
- Department of Mechanical Engineering and Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK S7N5A9, Canada
| | - Jianxin Wang
- School of Computer Science and Engineering, Central South University, Changsha, 410083, P.R. China; Hunan Provincial Key Lab on Bioinformatics, Central South University, Changsha, 410083, P.R. China.
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Ni L, Zhou F, Qing Z, Zhang X, Li M, Zhu B, Zhang B, Xu Y. The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade. Front Aging Neurosci 2020; 12:163. [PMID: 32655391 PMCID: PMC7324557 DOI: 10.3389/fnagi.2020.00163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose The contribution of intracranial atherosclerotic stenosis (ICAS) to the development of white matter hyperintensities (WMHs) has not been fully elucidated. We aimed to retrospectively assess the relationship between WMH burden and unilateral ICAS by combined examination of lumen stenosis, plaque enhancement, and cerebral perfusion. Materials and methods A cross-sectional study of 41 patients with symptomatic unilateral ICAS (mean age 57 ± 10 years; 26 males) was conducted. Detailed clinical data, including vascular risk factors, were obtained. WMH volume was derived from 3D-fluid-attenuated inversion recovery (3D-FLAIR) and was assessed by using a validated semi-automated protocol. Lumen stenosis, plaque enhancement, and cerebral perfusion (assessed on time-to-peak parameter using the Alberta Stroke Program Early CT score (TTP-ASPECTS) scale) were evaluated. The WMH volumes of peri-ventricular (PWMH) and deep (DWMH) white matter were calculated separately and compared between hemispheres. Associations between WMH volume (inter-hemispheric volume difference, ipsilateral and contralateral to the ICAS site separately), unilateral ICAS imaging metrics, and vascular risk factors were assessed by using linear regression. Results The DWMH volume ipsilateral to the ICAS site (ipsilateral DWMH volume) was significantly greater than that of the contralateral site (P < 0.001), while the PWMH volume difference between hemispheres did not reach statistical significance. The inter-hemispheric DWMH volume difference was significantly associated with a higher plaque enhancement grade (β = 0.436, P = 0.005) and inversely associated with cerebral hypoperfusion (lower TTP-ASPECTS) (β = −0.613, P < 0.001). In the between-subject multivariable regression analysis, while older age (β = 0.323, P = 0.025), hypoperfusion (β = −0.394, P = 0.007), and hypertension (β = 0.378, P = 0.011) were independently associated with ipsilateral DWMH volume, plaque enhancement did not show an association with ipsilateral DWMH volume. The association between ipsilateral DWMH volume and lumen stenosis approached statistical significance (β = 0.274, P = 0.084). Conclusion The DWMH was attributed to chronic hypoperfusion secondary to atherosclerotic stenosis. The association between the asymmetry of deep white matter lesions and plaque enhancement might suggest that increased deep white matter lesions are those ischemic lesions, which are more prone to the development of stroke.
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Affiliation(s)
- Ling Ni
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fei Zhou
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhao Qing
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ming Li
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bin Zhu
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
| | - Yun Xu
- Department of Neurology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Xu J, Ma J, Shi Y, Yin D, Zhang Y, Dai P, Zhao W, Zhang T. Differential Protein Expression between Cystic and Solid Vestibular Schwannoma Using Tandem Mass Tag-Based Quantitative Proteomic Analysis. Proteomics Clin Appl 2020; 14:e1900112. [PMID: 32157794 DOI: 10.1002/prca.201900112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/04/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Cystic vestibular schwannoma (CVS) and solid vestibular schwannoma (SVS) are subgroups of vestibular schwannoma (VS). The tumorigenesis of CVS and SVS have not been fully elucidated, and this study is designed to identify differentially expressed proteins involved in the tumorigenesis of CVS and SVS. EXPERIMENTAL DESIGN Tandem mass tag-based proteomics is used to determine the protein expression profiles from CVS and SVS tissues. RESULTS A total of 30 differentially expressed proteins are identified between CVS and SVS, with 6 being upregulated and 24 being downregulated. Bioinformatics analyses are performed according to Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses. These results indicate that two selected proteins (COL1A1 and COL1A2) are potential biomarkers for distinguishing CVS and SVS. CONCLUSIONS AND CLINICAL RELEVANCE Differentially expressed proteins linked to CVS and SVS are identified, and these proteins might provide potential biomarkers for human VS diagnosis. Furthermore, the present study supports the notion that decreased collagen might be the reason for bleeding associated with CVS.
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Affiliation(s)
- Jianhui Xu
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Jing Ma
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Yuxuan Shi
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Dongming Yin
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Yang Zhang
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Peidong Dai
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
| | - Weidong Zhao
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Department of Otology and Skull Base Surgery, Eye and Ear, Nose, Throat Hospital of Fudan University, Shanghai, 200031, China
| | - Tianyu Zhang
- ENT Institute and Otorhinolaryngology Department of Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, 200031, China.,Key Laboratory of Hearing Medicine of NHFPC, Shanghai, 200031, China
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Blair GW, Thrippleton MJ, Shi Y, Hamilton I, Stringer M, Chappell F, Dickie DA, Andrews P, Marshall I, Doubal FN, Wardlaw JM. Intracranial hemodynamic relationships in patients with cerebral small vessel disease. Neurology 2020; 94:e2258-e2269. [PMID: 32366534 PMCID: PMC7357294 DOI: 10.1212/wnl.0000000000009483] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate cerebrovascular reactivity (CVR), blood flow, vascular and CSF pulsatility, and their independent relationship with cerebral small vessel disease (SVD) features in patients with minor ischemic stroke and MRI evidence of SVD. Methods We recruited patients with minor ischemic stroke and assessed CVR using blood oxygen level–dependent MRI during a hypercapnic challenge, cerebral blood flow (CBF), vascular and CSF pulsatility using phase-contrast MRI, and structural magnetic resonance brain imaging to quantify white matter hyperintensities (WMHs) and perivascular spaces (PVSs). We used multiple regression to identify parameters associated with SVD features, controlling for patient characteristics. Results Fifty-three of 60 patients completed the study with a full data set (age 68.0% ± 8.8 years, 74% male, 75% hypertensive). After controlling for age, sex, and systolic blood pressure, lower white matter CVR was associated with higher WMH volume (−0.01%/mm Hg per log10 increase in WMH volume, p = 0.02), basal ganglia PVS (−0.01%/mm Hg per point increase in the PVS score, p = 0.02), and higher venous pulsatility (superior sagittal sinus −0.03%/mm Hg, p = 0.02, per unit increase in the pulsatility index) but not with CBF (p = 0.58). Lower foramen magnum CSF stroke volume was associated with worse white matter CVR (0.04%/mm Hg per mL increase in stroke volume, p = 0.04) and more severe basal ganglia PVS (p = 0.09). Conclusions Lower CVR, higher venous pulsatility, and lower foramen magnum CSF stroke volume indicate that dynamic vascular dysfunctions underpin PVS dysfunction and WMH development. Further exploration of microvascular dysfunction and CSF dynamics may uncover new mechanisms and intervention targets to reduce SVD lesion development, cognitive decline, and stroke.
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Affiliation(s)
- Gordon W Blair
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Michael J Thrippleton
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Yulu Shi
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Iona Hamilton
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Michael Stringer
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Francesca Chappell
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - David Alexander Dickie
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Peter Andrews
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Ian Marshall
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Fergus N Doubal
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the Brain Research Imaging Centre (G.W.B., M.J.T., Y.S., I.H., M.S., F.C., P.A., I.M., F.N.D., J.M.W.), Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom; UK Dementia Research Institute at The University of Edinburgh (G.W.B., M.J.T., Y.S., I.H., M.S., F.N.D., J.M.W.), Edinburgh Medical School, United Kingdom; Beijing Tiantan Hospital Affiliated to Capital Medical University (Y.S.), China; Institute of Cardiovascular and Medical Sciences (D.A.D.), University of Glasgow, United Kingdom; and Centre for Cognitive Ageing and Cognitive Epidemiology (J.M.W.), University of Edinburgh, United Kingdom.
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Liu L, Chen S, Zhu X, Zhao XM, Wu FX, Wang J. Deep convolutional neural network for accurate segmentation and quantification of white matter hyperintensities. Neurocomputing 2020. [DOI: 10.1016/j.neucom.2019.12.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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