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Li KH, Krakauer C, Nelson JC, Crane PK, Andre JB, Curl PK, Yuh E, Mossa-Basha M, Ralston JD, Mac Donald CL, Gray SL. Cumulative anticholinergic exposure and white matter hyperintensity burden in community-dwelling older adults. J Am Geriatr Soc 2024. [PMID: 39697086 DOI: 10.1111/jgs.19325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 11/01/2024] [Accepted: 11/29/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND Anticholinergic exposure is associated with dementia risk; however, the mechanisms for this association remain unclear. The objective of this study was to examine the association between anticholinergic exposure and white matter hyperintensity (WMH) burden. METHODS This was a retrospective analysis of data from the Adult Changes in Thought (ACT) study, a prospective cohort study among adults aged ≥65 years on dementia risk factors. We used data collected through March 2020 for this analysis. The sample included ACT participants who were referred for and had a clinical magnetic resonance imaging (MRI) scan and ≥10 years of continuous healthcare enrollment prior to the scan. Our primary exposure was total standardized daily dose (TSDD) of anticholinergics. Outcomes included three semi-quantitative ratings of WMH volume. We used separate linear regression models for each outcome to estimate and compare covariate-adjusted mean values of WMH ratings in each exposure group. RESULTS Of the 1043 individuals included in the analyses, 28% had no use, 33% had 1-90 TSDD, 15% had 91-365 TSDD, 7% had 366-1095 TSDD, and 17% had ≥1096 TSDD. The mean age was 81 years, most were female (58%) and White race (88%). Compared to those with no use, the ≥1096 TSDD group had a higher (worse) adjusted mean [95% confidence intervals] Fazekas (4.0 [3.8, 4.2] vs. 3.4 [3.2, 3.5]; p: <0.001), Modified Scheltens (14.3 [13.4, 15.2] vs. 12.2 [11.5, 12.9]; p: <0.001), and Age-Related White Matter Changes (5.6 [5.3, 6.0] vs. 4.8 [4.5, 5.1]; p = 0.001). A dose-response relationship was not found. CONCLUSIONS The highest anticholinergic exposure was associated with greater WMH burden. Future studies should focus on longitudinal changes of WMH burden to better understand the biological mechanisms underlying the link between anticholinergics and dementia risk.
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Affiliation(s)
- Kevin H Li
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Chloe Krakauer
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
| | - Jennifer C Nelson
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jalal B Andre
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Patti K Curl
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Esther Yuh
- University of California, San Francisco, San Francisco, California, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - James D Ralston
- Kaiser Permanente Washington Research Institute, Seattle, Washington, USA
| | | | - Shelly L Gray
- School of Pharmacy, University of Washington, Seattle, Washington, USA
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Yang X, Liechti MD, Kanber B, Sudre CH, Castellazzi G, Zhang J, Yiannakas MC, Gonzales G, Prados F, Toosy AT, Gandini Wheeler-Kingshott CAM, Panicker JN. White Matter Magnetic Resonance Diffusion Measures in Multiple Sclerosis with Overactive Bladder. Brain Sci 2024; 14:975. [PMID: 39451989 PMCID: PMC11506346 DOI: 10.3390/brainsci14100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/22/2024] [Accepted: 09/25/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Lower urinary tract (LUT) symptoms are reported in more than 80% of patients with multiple sclerosis (MS), most commonly an overactive bladder (OAB). The relationship between brain white matter (WM) changes in MS and OAB symptoms is poorly understood. OBJECTIVES We aim to evaluate (i) microstructural WM differences across MS patients (pwMS) with OAB symptoms, patients without LUT symptoms, and healthy subjects using diffusion tensor imaging (DTI), and (ii) associations between clinical OAB symptom scores and DTI indices. METHODS Twenty-nine female pwMS [mean age (SD) 43.3 years (9.4)], including seventeen with OAB [mean age (SD) 46.1 years (8.6)] and nine without LUT symptoms [mean age (SD) 37.5 years (8.9)], and fourteen healthy controls (HCs) [mean age (SD) 48.5 years (20)] were scanned in a 3T MRI with a DTI protocol. Additionally, clinical scans were performed for WM lesion segmentation. Group differences in fractional anisotropy (FA) were evaluated using tract-based spatial statistics. The Urinary Symptom Profile questionnaire assessed OAB severity. RESULTS A statistically significant reduction in FA (p = 0.004) was identified in microstructural WM in pwMS, compared with HCs. An inverse correlation was found between FA in frontal and parietal WM lobes and OAB scores (p = 0.021) in pwMS. Areas of lower FA, although this did not reach statistical significance, were found in both frontal lobes and the rest of the non-dominant hemisphere in pwMS with OAB compared with pwMS without LUT symptoms (p = 0.072). CONCLUSIONS This study identified that lesions affecting different WM tracts in MS can result in OAB symptoms and demonstrated the role of the WM in the neural control of LUT functions. By using DTI, the association between OAB symptom severity and WM changes were identified, adding knowledge to the current LUT working model. As MS is predominantly a WM disease, these findings suggest that regional WM involvement, including of the anterior corona radiata, anterior thalamic radiation, superior longitudinal fasciculus, and superior frontal-occipital fasciculus and a non-dominant prevalence in WM, can result in OAB symptoms. OAB symptoms in MS correlate with anisotropy changes in different white matter tracts as demonstrated by DTI. Structural impairment in WM tracts plays an important role in LUT symptoms in MS.
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Affiliation(s)
- Xixi Yang
- Department of Neurology, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China
- Department of Brain Repair and Rehabilitation, Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London WC1E 6BT, UK; (M.D.L.); (J.N.P.)
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK;
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
| | - Martina D. Liechti
- Department of Brain Repair and Rehabilitation, Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London WC1E 6BT, UK; (M.D.L.); (J.N.P.)
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK;
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8006 Zürich, Switzerland
| | - Baris Kanber
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK;
| | - Carole H. Sudre
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK;
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK
- Dementia Research Centre, Institute of Neurology, University College London, London WC1E 6BT, UK
| | - Gloria Castellazzi
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
| | - Jiaying Zhang
- School of Artificial Intelligence, Beijing University of Post and Communications, Beijing 100876, China;
- Department of Computer Science and Centre for Medical Image Computing, University College London, London WC1E 6BT, UK
| | - Marios C. Yiannakas
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
| | - Gwen Gonzales
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK;
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, UK;
- e-Health Centre, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Ahmed T. Toosy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
| | - Claudia A. M. Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, University College London, London WC1E 6BT, UK; (B.K.); (G.C.); (M.C.Y.); (F.P.); (A.T.T.); (C.A.M.G.W.-K.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Digital Neuroscience Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Jalesh N. Panicker
- Department of Brain Repair and Rehabilitation, Faculty of Brain Sciences, Queen Square Institute of Neurology, University College London, London WC1E 6BT, UK; (M.D.L.); (J.N.P.)
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK;
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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024; 43:1261-1271. [PMID: 38178627 DOI: 10.1002/nau.25377] [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: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Zhao J, Luo X, Yang C, Yang X, Deng M, Sun B, Zhu J, Dong Z, Wang Y, Li J, Yang X, Li B, Wang X, Zheng J. Chemokine receptor 7 contributes to T- and B-cell filtering in ageing bladder, cystitis and bladder cancer. Immun Ageing 2024; 21:33. [PMID: 38762550 PMCID: PMC11102276 DOI: 10.1186/s12979-024-00432-5] [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: 02/27/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Research has suggested significant correlations among ageing, immune microenvironment, inflammation and tumours. However, the relationships among ageing, immune microenvironment, cystitis and bladder urothelial carcinoma (BLCA) in the bladder have rarely been reported. METHODS Bladder single-cell and transcriptomic data from young and old mice were used for immune landscape analysis. Transcriptome, single-cell and The Cancer Genome Atlas Program datasets of BLCA and interstitial cystitis/bladder pain syndrome (IC/BPS) were used to analyse immune cell infiltration and molecular expression. Bladder tissues from mice, IC/BPS and BLCA were collected to validate the results. RESULTS Eight types of immune cells (macrophages, B-cells, dendritic cells, T-cells, monocytes, natural killer cells, γδ T-cells and ILC2) were identified in the bladder of mice. Aged mice bladder tissues had a significantly higher number of T-cells, γδ T-cells, ILC2 and B-cells than those in the young group (P < 0.05). Three types of T-cells (NK T-cells, γδ T-cells and naïve T-cells) and three types of B-cells (follicular B-cells, plasma and memory B-cells) were identified in aged mice bladder. Chemokine receptor 7 (CCR7) is highly expressed in aged bladder, IC/BPS and BLCA (P < 0.05). CCR7 is likely to be involved in T- and B-cell infiltration in aged bladder, IC/BPS and BLCA. Interestingly, the high CCR7 expression on BLCA cell membranes was a prognostic protective factor. CONCLUSIONS In this study, we characterised the expression profiles of immune cells in bladder tissues of aged and young mice and demonstrated that CCR7-mediated T- and B-cell filtration contributes to the development of bladder ageing, IC/BPS and BLCA.
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Affiliation(s)
- Jiang Zhao
- Department of Urology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, PR China.
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China.
- Department of Urology, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Xing Luo
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Chengfei Yang
- Department of Thoracic Surgery, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Xiao Yang
- Institute of Life Sciences, Chongqing Medical University, Chongqing, 400037, China
| | - Min Deng
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Bishao Sun
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Jingzhen Zhu
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Zongming Dong
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Yangcai Wang
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Jia Li
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Xingliang Yang
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China
| | - Benyi Li
- Department of Urology, The University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Xiangwei Wang
- Department of Urology, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, PR China.
| | - Ji Zheng
- Department of Urology, The Second Affiliated Hospital, Army Military Medical University, Chongqing, 400037, China.
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Zuo L, Tian T, Wang B, Gu H, Wang S. Microstructural white matter abnormalities in overactive bladder syndrome evaluation with diffusion kurtosis imaging tract-based spatial statistics analysis. World J Urol 2024; 42:36. [PMID: 38217714 DOI: 10.1007/s00345-023-04709-0] [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: 05/02/2023] [Accepted: 10/16/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE This prospective study aimed to explore the microstructural alterations of the white matter in overactive bladder syndrome (OAB) using the Tract-based Spatial Statistics (TBSS) method of diffusion kurtosis imaging (DKI). METHODS A total of 30 patients were enrolled and compared with 30 controls. White matter (WM) status was assessed using tract-based spatial statistics for DKI. The differences in DKI-derived parameters, including kurtosis fractional anisotropy (KFA), fractional anisotropy (FA), mean kurtosis (MK), mean diffusivity (MD), radial kurtosis (RK), axial kurtosis (AK), axial diffusivity (AD), and radial diffusivity (RD), were compared between the two groups using the TBSS method. The correlation between the altered DKI-derived parameters and the (OABSS) scores was analyzed. A receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of different white matter parameters. RESULTS As a result, compared with the HC group, the KFA, and FA values decreased significantly in the OAB group. Compared with the HC group, the MK and MD values increased significantly in the OAB group. The KFA values of the genu of corpus callosum (GCC) were significantly correlated with the OABSS scores (r = - 0.509; p = 0.004). The FA values of anterior corona radiata (ACR) were significantly correlated with OABSS scores (r = - 0.447; p = 0.013). The area under the ROC curve (AUC) for the genu of corpus callosum KFA values was higher than FA for the diagnosis of OAB patients. CONCLUSION DKI is a promising approach to the investigation of the pathophysiology of OAB and a potential biomarker for clinical diagnosis of OAB.
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Affiliation(s)
- Long Zuo
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Tian Tian
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Biao Wang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hua Gu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Shuangkun Wang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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