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Chkili S, Lefebvre Y, Chao SL, Bali MA, Lemort M, Coquelet N. Optimization of workflow for detection of brain metastases at 3T: is a black-blood MTC prepared 3D T1 used alone robust enough to replace the combination of conventional 3D T1 and the black-blood 3D T1 MTC? Neuroradiology 2023:10.1007/s00234-023-03143-8. [PMID: 36995375 DOI: 10.1007/s00234-023-03143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE) is a black-blood 3D T1-weighted (T1w) magnetic resonance imaging (MRI) sequence that has shown robust performance for brain metastases detection. However, this could generate false positive results due to suboptimal blood signal suppression. For that reason, SPACE is used in our institution alongside a non-black-blood T1w sequence: volumetric interpolated breath-hold examination (VIBE). Our study aims to (i) evaluate the diagnostic accuracy of SPACE compared to its use in combination with VIBE, (ii) investigate the effect of radiologist's experience in the sequence's performance, and (iii) analyze causes of discordants results. METHODS Four hundred seventy-three 3T MRI scans were retrospectively analyzed following a monocentric study design. Two studies were formed: one including SPACE alone and one combining both sequences (SPACE + VIBE, the reference). An experienced neuroradiologist and a radiology trainee independently reviewed the images of each study and reported the number of brain metastases. The sensitivity (Se) and specificity (Sp) of SPACE compared to SPACE + VIBE in metastases detection were reported. Diagnostic accuracy of SPACE compared to SPACE + VIBE was assessed by using McNemar's test. Significance was set at p < 0.05. Cohen's kappa was used for inter-method and inter-observer variability. RESULTS No significant difference was found between the two methods, with SPACE having a Se > 93% and a Sp > 87%. No effect of readers' experience was disclosed. CONCLUSION Independently of radiologist's experience, SPACE alone is robust enough to replace SPACE + VIBE for brain metastases detection.
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Affiliation(s)
- Sophia Chkili
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium.
| | - Yolène Lefebvre
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Shih-Li Chao
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Marc Lemort
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Nicolas Coquelet
- Department of Radiology, Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
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Bahrani AA, Abner EL, DeCarli CS, Barber JM, Sutton AC, Maillard P, Sandoval F, Arfanakis K, Yang YC, Evia AM, Schneider JA, Habes M, Franklin CG, Seshadri S, Satizabal CL, Caprihan A, Thompson JF, Rosenberg GA, Wang DJ, Jann K, Zhao C, Lu H, Rosenberg PB, Albert MS, Ali DG, Singh H, Schwab K, Greenberg SM, Helmer KG, Powel DK, Gold BT, Goldstein LB, Wilcock DM, Jicha GA. Multi-Site Cross-Site Inter-Rater and Test-Retest Reliability and Construct Validity of the MarkVCID White Matter Hyperintensity Growth and Regression Protocol. J Alzheimers Dis 2023; 96:683-693. [PMID: 37840499 PMCID: PMC11009792 DOI: 10.3233/jad-230629] [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: 10/17/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) that occur in the setting of vascular cognitive impairment and dementia (VCID) may be dynamic increasing or decreasing volumes or stable over time. Quantifying such changes may prove useful as a biomarker for clinical trials designed to address vascular cognitive-impairment and dementia and Alzheimer's Disease. OBJECTIVE Conducting multi-site cross-site inter-rater and test-retest reliability of the MarkVCID white matter hyperintensity growth and regression protocol. METHODS The NINDS-supported MarkVCID Consortium evaluated a neuroimaging biomarker developed to track WMH change. Test-retest and cross-site inter-rater reliability of the protocol were assessed. Cognitive test scores were analyzed in relation to WMH changes to explore its construct validity. RESULTS ICC values for test-retest reliability of WMH growth and regression were 0.969 and 0.937 respectively, while for cross-site inter-rater ICC values for WMH growth and regression were 0.995 and 0.990 respectively. Word list long-delay free-recall was negatively associated with WMH growth (p < 0.028) but was not associated with WMH regression. CONCLUSIONS The present data demonstrate robust ICC validity of a WMH growth/regression protocol over a one-year period as measured by cross-site inter-rater and test-retest reliability. These data suggest that this approach may serve an important role in clinical trials of disease-modifying agents for VCID that may preferentially affect WMH growth, stability, or regression.
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Affiliation(s)
- Ahmed A. Bahrani
- Department of Neurology, University of Kentucky, College of Medicine, Lexington, KY, USA
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Erin L. Abner
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
- Department of Epidemiology & Environmental Health, University of Kentucky, College of Public Health, Lexington, KY, USA
| | | | - Justin M. Barber
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Abigail C. Sutton
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Pauline Maillard
- Department of Neurology, University of California, Davis, CA, USA
| | | | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA
| | - Yung-Chuan Yang
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Arnold M. Evia
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Julie A. Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Mohamad Habes
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Crystal G. Franklin
- Research Imaging Institute, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases, University of Texas Health San Antonio, San Antonio, TX, USA
| | | | | | - Gary A. Rosenberg
- Center for Memory and Aging, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA
| | - Danny J.J. Wang
- Departments of Neurology and Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kay Jann
- Departments of Neurology and Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chenyang Zhao
- Departments of Neurology and Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hanzhang Lu
- Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Paul B. Rosenberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Doaa G. Ali
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Herpreet Singh
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Karl G. Helmer
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David K. Powel
- Department of Neuroscience, University of Kentucky, College of Medicine, Lexington, KY, USA
- Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, USA
| | - Brian T. Gold
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
- Department of Neuroscience, University of Kentucky, College of Medicine, Lexington, KY, USA
- Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, USA
| | - Larry B. Goldstein
- Department of Neurology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Donna M. Wilcock
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
- Department of Physiology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Gregory A. Jicha
- Department of Neurology, University of Kentucky, College of Medicine, Lexington, KY, USA
- Sanders-Brown Center on Aging, University of Kentucky, College of Medicine, Lexington, KY, USA
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Kim T, Aizenstein HJ, Snitz BE, Cheng Y, Chang YF, Roush RE, Huppert TJ, Cohen A, Doman J, Becker JT. Tract Specific White Matter Lesion Load Affects White Matter Microstructure and Their Relationships With Functional Connectivity and Cognitive Decline. Front Aging Neurosci 2022; 13:760663. [PMID: 35185514 PMCID: PMC8848259 DOI: 10.3389/fnagi.2021.760663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
White matter hyperintensities (WMHs) are associated with cognitive decline. Assessing the effect of WMH on WM microstructural changes and its relationships with structural and functional connectivity to multiple cognitive domains are helpful to better understand the pathophysiological processes of cognitive impairment. 65 participants (49 normal and 16 MCI subjects, age: 67.4 ± 8.3 years, 44 females) were studied at 3T. The WMHs and fifty fiber tracts were automatically segmented from the T1/T2-weighted images and diffusion-weighted images, respectively. Tract-profiles of WMH were compared with those of apparent fiber density (AFD). The relationship between AFD and tract connectivity (TC) was assessed. Functional connectivity (FC) between tract ends obtained from resting-state functional MRI was examined in relation to TC. Tract-specific relationships of WMH, TC and FC with a multi-domain neuropsychological test battery and Montreal Cognitive Assessment (MoCA) were also separately assessed by lasso linear regression. Indirect pathways of TC and FC between WMH and multiple cognitive measures were tested using the mediation analysis. Higher WMH loads in WM tracts were locally matched with the reduced AFD, which was related to decrease in TC. However, no direct relationship was found between TC and FC. Tract-specific changes on WMH, TC and FC for each cognitive performance may explain that macro- and microstructural and functional changes are associated differently with each cognitive domain in a fiber specific manner. In these identified tracts, the differences between normal and MCI for WMH and TC were increased, and the relationships of WMH, TC and FC with cognitive outcomes were more significant, compared to the results from all tracts. Indirect pathways of two-step (TC-FC) between WMH and all cognitive domains were significant (p < 0.0083 with Bonferroni correction), while the separated indirect pathways through TC and through FC were different depending on cognitive domain. Deterioration in specific cognitive domains may be affected by alterations in a set of different tracts that are differently associated with macrostructural, microstructural, and function changes. Thus, assessments of WMH and its associated changes on specific tracts help for better understanding of the interrelationships of multiple changes in cognitive impairment.
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Affiliation(s)
- Tae Kim
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Tae Kim,
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Beth E. Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yu Cheng
- Departments of Statistics and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yue-Fang Chang
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca E. Roush
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Theodore J. Huppert
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
- Deparement of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Annie Cohen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jack Doman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - James T. Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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Hwang I, Yeon EK, Lee JY, Yoo RE, Kang KM, Yun TJ, Choi SH, Sohn CH, Kim H, Kim JH. Prediction of brain age from routine T2-weighted spin-echo brain magnetic resonance images with a deep convolutional neural network. Neurobiol Aging 2021; 105:78-85. [PMID: 34049061 DOI: 10.1016/j.neurobiolaging.2021.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Our study investigated the feasibility and clinical relevance of brain age prediction using axial T2-weighted images (T2-WIs) with a deep convolutional neural network (CNN) algorithm. The CNN model was trained by 1,530 scans in our institution. The performance was evaluated by the mean absolute error (MAE) between the predicted brain age and the chronological age based on an internal test set (n=270) and an external test set (n=560). The ensemble CNN model showed an MAE of 4.22 years in the internal test set and 9.96 years in the external test set. Participants with grade 2-3 white matter hyperintensity (WMH) showed a higher corrected predicted age difference (PAD) than grade 0 WMH (posthoc p<0.001). Participants diagnosed with diabetes mellitus also had a higher corrected PAD than those without diabetes (adjusted p=0.048), although it showed no significant differences according to the diagnosis of hypertension or dyslipidemia. We suggest that routine clinical T2-WIs are feasible to predict brain age, and it might be clinically relevant according to the WMH grade and the presence of diabetes mellitus.
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Affiliation(s)
- Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eung Koo Yeon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyeonjin Kim
- Department of Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
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5
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Kasahara H, Ikeda M, Nagashima K, Fujita Y, Makioka K, Tsukagoshi S, Yamazaki T, Takai E, Sanada E, Kobayashi A, Kishi K, Suto T, Higuchi T, Tsushima Y, Ikeda Y. Deep White Matter Lesions Are Associated with Early Recognition of Dementia in Alzheimer's Disease. J Alzheimers Dis 2020; 68:797-808. [PMID: 30775989 DOI: 10.3233/jad-180939] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuroimages of cerebral amyloid-β (Aβ) accumulation and small vessel disease (SVD) were examined in patients with various types of cognitive disorders using 11C-labeled Pittsburgh Compound B-positron emission tomography (PiB-PET) and magnetic resonance imaging (MRI). The mean cortical standardized uptake value ratio (mcSUVR) was applied for a quantitative analysis of PiB-PET data. The severity of white matter lesions (WML) and enlarged perivascular spaces (EPVS) on MRI were assessed to evaluate complicating cerebral SVD using semiquantitative scales. In homozygous apolipoprotein E ɛ3/ɛ3 carriers, the incidence of more severe WML and EPVS was higher in PiB-positive than PiB-negative patients, indicating that WML and EPVS might be associated with enhanced Aβ accumulation. An association study between PiB-PET and MRI findings revealed that higher WML grades significantly correlate with lower mcSUVRs, especially in the frontal area, indicating that more severe ischemic MRI findings are associated with milder Aβ accumulation among patients with Alzheimer's disease. In these patients SVD may accelerate the occurrence of cognitive decline and facilitate early recognition of dementia.
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Affiliation(s)
- Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaki Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Setsuki Tsukagoshi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tsuneo Yamazaki
- Department of Rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
| | - Eriko Takai
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Etsuko Sanada
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayumi Kobayashi
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuhiro Kishi
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
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6
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Lee Y, Ko J, Choi YE, Oh JS, Kim JS, Sunwoo MK, Yoon JH, Kang SY, Hong JY. Areas of white matter hyperintensities and motor symptoms of Parkinson disease. Neurology 2020; 95:e291-e298. [PMID: 32576636 DOI: 10.1212/wnl.0000000000009890] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether deep white matter and periventricular hyperintensities affect the motor symptoms of Parkinson disease (PD) differently, we analyzed MRI and dopamine transporter imaging. METHODS We analyzed the medical records of patients with de novo PD who underwent dopamine transporter PET scanning and MRI at their first visit. Deep white matter and periventricular hyperintensities were scored with a visual rating scale, and motor symptoms were assessed by Unified Parkinson's Disease Rating Scale motor score and tremor, rigidity, bradykinesia, and axial symptom subscores. The influence of white matter hyperintensity on motor symptoms was explored using multivariable linear regression models. RESULTS A total of 93 patients (mean age, 67.2 ± 9.9 years; 44 male) were included and the mean motor score was 25.0 ± 10.8. Subscores for bradykinesia and axial symptoms were correlated with both deep white matter and periventricular hyperintensities scores. Multivariable linear regression models revealed that deep white matter hyperintensities score was significantly associated with subscore for bradykinesia and periventricular hyperintensities score was associated with subscores for bradykinesia and axial symptoms after adjusting for putaminal dopamine transporter availability and clinical factors. CONCLUSIONS These results demonstrate that deep white matter hyperintensities are associated with bradykinesia and periventricular hyperintensities are associated with bradykinesia and axial symptoms in patients with PD independently of the severity of dopaminergic depletion.
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Affiliation(s)
- Yoonju Lee
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jeongmin Ko
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Ye Eun Choi
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jungsu S Oh
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jae Seung Kim
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Mun Kyung Sunwoo
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jung Han Yoon
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Suk Yun Kang
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea
| | - Jin Yong Hong
- From the Department of Health Promotion (Y.L.), Severance Check-up, Yonsei University Health System, Seoul; Department of Neurology (Y.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (J.K., J.Y.H.), Yonsei University Wonju College of Medicine, Wonju; Department of Nuclear Medicine (Y.E.C., J.S.O., J.S.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul; INFINITT Healthcare (Y.E.C.), Seoul; Department of Neurology (M.K.S.), Bundang Jesaeng General Hospital, Seongnam; Department of Neurology (J.H.Y.), Ajou University School of Medicine, Suwon; and Department of Neurology (S.Y.K.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea.
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Schwartz DL, Boespflug EL, Lahna DL, Pollock J, Roese NE, Silbert LC. Autoidentification of perivascular spaces in white matter using clinical field strength T 1 and FLAIR MR imaging. Neuroimage 2019; 202:116126. [PMID: 31461676 PMCID: PMC6819269 DOI: 10.1016/j.neuroimage.2019.116126] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/18/2019] [Accepted: 08/23/2019] [Indexed: 11/18/2022] Open
Abstract
Recent interest in enlarged perivascular spaces (ePVS) in the brain, which can be visualized on MRI and appear isointense to cerebrospinal fluid on all sequence weightings, has resulted in the necessity of reliable algorithms for automated segmentation to allow for whole brain assessment of ePVS burden. However, several publicly available datasets do not contain sequences required for recently published algorithms. This prospective study presents a method for identification of enlarged perivascular spaces (ePVS) in white matter using 3T T1 and FLAIR MR imaging (MAPS-T1), making the algorithm accessible to groups with valuable sets of limited data. The approach was applied identically to two datasets: 1) a repeated measurement in a dementia-free aged human population (N = 14), and 2) an aged sample of multisite ADNI datasets (N = 30). ePVS segmentation was accomplished by a stepwise local homogeneity search of white matter-masked T1-weighted data, constrained by FLAIR hyperintensity, and further constrained by width, volume, and linearity measurements. Pearson's r was employed for statistical testing between visual (gold standard) assessment and repeated measures in cohort one. Visual ePVS counts were significantly correlated with MAPS-T1 (r = .72, P < .0001). Correlations between repeated measurements in cohort one were significant for both visual and automated methods in the single visually-rated slice (MAPS-T1: r = .87, P < .0001, visual: (r = .86, P < .0001) and for whole brain assessment (MAPS-T1: r = .77, P = .001). Results from each cohort were manually inspected and found to have positive predictive values of 77.5% and 87.5%, respectively. The approach described in this report is an important tool for detailed assessment of ePVS burden in white matter on routinely acquired MRI sequences.
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Affiliation(s)
- Daniel L Schwartz
- Oregon Health & Science University, Layton Aging and Alzheimer's Disease Center, Neurology, USA; Oregon Health & Science University, Advanced Imaging Research Center, USA.
| | - Erin L Boespflug
- Oregon Health & Science University, Layton Aging and Alzheimer's Disease Center, Neurology, USA.
| | - David L Lahna
- Oregon Health & Science University, Layton Aging and Alzheimer's Disease Center, Neurology, USA
| | | | - Natalie E Roese
- Oregon Health & Science University, Layton Aging and Alzheimer's Disease Center, Neurology, USA
| | - Lisa C Silbert
- Oregon Health & Science University, Layton Aging and Alzheimer's Disease Center, Neurology, USA; Portland Veterans Affairs Medical Center, Neurology, USA
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8
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de la Monte SM. The Full Spectrum of Alzheimer's Disease Is Rooted in Metabolic Derangements That Drive Type 3 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1128:45-83. [PMID: 31062325 PMCID: PMC9996398 DOI: 10.1007/978-981-13-3540-2_4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The standard practice in neuropathology is to diagnose Alzheimer's disease (AD) based on the distribution and abundance of neurofibrillary tangles and Aβ deposits. However, other significant abnormalities including neuroinflammation, gliosis, white matter degeneration, non-Aβ microvascular disease, and insulin-related metabolic dysfunction require further study to understand how they could be targeted to more effectively remediate AD. This review addresses non-Aβ and non-pTau AD-associated pathologies, highlighting their major features, roles in neurodegeneration, and etiopathic links to deficits in brain insulin and insulin-like growth factor signaling and cognitive impairment. The discussion delineates why AD with its most characteristic clinical and pathological phenotypic profiles should be regarded as a brain form of diabetes, i.e., type 3 diabetes, and entertains the hypothesis that type 3 diabetes is just one of the categories of insulin resistance diseases that can occur independently or overlap with one or more of the others, including type 2 diabetes, metabolic syndrome, and nonalcoholic fatty liver disease.
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Affiliation(s)
- Suzanne M de la Monte
- Departments of Neurology, Neuropathology, and Neurosurgery, Rhode Island Hospital, and the Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Pathology and Laboratory Medicine, Providence VA Medical Center, Providence, RI, USA.
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9
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Kim JS, Kim M, Kang SH, Oh K, Suh S, Seo WK. The associations between bone mineral density and cerebral white matter hyperintensity in elderly stroke patients. PRECISION AND FUTURE MEDICINE 2018. [DOI: 10.23838/pfm.2018.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Huang CC, Yang AC, Chou KH, Liu ME, Fang SC, Chen CC, Tsai SJ, Lin CP. Nonlinear pattern of the emergence of white matter hyperintensity in healthy Han Chinese: an adult lifespan study. Neurobiol Aging 2018; 67:99-107. [DOI: 10.1016/j.neurobiolaging.2018.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/25/2018] [Accepted: 03/10/2018] [Indexed: 12/24/2022]
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11
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Cruz-Aguilar MA, Ramírez-Salado I, Guevara MA, Hernández-González M, Benitez-King G. Melatonin Effects on EEG Activity During Sleep Onset in Mild-to-Moderate Alzheimer's Disease: A Pilot Study. J Alzheimers Dis Rep 2018; 2:55-65. [PMID: 30480249 PMCID: PMC6159690 DOI: 10.3233/adr-170019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 11/21/2022] Open
Abstract
There is evidence demonstrating that 5-mg of fast-release melatonin significantly reduces nocturnal sleep onset in patients with mild-to-moderate Alzheimer's disease (AD). However, the physiological mechanism that could promote sleep installation by melatonin in patients with AD is still poorly understood. The present pilot study was designed to analyze the effects of melatonin on cortical activity during the sleep onset period (SOP) in eight mild-to-moderate AD patients treated with 5-mg of fast-release melatonin. Electroencephalographic recordings were obtained from C3-A1, C4-A2, F7-T3, F8-T4, F3-F4, and O1-O2. The relative power (RP), interhemispheric, intrahemispheric, and fronto-posterior correlations of six electroencephalographic bands were calculated and compared between two conditions: placebo and melatonin. Results show that at F7-T3, F3-F4, and C3-A1, melatonin induced an increase of the RP of the delta band. Likewise, in F7-T3, melatonin induced a decrease of the RP in the alpha1 band. Similarly, results show a lower interhemispheric correlation between the F7-T3 and F8-T4 derivations in the alpha1 band compared to the placebo condition. We conclude that the short sleep onset related to melatonin intake in AD patients was associated with a lower RP of the alpha1, a higher RP of the delta band (mainly in the left hemisphere) and a decreased interhemispheric EEG coupling in the alpha1 band. The possible role of the GABAergic neurotransmission as well as of the cascade of neurochemical events that melatonin triggers on sleep onset are discussed.
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Affiliation(s)
- Manuel Alejandro Cruz-Aguilar
- Universidad de Guadalajara, Instituto de Neurociencias, CUCBA, Laboratorio de Correlación Electroencefalográfica y Conducta, Guadalajara, Jalisco, México
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Dirección de Investigaciones en Neurociencias, Laboratorio de Cronobiología y Sueño, CDMX, México
| | - Ignacio Ramírez-Salado
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Dirección de Investigaciones en Neurociencias, Laboratorio de Cronobiología y Sueño, CDMX, México
| | - Miguel Angel Guevara
- Universidad de Guadalajara, Instituto de Neurociencias, CUCBA, Laboratorio de Correlación Electroencefalográfica y Conducta, Guadalajara, Jalisco, México
| | - Marisela Hernández-González
- Universidad de Guadalajara, Instituto de Neurociencias, CUCBA, Laboratorio de Neurofisiología de la Conducta Reproductiva, Guadalajara, Jalisco, México
| | - Gloria Benitez-King
- Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Subdirección de Investigaciones Clínicas, Laboratorio de Neurofarmacología, CDMX, México
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12
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Li R, Lai Y, Zhang Y, Yao L, Wu X. Classification of Cognitive Level of Patients with Leukoaraiosis on the Basis of Linear and Non-Linear Functional Connectivity. Front Neurol 2017; 8:2. [PMID: 28154549 PMCID: PMC5243822 DOI: 10.3389/fneur.2017.00002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/04/2017] [Indexed: 11/18/2022] Open
Abstract
Leukoaraiosis (LA) describes diffuse white matter abnormalities apparent in computed tomography (CT) or magnetic resonance (MR) brain scans. Patients with LA generally show varying degrees of cognitive impairment, which can be classified as cognitively normal (CN), mild cognitive impairment (MCI), and dementia. However, a consistent relationship between the degree of LA and the level of cognitive impairment has not yet been established. We used functional magnetic resonance imaging (fMRI) to explore possible neuroimaging biomarkers for classification of cognitive level in LA. Functional connectivity (FC) between brain regions was calculated using Pearson’s correlation coefficient (PCC), maximal information coefficient (MIC), and extended maximal information coefficient (eMIC). Next, FCs with high discriminative power for different cognitive levels in LA were used as features for classification based on support vector machine. CN and MCI were classified with accuracies of 75.0, 61.9, and 91.1% based on features from PCC, MIC, and eMIC, respectively. MCI and dementia were classified with accuracies of 80.1, 86.2, and 87.4% based on features from PCC, MIC, and eMIC, respectively. CN and dementia were classified with accuracies of 80.1, 89.9, and 94.4% based on features from PCC, MIC, and eMIC, respectively. Our results suggest that features extracted from fMRI were efficient for classification of cognitive impairment level in LA, especially, when features were based on a non-linear method (eMIC).
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Affiliation(s)
- Ranran Li
- College of Information Science and Technology, Beijing Normal University , Beijing , China
| | - Youzhi Lai
- College of Information Science and Technology, Beijing Normal University , Beijing , China
| | - Yumei Zhang
- Neurology Department, Beijing Tiantan Hospital Affiliated with Capital Medical University , Beijing , China
| | - Li Yao
- College of Information Science and Technology, Beijing Normal University, Beijing, China; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xia Wu
- College of Information Science and Technology, Beijing Normal University, Beijing, China; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
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13
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Ding JR, Ding X, Hua B, Xiong X, Wang Q, Chen H. Abnormal functional connectivity density in patients with ischemic white matter lesions: An observational study. Medicine (Baltimore) 2016; 95:e4625. [PMID: 27603353 PMCID: PMC5023875 DOI: 10.1097/md.0000000000004625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
White matter lesions (WMLs) are frequently detected in elderly people. Previous structural and functional studies have demonstrated that WMLs are associated with cognitive and motor decline. However, the underlying mechanism of how WMLs lead to cognitive decline and motor disturbance remains unclear. We used functional connectivity density mapping (FCDM) to investigate changes in brain functional connectivity in 16 patients with ischemic WMLs and 13 controls. Both short- and long-range FCD maps were computed, and group comparisons were performed between the 2 groups. A correlation analysis was further performed between regions with altered FCD and cognitive test scores (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]) in the patient group. We found that patients with ischemic WMLs showed reduced short-range FCD in the temporal cortex, primary motor cortex, and subcortical region, which may account for inadequate top-down attention, impaired motor, memory, and executive function associated with WMLs. The positive correlation between primary motor cortex and MoCA scores may provide evidence for the influences of cognitive function on behavioral performance. The inferior parietal cortex exhibited increased short-range FCD, reflecting a hyper bottom-up attention to compensate for the inadequate top-down attention for language comprehension and information retrieval in patients with WMLs. Moreover, the prefrontal and primary motor cortex showed increased long-range FCD and the former positively correlated with MoCA scores, which may suggest a strategy of cortical functional reorganization to compensate for motor and executive deficits. Our findings provide new insights into how WMLs cause cognitive and motor decline from cortical functional connectivity perspective.
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Affiliation(s)
- Ju-Rong Ding
- School of Automation and Electronic Information, Sichuan University of Science and Engineering, Zigong
- Correspondence: Ju-Rong Ding, School of Automation and Electronic Information, Sichuan University of Science and Engineering, Zigong, China (e-mail: ); Qingsong Wang, Department of Neurology, Chengdu Military General Hospital, Chengdu, China (e-mail: )
| | - Xin Ding
- Department of Neurology, Chengdu Military General Hospital
| | - Bo Hua
- School of Automation and Electronic Information, Sichuan University of Science and Engineering, Zigong
| | - Xingzhong Xiong
- School of Automation and Electronic Information, Sichuan University of Science and Engineering, Zigong
| | - Qingsong Wang
- Department of Neurology, Chengdu Military General Hospital
- Correspondence: Ju-Rong Ding, School of Automation and Electronic Information, Sichuan University of Science and Engineering, Zigong, China (e-mail: ); Qingsong Wang, Department of Neurology, Chengdu Military General Hospital, Chengdu, China (e-mail: )
| | - Huafu Chen
- Key Laboratory for Neuroinformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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14
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Pelliccioli G, Parnetti L, Chiarini P, Floridi P, Campanella S, Guercini G, Leone F. Riferimenti neuroradiologici nella diagnostica differenziale delle demenze dell'età avanzata. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140099600900415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Allo scopo di fornire un contributo nella diagnostica delle demenze dell'età avanzata abbiamo valutato con risonanza magnetica i due reperti di maggiore interesse nell'invecchiamento cerebrale, volumetria ippocampale e lesioni iperintense della sostanza bianca e dei nuclei della base, in 12 pazienti affetti da malattia di Alzheimer (AD), in 9 da demenza vascolare (VD), in 12 con Age Associated Memory Impairment (AAMI), entità clinica di riscontro relativamente frequente nell'anziano su cui non esistono ancora pareri univoci, e in 9 soggetti di controllo di analoga fascia di età. I gruppi AD e AAMI sono risultati indistinguibili, in quanto entrambi hanno presentato una significativa riduzione del volume ippocampale rispetto agli altri gruppi ed una presenza di iperintensità della sostanza bianca analoga ai controlli. Nel gruppo VD al contrario la presenza di iperintensità della sostanza bianca, distinte dalla parete ventricolare, è risultata significativamente superiore rispetto a tutti gli altri gruppi; analogo andamento è stato osservato anche per le iperintensità dei nuclei della base ed infratentoriali. Le iperintensità periventricolari si sono invece dimostrate reperto meramente associato all'età. Questi risultati sembrano indicare che un esame RM, basato sulla combinazione di uno studio volumetrico ippocampale e di una valutazione semiquantitativa delle lesioni iperintense, offre fondamentali elementi «in positivo» nella diagnostica differenziale delle demenze. In particolare la AD e la VD sono ben caratterizzate e l'AAMI sembra essere una fase precoce di AD piuttosto che un'entità a se stante.
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Affiliation(s)
| | - L. Parnetti
- Istituto di Gerontologia e Geriatria, Università degli Studi; Perugia
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15
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Ikram MA, van der Lugt A, Niessen WJ, Koudstaal PJ, Krestin GP, Hofman A, Bos D, Vernooij MW. The Rotterdam Scan Study: design update 2016 and main findings. Eur J Epidemiol 2015; 30:1299-315. [PMID: 26650042 PMCID: PMC4690838 DOI: 10.1007/s10654-015-0105-7] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/25/2015] [Indexed: 12/20/2022]
Abstract
Imaging plays an essential role in research on neurological diseases in the elderly. The Rotterdam Scan Study was initiated as part of the ongoing Rotterdam Study with the aim to elucidate the causes of neurological disease by performing imaging of the brain in a prospective population-based setting. Initially, in 1995 and 1999, random subsamples of participants from the Rotterdam Study underwent neuroimaging, whereas from 2005 onwards MRI has been implemented into the core protocol of the Rotterdam Study. In this paper, we discuss the background and rationale of the Rotterdam Scan Study. Moreover, we describe the imaging protocol, image post-processing techniques, and the main findings to date. Finally, we provide recommendations for future research, which will also be topics of investigation in the Rotterdam Scan Study.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiro J Niessen
- Biomedical Imaging Group Rotterdam, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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16
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Yoo DH, Song SW, Yun TJ, Kim TM, Lee SH, Kim JH, Sohn CH, Park SH, Park CK, Kim IH, Choi SH. MR Imaging Evaluation of Intracerebral Hemorrhages and T2 Hyperintense White Matter Lesions Appearing after Radiation Therapy in Adult Patients with Primary Brain Tumors. PLoS One 2015; 10:e0136795. [PMID: 26322780 PMCID: PMC4556481 DOI: 10.1371/journal.pone.0136795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/07/2015] [Indexed: 12/04/2022] Open
Abstract
The purpose of our study was to determine the frequency and severity of intracerebral hemorrhages and T2 hyperintense white matter lesions (WMLs) following radiation therapy for brain tumors in adult patients. Of 648 adult brain tumor patients who received radiation therapy at our institute, magnetic resonance (MR) image data consisting of a gradient echo (GRE) and FLAIR T2-weighted image were available three and five years after radiation therapy in 81 patients. Intracerebral hemorrhage was defined as a hypointense dot lesion appearing on GRE images after radiation therapy. The number and size of the lesions were evaluated. The T2 hyperintense WMLs observed on the FLAIR sequences were graded according to the extent of the lesion. Intracerebral hemorrhage was detected in 21 (25.9%) and 35 (43.2) patients in the three- and five-year follow-up images, respectively. The number of intracerebral hemorrhages per patient tended to increase as the follow-up period increased, whereas the size of the intracerebral hemorrhages exhibited little variation over the course of follow-up. T2 hyperintense WMLs were observed in 27 (33.3%) and 32 (39.5) patients in the three and five year follow-up images, respectively. The age at the time of radiation therapy was significantly higher (p < 0.001) in the patients with T2 hyperintense WMLs than in those without lesions. Intracerebral hemorrhages are not uncommon in adult brain tumor patients undergoing radiation therapy. The incidence and number of intracerebral hemorrhages increased over the course of follow-up. T2 hyperintense WMLs were observed in more than one-third of the study population.
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Affiliation(s)
- Dong Hyun Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sang Woo Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- * E-mail: (SHC); (IHK); (CKP)
| | - Il Han Kim
- Department of Radiation Oncology, Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
- * E-mail: (SHC); (IHK); (CKP)
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- * E-mail: (SHC); (IHK); (CKP)
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17
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Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. Anesth Analg 2015; 120:176-185. [PMID: 25268397 DOI: 10.1213/ane.0000000000000455] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated to increase susceptibility to rare, but devastating, neurologic complications after shoulder surgery in the beach chair position (BCP). We hypothesized that patients in the BCP have diminished cerebral blood flow autoregulation than those who undergo surgery in the lateral decubitus position (LDP). A secondary aim was to examine whether there is a relationship between patient positioning during surgery and postoperative cognition or serum brain injury biomarker levels. METHODS Patients undergoing shoulder surgery in the BCP (n = 109) or LDP (n = 109) had mean arterial blood pressure (MAP) and regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy. A continuous, moving Pearson correlation coefficient was calculated between MAP and rScO2, generating the variable cerebral oximetry index (COx). When MAP is in the autoregulated range, COx approaches zero because there is no correlation between cerebral blood flow and arterial blood pressure. In contrast, when MAP is below the limit of autoregulation, COx is higher because there is a direct relationship between lower arterial blood pressure and lower cerebral blood flow. Thus, diminished autoregulation would be manifest as higher COx. Psychometric testing was performed before surgery and then 7 to 10 days and 4 to 6 weeks after surgery. A composite cognitive outcome was determined as the Z-score. Serum S100β, neuron-specific enolase, and glial fibrillary acidic protein were measured at baseline, after surgery, and on postoperative day 1. RESULTS After adjusting for age and history of hypertension, COx (P = 0.035) was higher and rScO2 lower (P < 0.0001) in the BCP group than in the LDP group. After adjusting for baseline composite cognitive outcome, there was no difference in Z-score 7 to 10 days (P = 0.530) or 4 to 6 weeks (P = 0.202) after surgery between the BCP and the LDP groups. There was no difference in serum biomarker levels between the 2 position groups CONCLUSIONS : Compared with patients in the LDP, patients undergoing shoulder surgery in the BCP are more likely to have higher COx indicating diminished cerebral autoregulation and lower rScO2. There were no differences in the composite cognitive outcome between the BCP and the LDP groups after surgery after accounting for baseline Z-score.
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Jäncke L, Mérillat S, Liem F, Hänggi J. Brain size, sex, and the aging brain. Hum Brain Mapp 2014; 36:150-69. [PMID: 25161056 DOI: 10.1002/hbm.22619] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/17/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022] Open
Abstract
This study was conducted to examine the statistical influence of brain size on cortical, subcortical, and cerebellar compartmental volumes. This brain size influence was especially studied to delineate interactions with Sex and Age. Here, we studied 856 healthy subjects of which 533 are classified as young and 323 as old. Using an automated segmentation procedure cortical (gray and white matter [GM and WM] including the corpus callosum), cerebellar (GM and WM), and subcortical (thalamus, putamen, pallidum, caudatus, hippocampus, amygdala, and accumbens) volumes were measured and subjected to statistical analyses. These analyses revealed that brain size and age exert substantial statistical influences on nearly all compartmental volumes. Analyzing the raw compartmental volumes replicated the frequently reported Sex differences in compartmental volumes with men showing larger volumes. However, when statistically controlling for brain size Sex differences and Sex × Age interactions practically disappear. Thus, brain size is more important than Sex in explaining interindividual differences in compartmental volumes. The influence of brain size is discussed in the context of an allometric scaling of the compartmental volumes.
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Affiliation(s)
- Lutz Jäncke
- Division Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland; International Normal Aging and Plasticity Imaging Center (INAPIC), University of Zurich, Switzerland; University Research Priority Program (URPP) "Dynamics of Healthy Aging", University of Zurich, Switzerland; Department of Special Education, King Abdulaziz University, Jeddah, Saudi Arabia
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Freeman LR, Haley-Zitlin V, Rosenberger DS, Granholm AC. Damaging effects of a high-fat diet to the brain and cognition: a review of proposed mechanisms. Nutr Neurosci 2013; 17:241-51. [PMID: 24192577 DOI: 10.1179/1476830513y.0000000092] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of obesity is growing and now includes at least one-third of the adult population in the United States. As obesity and dementia rates reach epidemic proportions, an even greater interest in the effects of nutrition on the brain have become evident. This review discusses various mechanisms by which a high fat diet and/or obesity can alter the brain and cognition. It is well known that a poor diet and obesity can lead to certain disorders such as type II diabetes, metabolic syndrome, and heart disease. However, long-term effects of obesity on the brain need to be further examined. The contribution of insulin resistance and oxidative stress is briefly reviewed from studies in the current literature. The role of inflammation and vascular alterations are described in more detail due to our laboratory's experience in evaluating these specific factors. It is very likely that each of these factors plays a role in diet-induced and/or obesity-induced cognitive decline.
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TDP-43 deposition in prospectively followed, cognitively normal elderly individuals: correlation with argyrophilic grains but not other concomitant pathologies. Acta Neuropathol 2013; 126:51-7. [PMID: 23604587 DOI: 10.1007/s00401-013-1110-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
TAR DNA-binding protein 43 (TDP-43) has been heavily researched in recent years due to its involvement in amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration. Several studies have also sought to investigate the frequency of TDP-43 deposition in other neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, but there has been relatively little work focused on the prevalence, distribution and histopathological associations of abnormal TDP-43 deposits in the brains of cognitively normal elderly subjects. We screened thick, free-floating coronal sections of mesial temporal lobe from 110 prospectively followed and autopsied cognitively normal subjects (age range 71-100 years) using an immunohistochemical method for phosphorylated TDP-43. We found a 36.4 % prevalence of pathologic TDP-43, mostly in the form of neurites while perikaryal cytoplasmic neuronal inclusions were uncommon and intranuclear inclusions were rare. With respect to other concomitant pathologies commonly found in elderly individuals, cases with TDP-43 had a greater prevalence of argyrophilic grains (ARG) (40 vs. 18.6 %) and overall ARG density (moderate vs. sparse). There were no additional associations with other concomitant pathologies, including cerebral white matter rarefaction, incidental Lewy bodies, neurofibrillary tangles or amyloid plaques. These results indicate deposition of TDP-43 occurs in a substantial subset of cognitively normal elderly subjects and is more common in those with ARG, supporting some previous studies linking pathological TDP-43 deposition with ARG and other pathological tau protein deposits.
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Alexopoulos GS, Bruce ML, Silbersweig D, Kalayam B, Stern E. Vascular depression: a new view of late-onset depression. DIALOGUES IN CLINICAL NEUROSCIENCE 2012. [PMID: 22033775 PMCID: PMC3181568 DOI: 10.31887/dcns.1999.1.2/galexopoulos] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have suggested that cerebrovascular disease may predispose, precipitate, or perpetuate some late-life depressive syndromes. The mechanisms of "vascular depression" include disruption of cortico-striato-pallido-thalamo-cortical (CSPTC) pathways or their modulating systems. This view is supported by the presentation of vascular depression, which consists of depressive symptoms, cognitive abnormalities, as well as neuroimaging findings that may result from CSPTC impairment. Moreover, clinical and electrophysiological evidence of CSPTC impairment, an abnormality frequently found in patients with vascular depression, appears to be associated with poor response to antidepressant treatment and early relapse and recurrence. The vascular depression hypothesis provides the conceptual background for studies that may have clinical and theoretical impact. Agents influencing dopamine, acetylcholine, and opioid neurotransmitters may be studied in vascular depression, since these are essential neurotransmitters of the frontostriatal circuitry. Drugs used for prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes. The choice of antidepressants in vascular depression may depend on their effect on neurological recovery from ischemic lesions. Finally, identification of specific relationships between specific symptoms, cognitive deficits, and disability may lead to interventions that target the patients' deficits as well as their interactions with psychosocial factors known to contribute to depression. Research can clarify the pathways to vascular depression by focusing on the site of lesion, the resultant brain dysfunction, the presentation of depression and time of onset, and the contribution of nonbiological factors.
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Affiliation(s)
- G S Alexopoulos
- Weill Medical College of Cornell University, White Plains, NY, USA. Professor of Psychiatry, Director Cornell Institute of Geriatric Psychiatry
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Della-Morte D, Guadagni F, Palmirotta R, Testa G, Caso V, Paciaroni M, Abete P, Rengo F, Ferroni P, Sacco RL, Rundek T. Genetics of ischemic stroke, stroke-related risk factors, stroke precursors and treatments. Pharmacogenomics 2012; 13:595-613. [DOI: 10.2217/pgs.12.14] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Stroke remains a leading cause of death worldwide and the first cause of disability in the western world. Ischemic stroke (IS) accounts for almost 80% of the total cases of strokes and is a complex and multifactorial disease caused by the combination of vascular risk factors, environment and genetic factors. Investigations of the genetics of atherosclerosis and IS has greatly enhanced our knowledge of this complex multifactorial disease. In this article we sought to review common single-gene disorders relevant to IS, summarize candidate gene and genome-wide studies aimed at discovering genetic stroke risk factors and subclinical phenotypes, and to briefly discuss pharmacogenetics related to stroke treatments. Genetics of IS is, in fact, one of the most promising research frontiers and genetic testing may be helpful for novel drug discoveries as well as for appropriate drug and dose selection for treatment of patients with cerebrovascular disease.
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Affiliation(s)
- David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, 00163 Rome, Italy
| | - Fiorella Guadagni
- Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, 00163 Rome, Italy
| | - Raffaele Palmirotta
- Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, 00163 Rome, Italy
| | - Gianluca Testa
- Department of Clinical Medicine, Cardiovascular Science & Immunology, Cattedra di Geriatria, University of Naples Federico II, Naples, Italy
- Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Valeria Caso
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, 06126 Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit & Division of Cardiovascular Medicine, University of Perugia, 06126 Perugia, Italy
| | - Pasquale Abete
- Department of Clinical Medicine, Cardiovascular Science & Immunology, Cattedra di Geriatria, University of Naples Federico II, Naples, Italy
| | - Franco Rengo
- Department of Clinical Medicine, Cardiovascular Science & Immunology, Cattedra di Geriatria, University of Naples Federico II, Naples, Italy
| | - Patrizia Ferroni
- Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele Pisana, 00163 Rome, Italy
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Windham BG, Griswold ME, Shibata D, Penman A, Catellier DJ, Mosley TH. Covert neurological symptoms associated with silent infarcts from midlife to older age: the Atherosclerosis Risk in Communities study. Stroke 2012; 43:1218-23. [PMID: 22382163 DOI: 10.1161/strokeaha.111.643379] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Unrecognized or unreported stroke-like symptoms, called covert symptoms, occur in persons free of clinical stroke. Whether covert symptoms are associated with subclinical brain infarcts (SBIs) is unknown. This study examined the association between covert stroke-like symptoms and SBI/stroke in persons with no history of stroke or transient ischemic attack. METHODS A total of 1881 Atherosclerosis Risk in Communities (ARIC) participants free of clinical stroke or transient ischemic attack (40% male, 50% black, 47-70 years) were queried for covert symptoms and underwent cerebral MRI during the baseline MRI visit. Symptoms were reassessed after 3 years at Visit 4 (n=1001; 39% male, 50% black) and approximately 10 years with a follow-up MRI (n=1006; 40% male, 50% black, 61-83 years). RESULTS Covert symptoms were associated with prevalent SBI (OR, 1.94; 95% CI, 1.21-3.11; P=0.006). No support was found for associations between baseline MRI symptoms and SBI at the follow up MRI visit. In participants without SBI at baseline, symptoms at Visit 4 (OR, 2.96; 1.23-7.13; P=0.016) and symptoms at the follow-up MRI visit (OR, 4.29; 2.51-7.33; P<0.001) were associated with a combined outcome of new SBI/clinical stroke on follow-up MRI. Covert symptoms at follow-up MRI visit were also associated with having new SBI (OR, 2.26; 1.18-4.32; P=0.014) on the follow-up MRI that were not seen on the baseline MRI. CONCLUSIONS Covert neurological symptoms were associated with prevalent SBI, and when ascertained at the time of follow-up MRI, with new SBI. Covert symptoms may reflect heightened risk for infarcts.
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Wu WE, Gass A, Glodzik L, Babb JS, Hirsch J, Sollberger M, Achtnichts L, Amann M, Monsch AU, Gonen O. Whole brain N-acetylaspartate concentration is conserved throughout normal aging. Neurobiol Aging 2012; 33:2440-7. [PMID: 22245316 DOI: 10.1016/j.neurobiolaging.2011.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 12/01/2011] [Accepted: 12/03/2011] [Indexed: 01/24/2023]
Abstract
We hypothesize that normal aging implies neuronal durability, reflected by age-independent concentrations of their marker--the amino acid derivative N-acetylaspartate (NAA). To test this, we obtained the whole-brain and whole-head N-acetylaspartate concentrations (WBNAA and WHNAA) with proton magnetic resonance (MR) spectroscopy; and the fractional brain parenchyma volume (fBPV)--a metric of atrophy, by segmenting the magnetic resonance image (MRI) from 42 (18 male) healthy young (31.9 ± 5.8 years old) and 100 (64 male, 72.6 ± 7.3 years old) cognitively normal elderly. The 12.8 ± 1.9 mM WBNAA of the young was not significantly different from the 13.1 ± 3.1 mM in the elderly (p > 0.05). In contrast, both fBPV (87.3 ± 4.7% vs. 74.8 ± 4.8%) and WHNAA (11.1 ± 1.7 mM vs. 9.8 ± 2.4 mM) were significantly higher in the young (approximately 14%; p < 0.0001 for both). The similarity in mean WBNAA between 2 cohorts 4 decades of normal aging apart suggests that neuronal integrity is maintained across the lifespan. Clinically, WBNAA could be used as a marker for normal (hence, also abnormal) brain aging. In contrast, WHNAA and fBPV seem age-related suggesting that brain atrophy may occur without compromising the remaining tissue.
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Affiliation(s)
- William E Wu
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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Ikram MA, van der Lugt A, Niessen WJ, Krestin GP, Koudstaal PJ, Hofman A, Breteler MMB, Vernooij MW. The Rotterdam Scan Study: design and update up to 2012. Eur J Epidemiol 2011; 26:811-24. [PMID: 22002080 PMCID: PMC3218266 DOI: 10.1007/s10654-011-9624-z] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 10/06/2011] [Indexed: 02/06/2023]
Abstract
Neuroimaging plays an important role in etiologic research on neurological diseases in the elderly. The Rotterdam Scan Study was initiated as part of the ongoing Rotterdam Study with the aim to unravel causes of neurological disease by performing neuroimaging in a population-based longitudinal setting. In 1995 and 1999 random subsets of the Rotterdam Study underwent neuroimaging, whereas from 2005 onwards MRI has been implemented into the core protocol of the Rotterdam Study. In this paper, we discuss the background and rationale of the Rotterdam Scan Study. We also describe the imaging protocol and post-processing techniques, and highlight the main findings to date. Finally, we make recommendations for future research, which will also be the main focus of investigation in the Rotterdam Scan Study.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Schmieder RE, Schmidt BMW, Raff U, Bramlage P, Dörfler A, Achenbach S, Schwab J, Kolominsky-Rabas P. Cerebral microangiopathy in treatment-resistant hypertension. J Clin Hypertens (Greenwich) 2011; 13:582-7. [PMID: 21806768 PMCID: PMC8108915 DOI: 10.1111/j.1751-7176.2011.00493.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 04/12/2011] [Accepted: 04/20/2011] [Indexed: 12/01/2022]
Abstract
Cerebral microangiopathy is a cause of cognitive impairment and indicates high risk for clinically overt cerebrovascular disease. It develops in patients with or without hypertension, and different pathologies may play a supporting role. In this pilot study, the authors aimed to elucidate risk factors contributing to the deleterious action of hypertension on cerebral small vessels. A cross-sectional study in 42 patients with treatment-resistant hypertension was performed. Microangiopathy was investigated by cerebral magnetic resonance imaging (MRI). Determinants were identified by clinical investigation, computed tomography, intima-media thickness and pulse wave velocity measurement, and urinary albumin excretion. Nineteen of 42 patients had cerebral microangiopathy (23 controls). Patients were different with respect to heart rate (60.5 ± 10.2 vs 69.7 ± 15.1 beats per minute; P = .029) and systolic blood pressure during nighttime (138 ± 13 mm Hg vs 126 ± 18 mm Hg; P = .019). In addition, there were significant differences in pulse wave velocity (10.7 ± 2.0 m/s vs 9.4 ± 1.4 m/s; P = .034), peripheral pulse pressure (70.8 ± 16.3 mm Hg vs 59.2 ± 13.6 mm Hg; P = .016), central pulse pressure (62.9 ± 15.8 mm Hg vs 50.3 ± 14.2 mm Hg; P = .012), and aortic augmentation pressure (15.9 ± 6.0 vs 11.8 ± 6.6; P = .040). Systolic blood pressure and signs of hypertensive vasculopathy such as peripheral and central pulse pressure and pulse wave velocity were associated with cerebral microangiopathy in patients with long-standing treatment-resistant hypertension.
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Affiliation(s)
- Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany.
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Correlations among brain gray matter volumes, age, gender, and hemisphere in healthy individuals. PLoS One 2011; 6:e22734. [PMID: 21818377 PMCID: PMC3144937 DOI: 10.1371/journal.pone.0022734] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 07/04/2011] [Indexed: 12/05/2022] Open
Abstract
To determine the relationship between age and gray matter structure and how interactions between gender and hemisphere impact this relationship, we examined correlations between global or regional gray matter volume and age, including interactions of gender and hemisphere, using a general linear model with voxel-based and region-of-interest analyses. Brain magnetic resonance images were collected from 1460 healthy individuals aged 20–69 years; the images were linearly normalized and segmented and restored to native space for analysis of global gray matter volume. Linearly normalized images were then non-linearly normalized and smoothed for analysis of regional gray matter volume. Analysis of global gray matter volume revealed a significant negative correlation between gray matter ratio (gray matter volume divided by intracranial volume) and age in both genders, and a significant interaction effect of age × gender on the gray matter ratio. In analyzing regional gray matter volume, the gray matter volume of all regions showed significant main effects of age, and most regions, with the exception of several including the inferior parietal lobule, showed a significant age × gender interaction. Additionally, the inferior temporal gyrus showed a significant age × gender × hemisphere interaction. No regional volumes showed significant age × hemisphere interactions. Our study may contribute to clarifying the mechanism(s) of normal brain aging in each brain region.
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Holland CM, Charil A, Csapo I, Liptak Z, Ichise M, Khoury SJ, Bakshi R, Weiner HL, Guttmann CR. The Relationship between Normal Cerebral Perfusion Patterns and White Matter Lesion Distribution in 1,249 Patients with Multiple Sclerosis. J Neuroimaging 2011; 22:129-36. [DOI: 10.1111/j.1552-6569.2011.00585.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Padovani A, Piero V, Bragoni M, Biase C, Trasimeni G, lannili M, Laudani G, Zanette E, Gualdi G, Lenzi G. Correlates of leukoaraiosis and ventricular enlargement on magnetic resonance imaging: a study in normal elderly and cerebrovascular patients. Eur J Neurol 2011; 4:15-23. [DOI: 10.1111/j.1468-1331.1997.tb00295.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
In spite of the breakneck speed at which understanding of the biological basis of the aging process has evolved, the important determinants of aging and longevity have yet to be uncovered. The preservation of cognitive functioning is an essential component of successful aging, and the ability to distinguish those who maintain cognitive health into advanced age from those who experience cognitive decline may influence public health efforts to prevent or delay the onset of cognitive impairment in old age. There is growing evidence implicating vascular risk factors and related subclinical cerebrovascular damage in cognitive impairment and dementia, but Alzheimer's disease is highly prevalent in older populations, and the role of inflammation in vascular and neurodegenerative processes is poorly understood. There is a growing need to examine the effects of these factors on normal cognitive aging. This brief survey of the literature reviews evidence of the roles of subclinical vascular brain damage and exposure to cerebrovascular risk factors in normal cognitive aging.
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Affiliation(s)
- Jessica R L Warsch
- Evelyn F. McKnight Center for Age-Related Memory Loss, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida 33133, USA.
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Reshef S, Fried L, Beauchamp N, Scharfstein D, Reshef D, Goodman S. Diastolic blood pressure levels and ischemic stroke incidence in older adults with white matter lesions. J Gerontol A Biol Sci Med Sci 2010; 66:74-81. [PMID: 21030465 DOI: 10.1093/gerona/glq166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal blood pressure level to minimize the risk of ischemic stroke (IS) in older adults is undetermined. Cerebral white matter lesions (WML), prevalent in older adults, may be a marker for vulnerability to IS. We aimed at determining the relationship between diastolic blood pressure (DBP) levels and IS in the presence of WML. METHODS The Cardiovascular Health Study population (N = 3,345, age ≥ 65 years, N = 3,345) was followed between 1989 and 2002 for IS incidence. Survival analysis included quintiles of DBP analyzed within WML levels controlling for age and cardiovascular disease. RESULTS DBP had no effect on IS incidence in low WML levels but had a marginally significant J-curve relationship with IS in high WML levels: the adjusted hazard ratio for IS in the lowest (<63 mmHg) and highest (≥ 80) DBP quintiles compared with the third (nadir, 69-73 mmHg) was 1.64 (95% confidence interval: 0.93-2.9) and 1.83 (95% confidence interval: 1.06-3.15), respectively. CONCLUSIONS In older adults with low-grade WML, low DBP may not pose a risk for IS. However, in high-grade WML, IS risk may increase in DBP less than 69 mmHg but is highest more than 80 mmHg. People with high-grade WML may be at risk of IS in high and low DBP.
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Affiliation(s)
- Shoshana Reshef
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Brickman AM, Muraskin J, Zimmerman ME. Structural neuroimaging in Altheimer's disease: do white matter hyperintensities matter? DIALOGUES IN CLINICAL NEUROSCIENCE 2009. [PMID: 19585953 PMCID: PMC2864151 DOI: 10.31887/dcns.2009.11.2/ambrickman] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The targeted brain dysfunction that accompanies aging can have a devastating effect on cognitive and intellectual abilities. A significant proportion of older adults experience precipitous cognitive decline that negatively impacts functional activities. Such individuals meet clinical diagnostic criteria for dementia, which is commonly attributed to Alzheimer's disease (AD). Structural neuroimaging, including magnetic resonance imaging (MRI), has contributed significantly to our understanding of the morphological and pathology-related changes that may underlie normal and disease-associated cognitive change in aging. White matter hyperintensities (WMH), which are distributed patches of increased hyperintense signal on T2-weighted MRI, are among the most common structural neuroimaging findings in older adults. In recent years, WMH have emerged as robust radiological correlates of cognitive decline. Studies suggest that WMH distributed in anterior brain regions are related to decline in executive abilities that is typical of normal aging, whereas WMH distributed in more posterior brain regions are common in AD. Although epidemiological, observational, and pathological studies suggest that WMH may be ischemic in origin and caused by consistent or variable hypoperfusion, there is emerging evidence that they may also reflect vascular deposition of (β-amyloid, particularly when they are distributed in posterior areas and are present in patients with AD. Findings from the literature highlight the potential contribution of small-vessel cerebrovascular disease to the pathogenesis of AD, and suggest a mechanistic interaction, but future longitudinal studies using multiple imaging modalities are required to fully understand the complex role of WMH in AD.
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Affiliation(s)
- Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Van Otterloo E, O’Dwyer G, Stockmeier CA, Steffens DC, Krishnan RR, Rajkowska G. Reductions in neuronal density in elderly depressed are region specific. Int J Geriatr Psychiatry 2009; 24:856-64. [PMID: 19405038 PMCID: PMC2756775 DOI: 10.1002/gps.2281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Frontal regions, including the orbitofrontal cortex (ORB) and dorsolateral prefrontal cortex (dlPFC) have been implicated in the neuropathology of geriatric depression. Prominent reductions in pyramidal neuron density have been recently reported in the ORB of older depressed subjects. However, the cellular pathology of the dlPFC has not yet been examined in these subjects. METHODS Postmortem tissue from the dlPFC (Brodmann's area 9, BA9) was collected from 10 older (>60 years old) subjects diagnosed with major depression and 10 age-matched non-psychiatric controls (CTRL). The majority of the subjects were the same as those used for our previous study on neuronal reductions in the ORB in older depressed. Overall (all six layers combined), and laminar density of pyramidal (presumably glutamatergic), and non-pyramidal (GABAergic) neurons as well as cortical and laminar width were measured using linear optical disector of Stereoinvestigator software. RESULTS Neither the overall nor laminar density of pyramidal or non-pyramidal neurons was significantly different between groups. The cortical and laminar widths were also not affected. CONCLUSIONS These results suggest that neuronal prefrontal pathology in elderly depressed is region specific. No significant changes were detected in the density of any type of neurons in the dlPFC of elderly depressed subjects (present study) whereas, prominent reductions in the density of pyramidal glutamatergic neurons were observed previously in the ORB.
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Affiliation(s)
- Eric Van Otterloo
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gillian O’Dwyer
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Craig A. Stockmeier
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - David C. Steffens
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Ranga R. Krishnan
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Grazyna Rajkowska
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA,Correspondence to: Dr G. Rajkowska, Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, 2500, North State Street, P.O. Box 127, Jackson 39216-4505, MS, USA. E-mail:
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Jefferson AL, Holland CM, Tate DF, Csapo I, Poppas A, Cohen RA, Guttmann CRG. Atlas-derived perfusion correlates of white matter hyperintensities in patients with reduced cardiac output. Neurobiol Aging 2009; 32:133-9. [PMID: 19269713 DOI: 10.1016/j.neurobiolaging.2009.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 01/13/2009] [Accepted: 01/21/2009] [Indexed: 11/26/2022]
Abstract
Reduced cardiac output is associated with increased white matter hyperintensities (WMH) and executive dysfunction in older adults, which may be secondary to relations between systemic and cerebral perfusion. This study preliminarily describes the regional distribution of cerebral WMH in the context of a normal cerebral perfusion atlas and aims to determine if these variables are associated with reduced cardiac output. Thirty-two participants (72 ± 8 years old, 38% female) with cardiovascular risk factors or disease underwent structural MRI acquisition at 1.5T using a standard imaging protocol that included FLAIR sequences. WMH distribution was examined in common anatomical space using voxel-based morphometry and as a function of normal cerebral perfusion patterns by overlaying a single photon emission computed tomography (SPECT) atlas. Doppler echocardiogram data was used to dichotomize the participants on the basis of low (n=9) and normal (n=23) cardiac output. Global WMH count and volume did not differ between the low and normal cardiac output groups; however, atlas-derived SPECT perfusion values in regions of hyperintensities were reduced in the low versus normal cardiac output group (p<0.001). Our preliminary data suggest that participants with low cardiac output have WMH in regions of relatively reduced perfusion, while normal cardiac output participants have WMH in regions with relatively higher regional perfusion. This spatial perfusion distribution difference for areas of WMH may occur in the context of reduced systemic perfusion, which subsequently impacts cerebral perfusion and contributes to subclinical or clinical microvascular damage.
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Affiliation(s)
- Angela L Jefferson
- Department of Neurology, Alzheimer's Disease Center, Boston University School of Medicine, Robinson Complex, Suite 7800 72 East Concord Street Boston, MA 02118-2526, USA.
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Chronic Information-processing Changes in Individuals With a First-ever Clinical Lacunar Syndrome. Cogn Behav Neurol 2008; 21:236-41. [DOI: 10.1097/wnn.0b013e31817d74d0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fractal dimension assessment of brain white matter structural complexity post stroke in relation to upper-extremity motor function. Brain Res 2008; 1228:229-40. [PMID: 18590710 DOI: 10.1016/j.brainres.2008.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 06/01/2008] [Indexed: 12/12/2022]
Abstract
Little is known about the association between brain white matter (WM) structure and motor function in humans. This study investigated complexity of brain WM interior shape as determined by magnetic resonance imaging (MRI) and its relationship with upper-extremity (UE) motor function in patients post stroke. We hypothesized that (1) the WM complexity would decrease following stroke, and (2) higher WM complexity in non-affected cortical areas would be related to greater UE motor function. Thirty-eight stroke patients (16 with left-hemisphere lesions) underwent MRI anatomical brain scans. Fractal dimension (FD), a quantitative shape metric, was applied onto skeletonized brain WM images to evaluate WM internal structural complexity. Wolf Motor Function Test (WMFT) and Fugl-Meyer Motor Assessment (FM) scores were measured to assess motor function of the affected limb. The WM complexity was lower in the stroke-affected hemisphere. The FD was associated with better motor function in two subgroups: with left-subcortical lesions, FD values of the lesion-free areas of the left hemisphere were associated with better FM scores; with right-cortical lesions, FD values of lesion-free regions were robustly associated with better WMFT scores. These findings suggest that greater residual WM complexity is associated with less impaired UE motor function, which is more robust in patients with right-hemisphere lesions. No correlations were found between lesion volume and WMFT or FM scores. This study addressed WM complexity in stroke patients and its relationship with UE motor function. Measurement of brain WM reorganization may be a sensitive correlate of UE function in people recovering from stroke.
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Bronge L, Wahlund LO. White matter changes in dementia: does radiology matter? Br J Radiol 2008; 80 Spec No 2:S115-20. [PMID: 18445741 DOI: 10.1259/bjr/35265137] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
White matter changes are frequently seen on MRI in elderly patients. The significance of these changes is still debated. The origin of white matter changes is heterogeneous but the majority are due to arteriosclerosis in brain vessels. The clinical consequence of the presence of white matter changes in relation to dementia is still unclear. Lately, however, many studies have found a relation between the presence and the degree of white matter changes and cognitive dysfunction. This is most obvious in vascular dementia, but has also been suggested to be of importance in Alzheimer's disease. In this review we discuss the background of these changes and the clinical consequences of them in relation to cognitive disorders.
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Affiliation(s)
- L Bronge
- Aleris Diagnostics, Sabbatsberg, SE-11328, Stockholm, Sweden
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Holland CM, Smith EE, Csapo I, Gurol ME, Brylka DA, Killiany RJ, Blacker D, Albert MS, Guttmann CRG, Greenberg SM. Spatial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Stroke 2008; 39:1127-33. [PMID: 18292383 DOI: 10.1161/strokeaha.107.497438] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE White-matter hyperintensities (WMHs) detected by magnetic resonance imaging are thought to represent the effects of cerebral small-vessel disease and neurodegenerative changes. We sought to determine whether the spatial distribution of WMHs discriminates between different disease groups and healthy aging individuals and whether these distributions are related to local cerebral perfusion patterns. METHODS We examined the pattern of WMHs by T2/fluid-attenuated inversion recovery-weighted magnetic resonance imaging in 3 groups of subjects: cerebral amyloid angiopathy (n=32), Alzheimer disease or mild cognitive impairment (n=41), and healthy aging (n=29). WMH frequency maps were calculated for each group, and spatial distributions were compared by voxel-wise logistic regression. WMHs were also analyzed as a function of normal cerebral perfusion patterns by overlaying a single photon emission computed tomography atlas. RESULTS Although WMH volume was greater in cerebral amyloid angiopathy and Alzheimer disease/mild cognitive impairment than in healthy aging, there was no consistent difference in the spatial distributions when controlling for total WMH volume. Hyperintensities were most frequent in the deep periventricular WM in all 3 groups. A strong inverse correlation between hyperintensity frequency and normal perfusion was demonstrated in all groups, demonstrating that WMHs were most common in regions of relatively lower normal cerebral perfusion. CONCLUSIONS WMHs show a common distribution pattern and predilection for cerebral WM regions with lower atlas-derived perfusion, regardless of the underlying diagnosis. These data suggest that across diverse disease processes, WM injury may occur in a pattern that reflects underlying tissue properties, such as relative perfusion.
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Affiliation(s)
- Christopher M Holland
- Center for Neurological Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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[Depression as the cause and consequence of cerebrovascular diseases]. MEDICINSKI PREGLED 2007; 60:255-60. [PMID: 17988059 DOI: 10.2298/mpns0706255r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Recent epidemiological, clinical, neuroimaging and neuropathological studies have reported substantial evidence on the complex interactive relationships between depression and cerebrovascular diseases, especially in older populations, and plausible explanations of the etiopathogenetic mechanisms in both directions have been proposed POSTSTROKE DEPRESSION Although there is no general consensus regarding its prevalence, it is widely accepted that major depression after stroke is common and that it should be recognized as a key factor in rehabilitation and outcome following stroke. VASCULAR DEPRESSION The "vascular depression" hypothesis presupposes that late-onset depression may often result from vascular damage to frontal-subcortical circuits implicated in mood regulation. This concept has stimulated many researches and the obtained results support the proposed hypothesis. DEPRESSION AS A STROKE RISK FACTOR Recent large studies have emphasised the role of depression per se in the development ofsubsequent stroke. Mechanisms proposed to explain the increased risk of cerebrovascular diseases in depressed patients There are a number ofplausible mechanisms that could explain why depression may increase the risk of subsequent cerebrovascular disease, the most important being sympathoadrenal hyperactivity, platelet activation, an increase in inflammatory cytokines and an increased risk of arrhythmias. CONCLUSION Thorough clinical examinations determining the conventional stroke risk factors in the population with depression, as well as management of depression as part of the overall measures for the reduction of cerebrovascular risk factors are of utmost importance.
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Bozzali M, Cherubini A. Diffusion tensor MRI to investigate dementias: a brief review. Magn Reson Imaging 2007; 25:969-77. [PMID: 17451903 DOI: 10.1016/j.mri.2007.03.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2007] [Indexed: 11/19/2022]
Abstract
Diffusion tensor magnetic resonance imaging (DT-MRI) is a powerful quantitative technique with the ability to detect in vivo microscopic characteristics and abnormalities of brain tissue. It has been successfully applied to a number of neurological conditions, such as stroke, multiple sclerosis and brain tumors, providing information otherwise inaccessible on the pathological substrates. DT-MRI has also been used to study patients with cognitive decline, mainly those with Alzheimer's disease. Several image-analysis approaches have been employed, including region of interest, histogram, voxel-based analyses and DT-MRI-based tractography. Specific patterns of spatial distribution of tissue damage and correlations with neuropsychological measures have been reported. This review focuses on the use of DT-MRI to investigate dementias. The main clinical results and the different methods of image analysis will be overviewed and discussed.
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Affiliation(s)
- Marco Bozzali
- Neuroimaging Laboratory, Fondazione Santa Lucia, IRCCS, Via Ardeatina 306, 00179 Rome, Italy.
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Tumeh PC, Alavi A, Houseni M, Greenfield A, Chryssikos T, Newberg A, Torigian DA, Moonis G. Structural and Functional Imaging Correlates for Age-Related Changes in the Brain. Semin Nucl Med 2007; 37:69-87. [PMID: 17289456 DOI: 10.1053/j.semnuclmed.2006.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In recent years, investigators have made significant progress in documenting brain structure and function as it relates to aging by using positron emission tomography, conventional magnetic resonance (MR) imaging, advanced MR techniques, and functional MR imaging. This review summarizes the latest advances in understanding physiologic maturation and aging as detected by these neuroimaging modalities. We also present our experience with MR volumetric and positron emission tomography analysis in separate cohorts of healthy subjects in the pediatric and adult age groups respectively. Our results are consistent with previous studies and include the following: total brain volume was found to increase with age (up to 20 years of age). Whole brain metabolism and frontal lobe metabolism both decrease significantly with age (38% and 42%, respectively), whereas cerebellar metabolism does not show a significant decline with age. Defining normal alterations in brain function and structure allows early detection of disorders such as Alzheimer's and Parkinson's diseases, which are commonly associated with normal aging.
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Affiliation(s)
- Paul C Tumeh
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
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Tomimoto H, Ohtani R, Wakita H, Lin JX, Ihara M, Miki Y, Oshima F, Murata T, Ishibashi K, Suenaga T, Mizuno T. Small artery dementia in Japan: radiological differences between CADASIL, leukoaraiosis and Binswanger's disease. Dement Geriatr Cogn Disord 2006; 21:162-9. [PMID: 16391479 DOI: 10.1159/000090677] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2005] [Indexed: 11/19/2022] Open
Abstract
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary small artery disease which is phenotypically similar to Binswanger's disease (BD), a nonhereditary form of small artery disease. Recent studies have indicated that lesions in the temporopolar, medial frontopolar areas and external capsule are frequently seen in Caucasian patients with CADASIL. However, it remains unclear whether magnetic resonance (MR) imaging findings are helpful in diagnosing small artery disease outside countries with Caucasian populations, since CADASIL is rare despite the high prevalence of small artery disease in Japan. We examined 58 patients with small artery disease, all of whom were devoid of major vessel occlusion or severe stenosis. These patients included 7 patients from 3 families with CADASIL, 27 nondemented patients with extensive leukoaraiosis (LA) and 24 patients with BD. On T(2)-weighted MR images, hyperintensities in the temporopolar areas were observed in all 7 patients with CADASIL, whereas these lesions were observed in only 1 subject from each of the nondemented LA and BD groups. Hyperintensities in the medial frontopolar areas were seen in 4 of the 7 patients with CADASIL (57%) and in 14 of the 24 patients with BD (58%), and were more frequent than in the nondemented LA group (4 of the 27 patients; 15%). In contrast, hyperintensities in the external capsule were frequently observed in all groups. Therefore, temporopolar lesions can also serve as diagnostic markers for CADASIL in non-Caucasian patients.
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Affiliation(s)
- Hidekazu Tomimoto
- Department of Neurology, Graduate School of Medicine, Kyoto University, Sakyo, Japan.
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Bozzali M, Falini A, Cercignani M, Baglio F, Farina E, Alberoni M, Vezzulli P, Olivotto F, Mantovani F, Shallice T, Scotti G, Canal N, Nemni R. Brain tissue damage in dementia with Lewy bodies: an in vivo diffusion tensor MRI study. ACTA ACUST UNITED AC 2005; 128:1595-604. [PMID: 15817515 DOI: 10.1093/brain/awh493] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of the present study was to apply diffusion tensor MRI (DT-MRI), a quantitative MRI measure which reflects tissue organization, to dementia with Lewy bodies (DLB). DT-MRI scans were obtained from 15 patients with probable DLB and 10 sex- and age-matched healthy controls. Abnormalities were found in the corpus callosum, pericallosal areas and the frontal, parietal, occipital and, less prominently, temporal white matter of patients compared with controls. Abnormalities were also found in the caudate nucleus and the putamen. The average grey matter volume was lower in patients than in controls. These findings of concomitant grey matter atrophy and white matter abnormalities (as detected by DT-MRI) in regions with a high prevalence of long connecting fibre tracts might suggest the presence of neurodegeneration involving associative cortices. The modest involvement of the temporal lobe fits with the relative preservation of global neuropsychological measures and memory tasks in the early stage of DLB. The selective involvement of parietal, frontal and occipital lobes might explain some of the clinical and neuropsychological features of DLB, providing a possible distinctive marker for this disease. The abnormalities found in the subcortical grey matter may indicate that DLB and Parkinson's disease share a similar nigrostriatal involvement caused by common pathophysiological mechanisms.
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Affiliation(s)
- M Bozzali
- Don Carlo Gnocchi Foundation, Scientific Institute and University, IRCCS, Milan, Italy.
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Park MK, Jo I, Park MH, Kim TK, Jo SA, Shin C. Cerebral white matter lesions and hypertension status in the elderly Korean: the Ansan Study. Arch Gerontol Geriatr 2004; 40:265-73. [PMID: 15814160 DOI: 10.1016/j.archger.2004.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Revised: 09/21/2004] [Accepted: 09/22/2004] [Indexed: 10/26/2022]
Abstract
There is evidence of an association of hypertension with white matter lesions (WMLs), leukoaraiosis, in the human brain in the United States, Europe and Japan. However, no study on this association has been reported in Korea. Community-dwelling elderly subjects aged over 61 years were randomly selected from samples of the Ansan Health Study, while their blood pressures (BPs) were measured using a highly standardized protocol. Hypertension was defined as a systolic BP> or =140 mmHg or a diastolic BP> or =90 mmHg or as reported treatment with hypertensive medication, and further subclassified with respect to its subtypes and control status. WMLs were determined by a 1.5-T MRI scan and further categorized into five subgroups with respect to its severity. Hypertension status, such as uncontrolled hypertension even after antihypertensive medication (adjusted odd ratio [OR]=6.07; 95% CI, 2.08-17.78), isolated systolic hypertension before medication (OR=2.66; 95% CI, 1.08-6.57), and hypertension before medication (OR=2.55; 95% CI, 1.19-5.46) were significantly and independently correlated with the presence and severity of WMLs. Advancing age (OR=1.76; 95% CI, 1.38-2.25), lacunar infarction (OR=3.19; 95% CI, 1.83-5.58), and cigarette smoking (OR=1.10; 95% CI, 1.03-1.18) were significantly related to the presence and severity of WMLs. Regular and tight control for hypertension should be exercised to prevent WMLs among the elderly with hypertension.
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Affiliation(s)
- Min Kyu Park
- Department of Neurology, Korea University Hospital, Ansan City, Gyeonggi-do 425-707, Republic of Korea
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Song SK, Kim JH, Lin SJ, Brendza RP, Holtzman DM. Diffusion tensor imaging detects age-dependent white matter changes in a transgenic mouse model with amyloid deposition. Neurobiol Dis 2004; 15:640-7. [PMID: 15056472 DOI: 10.1016/j.nbd.2003.12.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Revised: 08/29/2003] [Accepted: 12/04/2003] [Indexed: 11/28/2022] Open
Abstract
Increasing evidence demonstrates that there is marked damage and dysfunction not only in the gray matter but also in the white matter in Alzheimer's disease (AD). In this study, transgenic mice overexpressing beta-amyloid precursor protein (APP) under control of the platelet-derived growth factor promoter (PDAPP mice) were examined using diffusion tensor magnetic resonance imaging (DTI) to evaluate the extent of white matter injury before and following the development of AD-like pathology. The profile of DTI parameters was significantly different in old PDAPP mice compared to that of old control mice following the development of AD-like pathology. No difference in DTI parameters was observed between the young PDAPP and control mice. Our results suggest that as amyloid beta (Abeta) deposition and levels increase over time in PDAPP mice, these changes lead to primary or secondary white matter injury that can be detected by DTI.
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Affiliation(s)
- Sheng-Kwei Song
- Department of Chemistry, Washington University, St. Louis, MO 63130, USA.
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Ding J, Eigenbrodt ML, Mosley TH, Hutchinson RG, Folsom AR, Harris TB, Nieto FJ. Alcohol intake and cerebral abnormalities on magnetic resonance imaging in a community-based population of middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Stroke 2004; 35:16-21. [PMID: 14657449 DOI: 10.1161/01.str.0000105929.88691.8e] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Accepted: 09/02/2003] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Although the risks associated with heavy drinking for increased stroke and neurodegenerative changes are well established, the effects on the brain of low to moderate alcohol intake are unclear. Subclinical cerebral abnormalities identified on MRI have been associated with neurocognitive decline and incident stroke. We examined the associations of alcohol intake with MRI-defined cerebral abnormalities in a middle-aged, population-based cohort. METHODS During 1993-1994, a total of 1909 middle-aged adults (40% men and 49% blacks) from 2 communities in the Atherosclerosis Risk in Communities (ARIC) Study (Forsyth County, North Carolina, and Jackson, Miss) underwent a cerebral MRI examination. Trained neuroradiologists coded the images for the presence of infarction and the extent (10-point scale) of white matter lesions, ventricular size, and sulcal size. RESULTS In logistic regression analyses, there was no association between alcohol intake and the presence of MRI infarction. In linear regression analyses, alcohol intake was not associated with white matter grade. However, intake of each additional alcoholic drink per week was associated with a 0.01 grade greater ventricular size (P=0.03) and a 0.009 grade greater sulcal size (P=0.02) after adjustment for age, sex, race, body mass index, smoking, income, sports index, and diabetes. The positive associations of alcohol intake with ventricular and sulcal size were consistent across sex and race subgroups. CONCLUSIONS A protective effect of low to moderate alcohol intake on cerebral infarction was not found; moreover, increased alcohol intake was associated with brain atrophy.
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Affiliation(s)
- Jingzhong Ding
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room 6009, Baltimore, Md 21205, USA.
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Ding J, Nieto FJ, Beauchamp NJ, Longstreth WT, Manolio TA, Hetmanski JB, Fried LP. A prospective analysis of risk factors for white matter disease in the brain stem: the Cardiovascular Health Study. Neuroepidemiology 2003; 22:275-82. [PMID: 12902622 DOI: 10.1159/000071190] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE White matter disease (WMD) in the brain stem may be a predictor of poor clinical outcome, independent of WMD in the periventricular and subcortical areas of the brain. Many cardiovascular risk factors such as older age, hypertension, and smoking have been suggested as risk factors for WMD in the periventricular and subcortical areas of the brain. However, no epidemiologic study has examined the associations between cardiovascular risk factors and WMD in the brain stem. METHODS A total of 789 participants, aged 65 years or older, from the Cardiovascular Health Study constituted the present study population. WMD, defined as hyperintensive lesions on magnetic resonance imaging (MRI), in the brain stem was measured in 1992/1993 and 1997/1998. RESULTS Of the 789 participants, 212 (26.9%) had WMD in the brain stem in 1997/1998. In multivariate logistic regression analysis, the presence of WMD in the brain stem in 1997/1998 was significantly associated with several variables measured in 1992/1993: an increase by 5 years of age (OR = 1.51, 95% CI: 1.25-1.83), a 10-pack-years increase in smoking (OR = 1.12, 95% CI: 1.04-1.21), a 0.1-liter increase in first-second forced expiratory volume (OR = 0.95, 95% CI: 0.92-0.99), a 1 micromol/l increase in fibrinogen level (OR = 1.13, 95% CI: 1.03-1.23), and MRI infarction (OR = 2.58, 95% CI: 1.78-3.74). Excluding those (n = 167) with WMD in the brain stem in 1992/1993, the pattern remained. Hypertension was not associated with WMD in the brain stem. CONCLUSIONS Increased age, smoking, lower forced expiratory volume, increased fibrinogen level, and MRI infarction, but not hypertension, may be independent risk factors for WMD in the brain stem in older adults.
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Affiliation(s)
- Jingzhong Ding
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room W6009, Baltimore, MD 21205, USA.
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Abstract
White matter lesion (WML) is thought to emerge and progress with increasing age but has not yet been well investigated. In this study of WML, risk factors and prevalence added to emergence rate (%/person year) and progress speed [increase of leukoencephalopathy score (LES)/person year] were investigated in 1674 brain check-up subjects from August 1993 to August 2001. Significant (P < 0.01) risk factors were aging and hypertension. Prevalence rate (%) was 0 in 20-29 years, 1.4 in 30-39 years, 4.2 in 40-49 years, 20.9 in 50-59 years, 42.6 in 60-69 years, and 73.9 in 70-years. Emergence rate was 0 in 20-29 years, 0.7 in 30-39 years, 1.5 in 40-49 years, 3.4 in 50-59 years, 6.0 in 60-69 years, and 20 in 70-years. And progress speed was 0.12 in 40-49 years, 0.15 in 50-59 years, 0.21 in 60-69 years, and 0.21 in 70-years. WML begins to emerge early in middle age and both prevalence and severity increase with age.
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Affiliation(s)
- Y Masana
- Department of Neurosurgery, Nishinomiya Municipal Central Hospital, 8-24 Hayashida-cho, Nishinomiya, Hyogo, Japan.
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Abstract
Non-specific white matter changes (WMC) in the brain are common findings in the elderly population. Although they are frequently seen in non-demented persons, WMC seem to be more common in demented patients. The significance of these changes, as well as their pathophysiological background, is incompletely understood. The aim of this thesis was to study different aspects of WMC using MR imaging (MRI) and to investigate the clinical significance of such changes in subjects with mild cognitive impairment or dementia. In study I post-mortem MRI of the brain was compared to corresponding neuropathology slices. WMC were quantified and found to be more extensive on neuropathology. The areas that appeared normal on MRI but not on histopathology represented only minor changes with increased distance between the myelinated fibres but with preserved axonal network and glial cell density. Study II evaluated the blood-brain barrier (BBB) integrity to investigate if an increased permeability could be shown in WMC. A contrast-enhanced MRI technique was used to detect small degrees of enhancement. No general increase in BBB could be detected in the WMC areas. In study III the relation between WMC and apolipoprotein E (APOE) genotype was explored in patients with Alzheimer's disease (AD). Results showed that AD patients, who were homozygous for the APOE epsilon 4 allele had more WMC than patients with other genotypes. This was most significant for changes in the deep white matter. Results also indicated that in AD patients carrying the epsilon 4 allele, WMC are not age-related phenomena, but might be related to the aetiology of the disease. Study IV aimed to investigate if WMC in a specific brain region affect cognitive functions related to that area. Periventricular WMC in the left frontal lobe predicted a decrease in initial word fluency, a test though to reflect left frontal lobe functioning. This indicates that WMC might have specific effects in different brain regions. In study V we evaluated the prognostic significance of WMC in patients with memory impairment, regarding the rate of further global cognitive decline. There was no difference in outcome between patients having extensive WMC and a matched control group, during 2-4 years of follow up, and assessed by the "Mini-Mental State Examination". In conclusion, this work has shown and characterised pathological changes in the white matter not visible on conventional MRI. We have also shown that there is no major general increase in BBB permeability in areas of WMC. In addition, homozygosity with regard to the APOE epsilon 4 gene allele implies an increased extent of WMC in AD patients. In AD patients carrying this gene allele, WMC are not merely age-related phenomena, but might be related to the aetiology of the disease. We also claim that WMC in a specific location might impair cognitive functions that rely on those specific pathways. In contrast, WMC do not seem to have any prognostic value in predicting the rate of global cognitive decline in patients at a memory clinic.
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Affiliation(s)
- Lena Bronge
- Department of Diagnostic Radiology, Huddinge University Hospital, SE-141 86 Stockholm
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