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Giroud M, Calviere L, Machado C, Reyes S, Mirabel H, Raposo N, Brandicourt P, Viguier A, Albucher JF, Bonneville F, Olivot JM, Péran P, Pariente J, Hervé D, Planton M. Prevalence and characteristics of vascular cognitive impairment in a European cohort of adult patients with Moyamoya angiopathy. J Neurol 2024:10.1007/s00415-024-12555-2. [PMID: 39017702 DOI: 10.1007/s00415-024-12555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Moyamoya angiopathy (MMA) is associated with a high risk of stroke, but it is also increasingly recognized as leading to cognitive impairment. The aim of this study was to determine the prevalence, nature, and severity of vascular cognitive impairment no dementia (VCIND) in adults with MMA and to identify clinical and imaging factors associated with VCIND. METHODS We conducted a retrospective study of consecutive adult patients with MMA followed in two tertiary hospitals (Toulouse and Paris Lariboisiere). All patients underwent neuropsychological assessment and brain magnetic resonance imaging (MRI). VCIND was defined as at least two variables of the same cognitive process with z-scores of < 2 standard deviations, regardless of the cognitive domain, that do not interfere in everyday life. Baseline demographic, clinical, and imaging data were compared between patients with and without VCIND. RESULTS A total of 102 patients (mean age 43 years; 65% women) were included. Thirty-four patients (33.3%) had VCIND. VCIND was mild in 20/34 (59%), moderate in 8/34 (23%), and severe in 6/34 (18%) patients. Executive function was the most widely affected (25.5%), followed by attention and processing speed (24.8%). In univariable analyses, VCIND was associated with ischemic stroke at diagnosis and the presence of ischemic lesions on MRI. CONCLUSIONS VCIND is highly prevalent in adults with MMA. Executive functions and processing speed are predominantly affected. These findings may guide clinicians in their evaluation of patients with MMA. Further research should assess the effect of revascularization therapies on cognitive functions.
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Affiliation(s)
- Marine Giroud
- Neurology Department, Toulouse University Hospital, Toulouse, France.
| | - Lionel Calviere
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Carla Machado
- Neurology Department, Hospital Paris Lariboisière, Paris, France
| | - Sonia Reyes
- Neurology Department, Hospital Paris Lariboisière, Paris, France
| | - Hélène Mirabel
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Nicolas Raposo
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | | | - Alain Viguier
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Jean-François Albucher
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Fabrice Bonneville
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Jean Marc Olivot
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Jérémie Pariente
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
| | - Dominique Hervé
- Neurology Department, Hospital Paris Lariboisière, Paris, France
| | - Mélanie Planton
- Neurology Department, Toulouse University Hospital, Toulouse, France
- Toulouse NeuroImaging Center ToNIC, Toulouse University, Toulouse, France
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Giroud M, Planton M, Darcourt J, Raposo N, Brandicourt P, Mirabel H, Hervé D, Viguier A, Albucher JF, Pariente J, Olivot JM, Bonneville F, Péran P, Calviere L. MRI hypoperfusion as a determinant of cognitive impairment in adults with Moyamoya angiopathy. Eur Stroke J 2024:23969873241240829. [PMID: 38501882 DOI: 10.1177/23969873241240829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION In Moyamoya angiopathy (MMA), mechanisms underlying cognitive impairment remain debated. We aimed to assess the association of cognitive impairment with the degree and the topography of cerebral hypoperfusion in MMA. METHODS A retrospective analysis of neuropsychological and perfusion MRI data from adults with MMA was performed. Ischemic and haemorrhagic lesion masks were created to account for cerebral lesions in the analysis of cerebral perfusion. Whole brain volume of hypoperfused parenchyma was outlined on perfusion maps using different Tmax thresholds from 4 to 12 s. Regional analysis produced mean Tmax values at different regions of interest. Analyses compared perfusion ratios in patients with and without cognitive impairment, with multivariable logistic regression analysis to identify predictive factors. RESULTS Cognitive impairment was found in 20/48 (41.7%) patients. Attention/processing speed and memory were equally impaired (24%) followed by executive domain (23%). After adjustment, especially for lesion volume, hypoperfused parenchyma volume outlined by Tmax > 4 s or Tmax > 5 s thresholds was an independent factor of cognitive impairment (OR for Tmax > 4 s = 1.06 [CI 95% 1.008-1.123]) as well as attention/processing speed (OR for Tmax > 4 s = 1.07 [CI 95% 1.003-1.133]) and executive domains (OR for Tmax > 5 s = 1.08 [CI 95% 1.004-1.158]). Regarding cognitive functions, patients with processing speed and flexibility impairment had higher frontal Tmax compared to other ROIs and to patients with normal test scores. DISCUSSION Cerebral hypoperfusion emerged as an independent factor of cognitive impairment in MMA particularly in attention/processing speed and executive domains, with a strong contribution of frontal areas. CONCLUSION Considering this association, revascularization surgery could improve cognitive impairment.
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Affiliation(s)
- Marine Giroud
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Mélanie Planton
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean Darcourt
- Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Nicolas Raposo
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | | | - Hélène Mirabel
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Dominique Hervé
- Neurology Department, Hospital Paris Lariboisière, Paris, France
| | - Alain Viguier
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean-François Albucher
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jérémie Pariente
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Jean Marc Olivot
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Fabrice Bonneville
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
- Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
| | - Lionel Calviere
- Neurology Department, Toulouse University Hospital, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Toulouse University, Toulouse, France
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Toh KZX, Koh MY, Loh EDW, Sia CH, Chong Y, Yeo LLL, Sharma VK, Lim MJR, Tan BYQ. Prevalence and Associations of Cognitive Impairment in Adult Patients with Moyamoya Disease: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2024; 97:541-552. [PMID: 38108354 DOI: 10.3233/jad-230979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND Cognitive impairment, and in the long term Alzheimer's disease, vascular, or mixed dementia, are potential complications of moyamoya disease (MMD), of which the prevalence and associations are not well established. OBJECTIVE We performed a systematic review and meta-analysis to investigate the prevalence of cognitive impairment in adult patients with MMD as well as its clinical and demographic correlates. METHODS We performed a systematic search of four electronic databases: PubMed (MEDLINE), EMBASE, Scopus, and Cochrane Library, profiling studies from inception until 7 May 2023. Clinical data consisting of population characteristics, comorbidities, cognitive assessment tools used, and prevalence of cognitive impairment was extracted. RESULTS Seventeen studies were included in the meta-analysis, with a total study population of 1,190 patients. All studies assessed cognition, and the overall prevalence of cognitive impairment in MMD patients was 54.59%. A subgroup analysis identified that the prevalence of executive dysfunction in MMD patients was 31.55%. We performed a meta-regression analysis which identified that cognitive impairment was not associated with age, education level, or a history of ischemic or hemorrhagic stroke. CONCLUSIONS A substantial proportion of MMD patients have cognitive impairment, and cognitive impairment was found to have no association with a history of stroke. Further research is necessary to investigate the longitudinal relationship of MMD and cognitive impairment, and the impact of bypass surgery on cognitive impairment.
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Affiliation(s)
- Keith Z X Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ming Yi Koh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Enver D W Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Yaofeng Chong
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Vijay K Sharma
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
| | - Mervyn J R Lim
- Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, Division of Neurology, National University Hospital, Singapore
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Zhang X, Wang Z, Zheng D, Cao X, Qi W, Yuan Q, Zhang D, Liang X, Ruan Y, Zhang S, Tang W, Huang Q, Xue C. Aberrant spontaneous static and dynamic amplitude of low-frequency fluctuations in cerebral small vessel disease with or without mild cognitive impairment. Brain Behav 2023; 13:e3279. [PMID: 37815202 PMCID: PMC10726894 DOI: 10.1002/brb3.3279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is considered an age-related degenerative neurological disorder and the most common risk factor for vascular cognitive impairment (VCI). The amplitude of fluctuation of low frequency (ALFF) can detect altered intrinsic brain activity in CSVD. This study explored the static and dynamic ALFFs in the early stage of CSVD with (CSVD-M) or without (CSVD-W) mild cognitive impairment (MCI) in these patients and how these changes contribute to cognitive deterioration. METHODS Thirty consecutive CSVD cases and 18 healthy controls (HC) were included in this study. All the participants underwent a 3D magnetization-prepared rapid gradient-echo (MPRAGE) sequence to obtain structural T1-weighted images. Simultaneous multislice imaging 5(SMS5) was used for resting-state functional MRI (rs-fMRI), and Data Processing and Analysis of Brain Imaging software helped determine static ALFF (sALFF). The dynamic ALFF (dALFF) was calculated using the sliding window method of DynamicBC software. Analysis of Covariance (ANCOVA) and two-sample t-test were used to evaluate the sALFF and temporal variability of dALFF among the three groups. The subjects were rated on a broad standard neuropsychological scale. Partial correlation analysis was used to evaluate the correlation between sALFF and dALFF variability and cognition (Bonferroni correction, statistical threshold set at p < .05). RESULTS Compared with HCs, the CSVD-M group indicated decreased sALFF values in the bilateral cerebellum posterior lobe (CPL) and the left inferior Parietal Lobule (IPL), with increased sALFF values in the right SFG. For dALFF analysis, the CSVD-W group had significant dALFF variability in the right fusiform gyrus compared with HC. Moreover, the postcentral gyrus (PoCG) was significantly high in the CSVD-W group. While in the CSVD-M group, the bilateral paracentral lobules (PL) revealed significantly elevated dALFF variability and low dALFF variability in the left CPL and right IPL compared with HCs. The CSVD-M group had high dALFF variability in the bilateral PL but low dALFF variability in the left middle temporal gyrus (MTG) and right PoCG compared with the CSVD-W group. The partial correlation analysis indicated that dALFF variability in the left MTG was positively associated with EM (r = 0.713, p = .002) in CSVD-W and CSVD-M groups. In the groups with CSVD-M and HC, altered dALFF variability in the bilateral PL was negatively correlated with EM (r = -0.560, p = .002). CONCLUSION There were significant changes in sALFF and dALFF variability in CSVD patients. Abnormal spontaneous static and dynamic ALFFs may provide new insights into cognitive dysfunction in CSVD with MCI and may be valuable biomarkers for early diagnosis.
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Affiliation(s)
- Xulian Zhang
- Department of RadiologyNantong Haimen District People's HospitalNantongChina
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhigang Wang
- Department of RadiologyNantong Haimen District People's HospitalNantongChina
| | - Darui Zheng
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Xuan Cao
- Division of Statistics and Data Science, Department of Mathematical SciencesUniversity of CincinnatiCincinnatiOhio
| | - Wenzhang Qi
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Qianqian Yuan
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Da Zhang
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Xuhong Liang
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Yiming Ruan
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Shaojun Zhang
- Department of StatisticsUniversity of FloridaGainesvilleFlorida
| | | | - Qingling Huang
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Chen Xue
- Department of RadiologyThe Affiliated Brain Hospital of Nanjing Medical UniversityNanjingChina
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Lu H, Dang M, Chen K, Shang H, Wang B, Zhao S, Li X, Zhang Z, Zhang J, Chen Y. Naoxin'an capsules protect brain function and structure in patients with vascular cognitive impairment. Front Pharmacol 2023; 14:1129125. [PMID: 37089924 PMCID: PMC10113453 DOI: 10.3389/fphar.2023.1129125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction: Vascular cognitive impairment (VCI) is one of the most common types of dementia. Naoxin'an capsule (NXA), a traditional Chinese medicine compound, has been used to treat VCI for a long time in the clinic. Previous studies proved that the NXA capsules could ameliorate the cerebral mitochondrion deficits of VCI animals. This study aimed to investigate the protectiveness of NXA on human brain structure and function in patients with VCI. Methods: In total, 100 VCI patients were enrolled in this 24-week trial and randomly divided into the NXA capsules group (n = 50) and the ginkgo biloba capsules control group (n = 50). Before and after the treatment, cognitive behavior tests and multimodal brain magnetic resonance imaging were analyzed to comprehensively evaluate the effectiveness of NXA treatment on VCI patients after 24 weeks. Results: We found that the NXA group significantly improved overall cognitive ability (Alzheimer's Disease Assessment Scale-Cognitive section, p = 0.001; Mini-Mental Status Examination, p = 0.003), memory (Rey-Osterrieth Complex Figure test, p < 0.001) and executive function (Trail Making Test-A, p = 0.024) performance after treatment compared with the control group. For brain function, the degree of centrality in the left middle frontal gyrus, right postcentral gyrus, and left supplementary motor area increased in the NXA group and decreased in the ginkgo biloba group after treatment. The fractional amplitude of low-frequency fluctuation (fALFF) of the left precentral and right superior parietal gyrus increased, and the fALFF of the right parahippocampal and left inferior temporal gyrus decreased in the NXA group after treatment. For brain structure, the gray matter density of the left postcentral gyrus increased in the NXA group after treatment, and the total volume of white matter hyperintensity showed a decreasing trend but was not statistically significant. Furthermore, the improvement effect of NXA on executive function was associated with changes in brain function. Conclusion: These findings suggest that the NXA capsules improved cognitive performance and multiregional brain function, as well as gray matter structure in the postcentral gyrus.
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Affiliation(s)
- Hui Lu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Mingxi Dang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Kewei Chen
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
| | - Huajie Shang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Bolong Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Shaokun Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
| | - Junying Zhang
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
- Institute of Basic Research in Clinical Medicine, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing, China
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Hu J, Wang Y, Zhu Y, Li Y, Chen J, Zhang Y, Xu D, Bai R, Wang L. Preoperative Brain Functional Connectivity Improve Predictive Accuracy of Outcomes After Revascularization in Moyamoya Disease. Neurosurgery 2023; 92:344-352. [PMID: 36637269 PMCID: PMC9815092 DOI: 10.1227/neu.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In patients with moyamoya disease (MMD), focal impairments in cerebral hemodynamics are often inconsistent with patients' clinical prognoses. Evaluation of entire brain functional networks may enable predicting MMD outcomes after revascularization. OBJECTIVE To investigate whether preoperative brain functional connectivity could predict outcomes after revascularization in MMD. METHODS We included 34 patients with MMD who underwent preoperative MRI scanning and combined revascularization surgery. We used region of interest analyses to explore the differences in functional connectivity for 90 paired brain regions between patients who had favorable outcomes 1 year after surgery (no recurrent stroke, with improved preoperative symptoms, or modified Rankin Scale [mRS]) and those who had unimproved outcomes (recurrent stroke, persistent symptoms, or declined mRS). Variables, including age, body mass index, mRS at admission, Suzuki stage, posterior cerebral artery involvement, and functional connectivity with significant differences between the groups, were included in the discriminant function analysis to predict patient outcomes. RESULTS Functional connectivity between posterior cingulate cortex and paracentral lobule within the right hemisphere, and interhemispheric connection between superior parietal gyrus and middle frontal gyrus, precuneus and middle cingulate cortex, cuneus and precuneus, differed significantly between the groups (P < .001, false discovery rate corrected) and had the greatest discriminant function in the prediction model. Although clinical characteristics of patients with MMD showed great accuracy in predicting outcomes (64.7%), adding information on functional connections improved accuracy to 91.2%. CONCLUSION Preoperative functional connectivity derived from rs-fMRI may be an early hallmark for predicting patients' prognosis after revascularization surgery for MMD.
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Affiliation(s)
- Junwen Hu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongjie Wang
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuhan Zhu
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Li
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyin Chen
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yifan Zhang
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Duo Xu
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ruiliang Bai
- Key Laboratory of Biomedical Engineering of Education Ministry, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
- Department of Physical Medicine and Rehabilitation of the Affiliated Sir Run Run Shaw Hospital and Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University School of Medicine, Hangzhou, China
- MOE Frontier Science Center for Brain Science and Brain-machine Integration, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
| | - Lin Wang
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Weng R, Ren S, Su J, Ni W, Yang C, Gao X, Xiao W, Zhang X, Jiang H, Guan Y, Huang Q, Gu Y. 18F-FDG PET and a classifier algorithm reveal a characteristic glucose metabolic pattern in adult patients with moyamoya disease and vascular cognitive impairment. Brain Imaging Behav 2023; 17:185-199. [PMID: 36637715 DOI: 10.1007/s11682-022-00752-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/14/2023]
Abstract
Vascular cognitive impairment (VCI) is a critical issue in moyamoya disease (MMD). However, the glucose metabolic pattern in these patients is still unknown. This study aimed to identify the metabolic signature of cognitive impairment in patients with MMD using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) and establish a classifier to identify VCI in patients with MMD. One hundred fifty-two patients with MMD who underwent brain 18F-FDG PET scans before surgery were enrolled and classified into nonvascular cognitive impairment (non-VCI, n = 52) and vascular cognitive impairment (VCI, n = 100) groups according to neuropsychological test results. Additionally, thirty-three health controls (HCs) were also enrolled. Compared to HCs, patients in the VCI group exhibited extensive hypometabolism in the bilateral frontal and cingulate regions and hypermetabolism in the bilateral cerebellum, while patients in the non-VCI group showed hypermetabolism only in the cerebellum and slight hypometabolism in the frontal and temporal regions. In addition, we found that the patients in the VCI group showed hypometabolism mainly in the left basal ganglia compared to those in the non-VCI group. The sparse representation-based classifier algorithm taking the SUVr of 116 Anatomical Automatic Labeling (AAL) areas as features distinguished patients in the VCI and non-VCI groups with an accuracy of 82.4%. This study demonstrated a characteristic metabolic pattern that can distinguish patients with MMD without VCI from those with VCI, namely, hypometabolic lesions in the left hemisphere played a more important role in cognitive decline in patients with MMD.
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Affiliation(s)
- Ruiyuan Weng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shuhua Ren
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiabin Su
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunlei Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinjie Gao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weiping Xiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hanqiang Jiang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Huang
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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8
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Sun R, Zhang SY, Cheng X, Zhang P, Qiao PG, Li GJ. Changes in sensory-related brain networks of patients with moyamoya disease with limb paresthesia: A resting-state fMRI-based functional connectivity analysis. Neuroimage Clin 2022; 36:103267. [PMID: 36510412 PMCID: PMC9668639 DOI: 10.1016/j.nicl.2022.103267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022]
Abstract
This study's aim was to investigate functional brain connectivity changes among patients with moyamoya disease (MMD) with limb paresthesia, using functional connectivity analysis based on resting-state functional magnetic resonance imaging (rs-fMRI). A total of 181 patients with MMD were enrolled, including 57 with left limb paresthesia (MLP group), 61 with right limb paresthesia (MRP group), and 63 without paresthesia (MWP group). Encephaloduroarteriosynangiosis (EDAS) was performed in 20 of the 57 patients with left limb paresthesia and 15 of the 61 patients with right limb paresthesia. Twenty-nine age- and sex-matched healthy controls (HC group) were recruited during the same period. All participants underwent rs-fMRI examination, and the patients treated with EDAS were re-examined 3-4 months after the surgery. After data preprocessing, we selected Brodmann area 3 on each side of the brain as the seed region to construct a functional connectivity network of the whole brain, and then we analyzed the differences in functional connectivity between the HC group, MWP group, MLP group, and MRP group. The functional connectivity of Brodmann area 3 (on either side) with the ipsilateral frontal (superior frontal gyrus, middle frontal gyrus, and inferior frontal gyrus) and parietal (supramarginal gyrus, angular gyrus, and superior parietal lobule) cortices was increased among patients with MMD. The functional connectivity enhancement in these brain regions was broader and greater in patients with contralateral limb paresthesia than in patients without paresthesia, and the regions with functional connectivity changes were roughly distributed symmetrically among the MLP group and the MRP group. There were no changes 3-4 months after EDAS in the increased functional connectivity between the frontal and parietal cortices and Brodmann area 3. Limb paresthesia in patients with MMD may be driven by abnormal functional connectivity in the frontal and parietal cortices. Functional changes in associated brain regions may be a target for evaluating the severity of MMD and its response to treatment.
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Affiliation(s)
- Rujing Sun
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shi-Yu Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xu Cheng
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peng-Gang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China,Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China,Corresponding authors at: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing 100050, China, (P.-G. Qiao). Department of Radiology, Affiliated hospital of Academy of Military Medical Sciences, #8 Fengtai dong street, Fengtai district, Beijing 100071, China, (G.-J. Li).
| | - Gong-Jie Li
- Department of Radiology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China,Corresponding authors at: Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 95 YongAn Road, Beijing 100050, China, (P.-G. Qiao). Department of Radiology, Affiliated hospital of Academy of Military Medical Sciences, #8 Fengtai dong street, Fengtai district, Beijing 100071, China, (G.-J. Li).
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9
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Hao X, Liu Z, He S, Wang Y, Zhao Y, Wang R. Application of DTI and fMRI in moyamoya disease. Front Neurol 2022; 13:948830. [PMID: 35989917 PMCID: PMC9391058 DOI: 10.3389/fneur.2022.948830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Moyamoya disease (MMD) is a chronic and progressive cerebrovascular stenosis or occlusive disease that occurs near Willis blood vessels. Diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) are used to detect the microstructure of white matter and the function of gray matter, respectively. The damage of these structures will lead to the change of cognitive level in patients with moyamoya disease. In this paper, the principles of DTI and fMRI, their applications and challenges in moyamoya disease are reviewed.
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Affiliation(s)
- Xiaokuan Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ziqi Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shihao He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yanru Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- *Correspondence: Rong Wang
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10
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Zou X, Yuan Y, Liao Y, Jiang C, Zhao F, Ding D, Gu Y, Chen L, Chu YH, Hsu YC, Liebig PA, Xu B, Mao Y. Moyamoya disease: A human model for chronic hypoperfusion and intervention in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12285. [PMID: 35415209 PMCID: PMC8985488 DOI: 10.1002/trc2.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/10/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
Abstract
Introduction Chronic cerebral hypoperfusion has been considered the etiology for sporadic Alzheimer's disease (AD). However, no valid clinical evidence exists due to the similar risk factors between cerebrovascular disease and AD. Methods We used moyamoya disease (MMD) as a model of chronic hypoperfusion and cognitive impairment, without other etiology interference. Results Based on the previous reports and preliminary findings, we hypothesized that chronic cerebral hypoperfusion could be an independent upstream crucial variable, resulting in AD, and induce pathological hallmarks such as amyloid beta peptide and hyperphosphorylated tau accumulation. Discussion Timely intervention with revascularisation would help reverse the brain damage with AD hallmarks and lead to cognitive improvement.
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Affiliation(s)
- Xiang Zou
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Yifan Yuan
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China
| | - Yujun Liao
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Conglin Jiang
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Fan Zhao
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Ding Ding
- Huashan Hospital Institute of Neurology Fudan University Shanghai China.,National Clinical Research Center for Aging and Medicine Huashan Hospital Fudan University Shanghai China
| | - Yuxiang Gu
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Liang Chen
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China.,Tianqiao and Chrissy Chen International Institute for Brain Diseases Shanghai China
| | - Ying-Hua Chu
- MR Collaboration Siemens Healthineers Ltd. Shanghai China
| | - Yi-Cheng Hsu
- MR Collaboration Siemens Healthineers Ltd. Shanghai China
| | | | - Bin Xu
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China
| | - Ying Mao
- Department of Neurosurgery Huashan Hospital Fudan University Shanghai China.,Neurosurgical Institute of Fudan University Shanghai China.,Shanghai Clinical Medical Center of Neurosurgery Shanghai China.,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration Shanghai China.,Huashan Hospital Institute of Neurology Fudan University Shanghai China.,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science School of Basic Medical Sciences and Institutes of Brain Science Fudan University Shanghai China
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11
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Wu J, Cao Y, Li M, Li B, Jia X, Cao L. Altered intrinsic brain activity in patients with CSF1R-related leukoencephalopathy. Brain Imaging Behav 2022; 16:1842-1853. [PMID: 35389179 DOI: 10.1007/s11682-022-00646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/26/2022]
Abstract
CSF1R-related leukoencephalopathy is an adult-onset white matter disease with high disability and mortality, while little is known about its pathogenesis. This study introduced amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) based on resting-state functional magnetic resonance imaging(rsfMRI) to compare the spontaneous brain activities of patients and healthy controls, aiming to enhance our understanding of the disease. RsfMRI was performed on 16 patients and 23 healthy controls, and preprocessed for calculation of ALFF and ReHo. Permutation tests with threshold free cluster enhancement (TFCE) was applied for comparison (number of permutations = 5,000). The TFCE significance threshold was set at [Formula: see text] < 0.05. In addition, 10 was set as the minimum cluster size. Compared to healthy controls, the patient group showed decreased ALFF in right paracentral lobule, and increased ALFF in bilateral insula, hippocampus, thalamus, supramarginal and precentral gyrus, right inferior, middle and superior frontal gyrus, right superior and middle occipital gyrus, as well as left parahippocampal gyrus, fusiform, middle occipital gyrus and angular gyrus. ReHo was decreased in right supplementary motor area, paracentral lobule and precentral gyrus, while increased in right superior occipital gyrus and supramarginal gyrus, left parahippocampal gyrus, hippocampus, fusiform, middle occipital gyrus and angular gyrus, as well as bilateral middle occipital gyrus and midbrain. These results revealed altered spontaneous brain activities in CSF1R-related leukoencephalopathy, especially in limbic system and motor cortex, which may shed light on underlying mechanisms.
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Affiliation(s)
- Jingying Wu
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yikang Cao
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Mengting Li
- School of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Binyin Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xize Jia
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Li Cao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
- Department of Neurology and Institute of Neurology, Ruijin Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Xu W, Song Y, Chen S, Xue C, Hu G, Qi W, Ma W, Lin X, Chen J. An ALE Meta-Analysis of Specific Functional MRI Studies on Subcortical Vascular Cognitive Impairment. Front Neurol 2021; 12:649233. [PMID: 34630270 PMCID: PMC8492914 DOI: 10.3389/fneur.2021.649233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Subcortical vascular cognitive impairment (sVCI), caused by cerebral small vessel disease, accounts for the majority of vascular cognitive impairment, and is characterized by an insidious onset and impaired memory and executive function. If not recognized early, it inevitably develops into vascular dementia. Several quantitative studies have reported the consistent results of brain regions in sVCI patients that can be used to predict dementia conversion. The purpose of the study was to explore the exact abnormalities within the brain in sVCI patients by combining the coordinates reported in previous studies. Methods: The PubMed, Embase, and Web of Science databases were thoroughly searched to obtain neuroimaging articles on the amplitude of low-frequency fluctuation, regional homogeneity, and functional connectivity in sVCI patients. According to the activation likelihood estimation (ALE) algorithm, a meta-analysis based on coordinate and functional connectivity modeling was conducted. Results: The quantitative meta-analysis included 20 functional imaging studies on sVCI patients. Alterations in specific brain regions were mainly concentrated in the frontal lobes including the middle frontal gyrus, superior frontal gyrus, medial frontal gyrus, and precentral gyrus; parietal lobes including the precuneus, angular gyrus, postcentral gyrus, and inferior parietal lobule; occipital lobes including the lingual gyrus and cuneus; temporal lobes including the fusiform gyrus and middle temporal gyrus; and the limbic system including the cingulate gyrus. These specific brain regions belonged to important networks known as the default mode network, the executive control network, and the visual network. Conclusion: The present study determined specific abnormal brain regions in sVCI patients, and these brain regions with specific changes were found to belong to important brain functional networks. The findings objectively present the exact abnormalities within the brain, which help further understand the pathogenesis of sVCI and identify them as potential imaging biomarkers. The results may also provide a basis for new approaches to treatment.
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Affiliation(s)
- Wenwen Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Song
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shanshan Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Xue
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Guanjie Hu
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China
| | - Wenzhang Qi
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenying Ma
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xingjian Lin
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiu Chen
- Institute of Brain Functional Imaging, Nanjing Medical University, Nanjing, China.,Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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13
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Changes in Brain Functional Network Connectivity in Adult Moyamoya Diseases. Cogn Neurodyn 2021; 15:861-872. [PMID: 34603547 DOI: 10.1007/s11571-021-09666-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/15/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Moyamoya disease (MMD) is a cerebrovascular disease that is characterized by progressive stenosis or occlusion of the internal carotid arteries and its main branches, which leads to the formation of abnormal small collateral vessels. However, little is known about how these special vascular structures affect cortical network connectivity and brain function. By applying EEG analysis and graphic network analyses undergoing EEG recording of subjects with eyes-closed (EC) and eyes-open (EO) resting states, and working memory (WM) tasks, we examined the brain network features of hemorrhagic (HMMD) and ischemic MMD (IMMD) brains. For the first time, we observed that IMMD had the much lower alpha-blocking rate during EO state than healthy controls while HMMD exhibited the relatively low EEG activity rate across all the behavior states. Further, IMMD showed strong network connections in the alpha-wave band in frontal and parietal regions during EO and WM states. EEG frequency and network topological maps during both resting and WM states indicated that the left frontal lobe and left parietal lobe in HMMD patients and the right parietal lobe and temporal lobe in IMMD patients have clear differences compared with controls, which provides a new insight to understand distinct electrophysiological features of MMD. However, due to the small sample size of recruited patient subjects, the result conclusion may be limited. Supplementary information The online version contains supplementary material available at (10.1007/s11571-021-09666-1).
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14
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Zhang X, Xue C, Cao X, Yuan Q, Qi W, Xu W, Zhang S, Huang Q. Altered Patterns of Amplitude of Low-Frequency Fluctuations and Fractional Amplitude of Low-Frequency Fluctuations Between Amnestic and Vascular Mild Cognitive Impairment: An ALE-Based Comparative Meta-Analysis. Front Aging Neurosci 2021; 13:711023. [PMID: 34531735 PMCID: PMC8438295 DOI: 10.3389/fnagi.2021.711023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Changes in the amplitude of low-frequency fluctuations (ALFF) and the fractional amplitude of low-frequency fluctuations (fALFF) have provided stronger evidence for the pathophysiology of cognitive impairment. Whether the altered patterns of ALFF and fALFF differ in amnestic cognitive impairment (aMCI) and vascular mild cognitive impairment (vMCI) is largely unknown. The purpose of this study was to explore the ALFF/fALFF changes in the two diseases and to further explore whether they contribute to the diagnosis and differentiation of these diseases. Methods: We searched PubMed, Ovid, and Web of Science databases for articles on studies using the ALFF/fALFF method in patients with aMCI and vMCI. Based on the activation likelihood estimation (ALE) method, connectivity modeling based on coordinate meta-analysis and functional meta-analysis was carried out. Results: Compared with healthy controls (HCs), patients with aMCI showed increased ALFF/fALFF in the bilateral parahippocampal gyrus/hippocampus (PHG/HG), right amygdala, right cerebellum anterior lobe (CAL), left middle temporal gyrus (MTG), left cerebrum temporal lobe sub-gyral, left inferior temporal gyrus (ITG), and left cerebrum limbic lobe uncus. Meanwhile, decreased ALFF/fALFF values were also revealed in the bilateral precuneus (PCUN), bilateral cuneus (CUN), and bilateral posterior cingulate (PC) in patients with aMCI. Compared with HCs, patients with vMCI predominantly showed decreased ALFF/fALFF in the bilateral CUN, left PCUN, left PC, and right cingulate gyrus (CG). Conclusions: The present findings suggest that ALFF and fALFF displayed remarkable altered patterns between aMCI and vMCI when compared with HCs. Thus, the findings of this study may serve as a reliable tool for distinguishing aMCI from vMCI, which may help understand the pathophysiological mechanisms of these diseases.
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Affiliation(s)
- Xulian Zhang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Xue
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Cao
- Division of Statistics and Data Science, Department of Mathematical Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Qianqian Yuan
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenzhang Qi
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwen Xu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shaojun Zhang
- Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Qingling Huang
- Department of Radiology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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15
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Reconfigured functional network dynamics in adult moyamoya disease: a resting-state fMRI study. Brain Imaging Behav 2021; 14:715-727. [PMID: 30511114 DOI: 10.1007/s11682-018-0009-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Treatment of vascular cognitive impairment (VCI) in adult moyamoya disease (MMD) is still unclear because of its unveiled neural synchronization. This study introduced a dynamic measurement of connectivity number entropy (CNE) to characterize both spatial and temporal dimensions of network interactions. Fifty-one patients with MMD were recruited (27 with VCI and 24 with intact cognition), as well as 26 normal controls (NCs). Static network properties were first examined to confirm its aberrance in MMD with VCI. Then, the dynamic measurement of CNE was used to detect the deteriorated flexibility of MMD with VCI at global, regional, and network levels. Finally, dynamic reconfiguration of flexible and specialized regions was traced across the three groups. Graph theory analysis indicated that MMD exhibited "small-world" network topology but presented with a deviating pattern from NC as the disease progressed in all topologic metrics of integration, segregation, and small-worldness. Subsequent dynamic analysis showed significant CNE differences among the three groups at both global (p < 0.001) and network levels (default mode network, p = 0.004; executive control network, p = 0.001). Specifically, brain regions related to key aspects of information processing exhibited significant CNE changes across the three groups. Furthermore, CNE values of both flexible and specialized regions changed with impaired cognition. This study not only sheds light on both the static and dynamic organizational principles behind network changes in adult MMD for the first time, but also provides a new methodologic viewpoint to acquire more knowledge of its pathophysiology and treatment direction.
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16
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Faded Critical Dynamics in Adult Moyamoya Disease Revealed by EEG and fMRI. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6640108. [PMID: 33953833 PMCID: PMC8064775 DOI: 10.1155/2021/6640108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/26/2020] [Accepted: 03/30/2021] [Indexed: 12/02/2022]
Abstract
Criticality is considered a dynamic signature of healthy brain activity that can be measured on the short-term timescale with neural avalanches and long-term timescale with long-range temporal correlation (LRTC). It is unclear how the brain dynamics change in adult moyamoya disease (MMD). We used BOLD-fMRI for LRTC analysis from 16 hemorrhagic (HMMD) and 34 ischemic (IMMD) patients and 25 healthy controls. Afterwards, they were examined by EEG recordings in the eyes-closed (EC), eyes-open (EO), and working memory (WM) states. The EEG data of 11 HMMD and 13 IMMD patients and 21 healthy controls were in good quality for analysis. Regarding the 4 metrics of neural avalanches (e.g., size (α), duration (β), κ value, and branching parameter (σ)), both MMD subtypes exhibited subcritical states in the EC state. When switching to the WM state, HMMD remained inactive, while IMMD surpassed controls and became supercritical (p < 0.05). Regarding LRTC, the amplitude envelope in the EC state was more analogous to random noise in the MMD patients than in controls. During state transitions, LRTC decreased sharply in the controls but remained chaotic in the MMD individuals (p < 0.05). The spatial LRTC reduction distribution based on both EEG and fMRI in the EC state implied that, compared with controls, the two MMD subtypes might exhibit mutually independent but partially overlapping patterns. The regions showing decreased LRTC in both EEG and fMRI were the left supplemental motor area of HMMD and right pre-/postcentral gyrus and right inferior temporal gyrus of IMMD. This study not only sheds light on the decayed critical dynamics of MMD in both the resting and task states for the first time but also proposes several EEG and fMRI features to identify its two subtypes.
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17
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Lei Y, Chen X, Su JB, Zhang X, Yang H, Gao XJ, Ni W, Chen L, Yu JH, Gu YX, Mao Y. Recognition of Cognitive Impairment in Adult Moyamoya Disease: A Classifier Based on High-Order Resting-State Functional Connectivity Network. Front Neural Circuits 2021; 14:603208. [PMID: 33408614 PMCID: PMC7779761 DOI: 10.3389/fncir.2020.603208] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Vascular cognitive impairment (VCI) is a common complication in adult patients with moyamoya disease (MMD), and is reversible by surgical revascularization in its early stage of mild VCI. However, accurate diagnosis of mild VCI is difficult based on neuropsychological examination alone. This study proposed a method of dynamic resting-state functional connectivity (FC) network to recognize global cognitive impairment in MMD. Methods: For MMD, 36 patients with VCI and 43 patients with intact cognition (Non-VCI) were included, as well as 26 normal controls (NCs). Using resting-state fMRI, dynamic low-order FC networks were first constructed with multiple brain regions which were generated through a sliding window approach and correlated in temporal dimension. In order to obtain more information of network interactions along the time, high-order FC networks were established by calculating correlations among each pair of brain regions. Afterwards, a sparse representation-based classifier was constructed to recognize MMD (experiment 1) and its cognitive impairment (experiment 2) with features extracted from both low- and high-order FC networks. Finally, the ten-fold cross-validation strategy was proposed to train and validate the performance of the classifier. Results: The three groups did not differ significantly in demographic features (p > 0.05), while the VCI group exhibited the lowest MMSE scores (p = 0.001). The Non-VCI and NCs groups did not differ significantly in MMSE scores (p = 0.054). As for the classification between MMD and NCs, the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity of the classifier reached 90.70, 88.57, 93.67, and 73.08%, respectively. While for the classification between VCI and Non-VCI, the AUC, accuracy, sensitivity, and specificity of the classifier reached 91.02, 84.81, 80.56, and 88.37%, respectively. Conclusion: This study not only develops a promising classifier to recognize VCI in adult MMD in its early stage, but also implies the significance of time-varying properties in dynamic FC networks.
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Affiliation(s)
- Yu Lei
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xi Chen
- Department of Electronic Engineering, Fudan University, Shanghai, China
| | - Jia-Bin Su
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Heng Yang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin-Jie Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin-Hua Yu
- Department of Electronic Engineering, Fudan University, Shanghai, China
| | - Yu-Xiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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18
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Kazumata K, Tha KK, Tokairin K, Ito M, Uchino H, Kawabori M, Sugiyama T. Brain Structure, Connectivity, and Cognitive Changes Following Revascularization Surgery in Adult Moyamoya Disease. Neurosurgery 2019; 85:E943-E952. [DOI: 10.1093/neuros/nyz176] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/23/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDThe effect of the combined direct/indirect revascularization surgery in Moyamoya disease has not been evaluated sufficiently with regard to cognitive function, brain microstructure, and connectivity.OBJECTIVETo investigate structural and functional changes following revascularization surgery in patients with moyamoya disease (MMD) through a combined analysis of brain morphology, microstructure, connectivity, and neurobehavioral data.METHODSNeurobehavioral and neuroimaging examinations were performed in 25 adults with MMD prior to and >12 mo after revascularization surgery. Cognitive function was investigated using the Wechsler Adult Intelligence Scale-III, Trail-Making Test, Wisconsin Card Sorting Test, Continuous Performance Test, Stroop test, and Wechsler Memory Scale. We assessed white matter integrity using diffusion tensor imaging, brain morphometry using magnetization-prepared rapid gradient-echo sequences, and brain connectivity using resting-state functional magnetic resonance imaging (MRI).RESULTSCognitive examinations revealed significant changes in the full-scale intelligence quotient (IQ), performance IQ (PIQ), perceptual organization (PO), processing speed, and Stroop test scores after surgery (P < .05). Enlargement of the lateral ventricle, volume reductions in the corpus callosum and subcortical nuclei, and cortical thinning in the prefrontal cortex were also observed (P < .05). Fractional anisotropy in the white matter tracts, including the superior longitudinal fasciculus, increased 2 to 4 yr after surgery, relative to that observed in the presurgical state (P < .05). Resting-state brain connectivity was increased predominantly in the fronto-cerebellar circuit and was positively correlated with improvements in PIQ and PO (P < .05).CONCLUSIONRevascularization surgery may improve processing speed and attention in adult patients with MMD. Further, multimodal MRI may be useful for detecting subtle postsurgical brain structural changes, reorganization of white matter tracts, and brain connectivity alterations.
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Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Khin Khin Tha
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
| | - Taku Sugiyama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Japan
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19
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Su JB, Xi SD, Zhou SY, Zhang X, Jiang SH, Xu B, Chen L, Lei Y, Gao C, Gu YX. Microstructural damage pattern of vascular cognitive impairment: a comparison between moyamoya disease and cerebrovascular atherosclerotic disease. Neural Regen Res 2019; 14:858-867. [PMID: 30688272 PMCID: PMC6375028 DOI: 10.4103/1673-5374.249234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Moyamoya disease and cerebrovascular atherosclerotic disease are both chronic ischemic diseases with similar presentations of vascular cognitive impairment. The aim of the present study was to investigate the patterns of microstructural damage associated with vascular cognitive impairment in the two diseases. The study recruited 34 patients with moyamoya disease (age 43.9 ± 9.2 years; 20 men and 14 women, 27 patients with cerebrovascular atherosclerotic disease (age: 44.6 ± 7.6 years; 17 men and 10 women), and 31 normal controls (age 43.6 ± 7.3 years; 18 men and 13 women) from Huashan Hospital of Fudan University in China. Cognitive function was assessed using the Mini-Mental State Examination, long-term delayed recall of Auditory Verbal Learning Test, Trail Making Test Part B, and the Symbol Digit Modalities Test. Single-photon emission-computed tomography was used to examine cerebral perfusion. Voxel-based morphometry and tract-based spatial statistics were performed to identify regions of gray matter atrophy and white matter deterioration in patients and normal controls. The results demonstrated that the severity of cognitive impairment was similar between the two diseases in all tested domains. Patients with moyamoya disease and those with cerebrovascular atherosclerotic disease suffered from disturbed supratentorial hemodynamics. Gray matter atrophy in bilateral middle cingulate cortex and parts of the frontal gyrus was prominent in both diseases, but in general, was more severe and more diffuse in those with moyamoya disease. White matter deterioration was significant for both diseases in the genu and body of corpus callosum, in the anterior and superior corona radiation, and in the posterior thalamic radiation, but in moyamoya disease, it was more diffuse and more severe. Vascular cognitive impairment was associated with regional microstructural damage, with a potential link between, gray and white matter damage. Overall, these results provide insight into the pathophysiological nature of vascular cognitive impairment. This study was approved by the Institutional Review Board in Huashan Hospital, China (approval No. 2014-278). This study was registered with ClinicalTrials.gov on December 2, 2014 with the identifier NCT02305407.
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Affiliation(s)
- Jia-Bin Su
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Si-Da Xi
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Shu-Yi Zhou
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shen-Hong Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Lei
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chao Gao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Xiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Sakamoto Y, Okamoto S, Maesawa S, Bagarinao E, Araki Y, Izumi T, Watanabe H, Sobue G, Wakabayashi T. Default Mode Network Changes in Moyamoya Disease Before and After Bypass Surgery: Preliminary Report. World Neurosurg 2018; 112:e652-e661. [PMID: 29374613 DOI: 10.1016/j.wneu.2018.01.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/14/2018] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Neurocognitive impairment is often reported in moyamoya disease. We aimed to detect default mode network (DMN) alterations using resting-state functional magnetic resonance imaging and their association with neurocognitive impairments. In addition, the influence of surgical treatment was individually evaluated. METHODS Seven patients with moyamoya disease underwent preoperative resting-state functional magnetic resonance imaging and neuropsychologic tests. We compared the resting-state networks (RSNs) of our patients with those obtained from relatively large cohort datasets (127 healthy controls) using group independent component analysis with dual regression analysis. We also explored correlations between RSN alterations and neuropsychologic scores. We evaluated individuals again 6 months after surgery to identify changes. RESULTS Patients had statistically significant differences in DMN connectivity compared with healthy controls. There were marked changes in functional connectivity of the ventral DMN of patients with low working memory and performance speed scores. These changes were characterized by increases and decreases in various locations. In contrast, patients with average or high neuropsychologic scores showed similar connectivity to the controls. In 5 patients who underwent vascular reconstruction surgery, DMN functional connectivity changed to resemble that of healthy controls. CONCLUSIONS In moyamoya disease, working memory and performance speed scores were inversely correlated to the degree of disruption of the DMN, suggesting a possible relationship between higher cognitive function and orderliness of fundamental brain networks. Vascular reconstruction surgery may contribute to normalization of brain networks. Analysis of RSNs may produce potential biomarkers for cognition in moyamoya disease.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sho Okamoto
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan.
| | - Epifanio Bagarinao
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Yoshio Araki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hirohisa Watanabe
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Gen Sobue
- The Brain and Mind Research Center, Nagoya University, Nagoya, Aichi, Japan; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Lei Y, Su J, Jiang H, Guo Q, Ni W, Yang H, Gu Y, Mao Y. Aberrant regional homogeneity of resting-state executive control, default mode, and salience networks in adult patients with moyamoya disease. Brain Imaging Behav 2018; 11:176-184. [PMID: 26843005 DOI: 10.1007/s11682-016-9518-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aberrant local connectivity within cerebral intrinsic connectivity networks (ICNs) at rest has not been reported in adult moyamoya disease (MMD). Our aim was to examine the regional homogeneity (ReHo) of executive control (ECN), default mode (DMN), and salience networks (SN) in patients with executive dysfunction to explore the underlying mechanism. Twenty-six adult patients with MMD and 24 normal control (NC) subjects were recruited. Executive function was evaluated by Trail Making Test Part B (TMT-B) and executive subtests of Memory and Executive Screening (MES-EX). Compared with NC, the case group exhibited ReHo decrease mainly in the frontal and parietal gyrus, and increase only in the left middle temporal gyrus. Subsequent ICNs analysis indicated that compared with NC, patients with MMD exhibited significantly decreased ReHo in the dorsolateral prefrontal cortex (DLPFC) and inferior parietal gyrus (IPG) of left ECN; the IPG, superior frontal gyrus, and DLPFC of the right ECN; the right precuneus, left medial superior frontal gyrus, and right medial orbitofrontal gyrus of the DMN; as well as the left middle frontal gyrus and right supplemental motor area of SN. When referring to the Suzuki's 6-stage classification, a trend of ReHo decrease with disease severity was observed in all of the ICNs examined, but only bilateral ECNs reached statistical significance. Finally, only bilateral ECNs exhibited a significant correlation of averaged ReHo values with executive performance. Our results provide new insight into the pathophysiology of adult MMD.
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Affiliation(s)
- Yu Lei
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
| | - Jiabin Su
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
| | - Hanqiang Jiang
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
| | - Qihao Guo
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, 200040, China
| | - Wei Ni
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
| | - Heng Yang
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital of Fudan University, Wulumuqi Zhong Road 12, Shanghai, 200040, China
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Qiao PG, Zuo ZW, Han C, Zhou J, Zhang HT, Duan L, Qian T, Li GJ. Cortical thickness changes in adult moyamoya disease assessed by structural magnetic resonance imaging. Clin Imaging 2017; 46:71-77. [DOI: 10.1016/j.clinimag.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 01/09/2023]
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Kazumata K, Tha KK, Uchino H, Ito M, Nakayama N, Abumiya T. Mapping altered brain connectivity and its clinical associations in adult moyamoya disease: A resting-state functional MRI study. PLoS One 2017; 12:e0182759. [PMID: 28783763 PMCID: PMC5544229 DOI: 10.1371/journal.pone.0182759] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/24/2017] [Indexed: 12/22/2022] Open
Abstract
Detection of subtle ischemic injuries in moyamoya disease may enable optimization of timing of revascularization surgery, and could potentially improve functional outcomes. Resting-state functional magnetic resonance imaging (rs-fMRI) is widely used to study functional organization of the brain, but it remains unclear whether rs-fMRI could elucidate distinct characteristics in moyamoya disease. Here, we aimed to determine changes in a conventional rs-fMRI measure and analyze any associations with clinical symptoms and cerebral hemodynamics. Thirty-one adults with moyamoya disease and 25 adult controls underwent rs-fMRI, in which we measured brain connectivity via temporal correlations of low-frequency BOLD signals. We identified the extent of between-group differences with multivoxel pattern analysis. Seed-based analysis was performed to determine associations with vascular lesions, symptoms, and regional cerebral blood flow (rCBF). There was significantly altered connectivity in the precentral gyrus, operculo-insular region, precuneus, cingulate cortex, and middle frontal gyrus in moyamoya disease. There was reduced connectivity in the left insula, left precuneus, right precentral, and right middle frontal regions, which form part of the salience, default mode, motor, and central executive networks, respectively. Patients with ischemic motor-related symptoms showed significantly decreased connectivity in precentral homotopic regions compared with those without, while there were no differences in vascular lesions or rCBF. Connectivity between the right occipital and left hippocampus was significantly associated with cognitive performance and posterior cerebral artery involvement. Our results demonstrate distinct alterations in the temporal correlations of low-frequency BOLD signals, predominantly in resting-state networks in moyamoya disease. Additionally, rs-fMRI measures were associated with ischemic motor-related symptoms and cognitive performance in the patients. Thus, rs-fMRI may offer a useful non-invasive method of acquiring additional information beyond cerebral perfusion as part of clinical investigations in patients with moyamoya disease.
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Affiliation(s)
- Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
- * E-mail:
| | - Khin Khin Tha
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Haruto Uchino
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
| | - Takeo Abumiya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Kita, Sapporo, Japan
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Lei Y, Li YJ, Guo QH, Liu XD, Liu Z, Ni W, Su JB, Yang H, Jiang HQ, Xu B, Gu YX, Mao Y. Postoperative executive function in adult moyamoya disease: a preliminary study of its functional anatomy and behavioral correlates. J Neurosurg 2016; 126:527-536. [PMID: 27058195 DOI: 10.3171/2015.12.jns151499] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic frontal hemodynamic disturbances are associated with executive dysfunction in adult patients with moyamoya disease (MMD). However, the impact of surgical revascularization on executive dysfunction and its underlying mechanism remains unclear. The aim of the present study was to examine the postoperative radiological correlates of cognitive improvement and thereby explore its underlying mechanism. METHODS Fourteen patients who met the inclusion criteria were identified at Huashan Hospital, were operated on, and were successfully followed up for 6 months. Postoperative changes in cortical perfusion and regional amplitude of low-frequency fluctuations (ALFF) were examined by SPECT and resting-state functional MRI, respectively. Executive function was evaluated by 2 tests (Trail Making Test Part B and the summation of executive subtests of Memory and Executive Screening [MES-EX]). Follow-up neuropsychological outcomes were then correlated with radiological changes to identify nodes functioning as leading contributors to postoperative executive outcomes. RESULTS All patients underwent successful unilateral bypass procedures, with some operations performed on the left side and some on the right side. At the 6-month follow-up, the baseline and follow-up test scores for the different sides did not differ significantly. The group with good collaterals (Matsushima Grade A, 9 patients) exhibited significantly increased postoperative perfusion (change in [△] hemodynamics) in bilateral frontal (left, p = 0.009; right, p = 0.003) and left parietal lobe (p = 0.014). The Spearman's correlation test suggested that only the right frontal lobe exhibited significant positive postoperative radiological correlates with cognitive performance (△MES-EX vs △hemodynamics, r = 0.620, p = 0.018; △MES-EX vs △ALFF, r = 0.676, p = 0.008; △hemodynamics vs △ALFF, r = 0.547, p = 0.043). Subsequent regional ALFF analysis revealed that the right dorsolateral prefrontal cortex (DLPFC) was the only node in the responsible hemisphere to exhibit significant postoperative changes. CONCLUSIONS The results not only advance our understanding of pathological interactions of postoperative executive performance in adult MMD, but also indicate that the right DLPFC amplitude might be a quantitative predictor of postoperative executive control improvement.
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Affiliation(s)
- Yu Lei
- Departments of 1 Neurosurgery
| | | | | | - Xing-Dang Liu
- Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhuang Liu
- Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Ni
- Departments of 1 Neurosurgery
| | | | | | | | - Bin Xu
- Departments of 1 Neurosurgery
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Lei Y, Su J, Guo Q, Yang H, Gu Y, Mao Y. Regional Gray Matter Atrophy in Vascular Mild Cognitive Impairment. J Stroke Cerebrovasc Dis 2015; 25:95-101. [PMID: 26432563 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/22/2015] [Accepted: 08/28/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the neuroanatomical bases of vascular mild cognitive impairment (VaMCI) with respect to attention/executive function, memory, language, and visuospatial function. METHODS We used voxel-based morphometric analysis to identify brain regions that significantly differed in terms of gray matter volumes (GMVs) between 43 patients with VaMCI and 55 healthy controls. Then, we compared the individual GMVs of the selected regions with the neuropsychological profiles of the VaMCI patients. RESULTS The delayed recall component of the Rey-Osterrieth Complex Figure Test (CFT) (74.4%), the Symbol Digit Modalities Test (74.4%), the Boston Naming Test (51.2%), and the CFT-copy (81.4%) shared the highest incidence of impairment in the 4 cognitive domains, respectively. Compared with controls, patients with VaMCI exhibited significantly reduced GMVs. This effect was mainly present in the frontal regions, including the bilateral dorsolateral prefrontal cortex (DLPFC), the orbital portion of the superior frontal gyrus (SFG), and the left supplemental motor area, and was also observed in the bilateral posterior cingulated cortex (PCC). GMVs were significantly correlated with performance in the Trail Making Test, part B, in the bilateral DLPFC and PCC, the clock drawing test in the right orbital portion of the SFG, and CFT-delayed recall in the right PCC. CONCLUSIONS These results, from the perspective of brain morphology, uniquely explored the specific cerebral structural changes of VaMCI, thus providing a deeper understanding of the pathophysiology of the disease.
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Affiliation(s)
- Yu Lei
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Jiabin Su
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Qihao Guo
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Heng Yang
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai, China
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26
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Li C, Yang J, Yin X, Liu C, Zhang L, Zhang X, Gui L, Wang J. Abnormal intrinsic brain activity patterns in leukoaraiosis with and without cognitive impairment. Behav Brain Res 2015; 292:409-13. [PMID: 26116811 DOI: 10.1016/j.bbr.2015.06.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/02/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
The amplitude of low frequency fluctuations (ALFF) from resting-state functional MRI (rs-fMRI) signals can be used to detect intrinsic spontaneous brain activity and provide valuable insights into the pathomechanism of neural disease. In this study, we recruited 56 patients who had been diagnosed as having mild to severe leukoaraiosis. According to the neuropsychological tests, they were subdivided into a leukoaraiosis with cognitive impairment group (n = 28) and a leukoaraiosis without cognitive impairment group (n = 28). 28 volunteers were included as normal controls. We found that the three groups showed significant differences in ALFF in the brain regions of the right inferior occipital gyrus (IOG_R), left middle temporal gyrus (MTG_L), left precuneus (Pcu_L), right superior frontal gyrus (SFG_R) and right superior occipital gyrus (SOG_R). Compared with normal controls, the leukoaraiosis without cognitive impairment group exhibited significantly increased ALFF in the IOG_R, Pcu_L, SFG_R and SOG_R. While compared with leukoaraiosis without cognitive impairment group, the leukoaraiosis with cognitive impairment group showed significantly decreased ALFF in IOG_R, MTG_L, Pcu_L and SOG_R. A close negative correlation was found between the ALFF values of the MTG_L and the Montreal Cognitive Assessment (MoCA) scores. Our data demonstrate that white matter integrity and cognitive impairment are associated with different amplitude fluctuations of rs-fMRI signals. Leukoaraiosis is related to ALFF increases in IOG_R, Pcu_L, SFG_Orb_R and SOG_R. Decreased ALFF in MTG_L is characteristic of cognitive impairment and may aid in its early detection.
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Affiliation(s)
- Chuanming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jun Yang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Lin Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Xiaochun Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Li Gui
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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