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Sekiguchi H, Kikuchi N, Ishida I, Sekiguchi N, Nishimura K, Shiga T, Kawana M, Hagiwara N, Takemura Y, Yamaguchi J. Direct Link Between Cardiac Failure and Global Cerebral Atrophy in a Young Adult: A Case Report on Reduced Cerebral Artery Blood Flow. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940892. [PMID: 37943737 PMCID: PMC10643886 DOI: 10.12659/ajcr.940892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Heart failure is associated with structural brain abnormalities, including atrophy of multiple brain regions. Previous studies have reported brain atrophy in middle-aged patients with systolic heart failure. In this report, we present the case of a 21-year-old woman with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy due to reduced cerebral artery blood flow. We also discuss the impact of brain atrophy in this young adult patient with severe heart failure and no risk factors for atherosclerosis. CASE REPORT A 21-year-old woman with dyspnea and leg edema was admitted to our hospital. After several examinations, an endomyocardial biopsy led to a diagnosis of idiopathic dilated cardiomyopathy, and transthoracic ultrasound cardiography revealed that her left ventricular ejection fraction was 36%. One year after the first hospitalization, her heart failure was classified as New York Heart Association Class III. Magnetic resonance imaging showed severe global brain atrophy, and single-photon emission computed tomography combined with brain computed tomography showed reduced blood flow to the entire brain. She had no risk factors for atherosclerosis and no atherosclerotic changes to her brain or carotid arteries, but her neuropsychological and neurological findings indicated more pronounced brain and cognitive dysfunction. CONCLUSIONS This young adult patient with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy showed reduced cerebral artery blood flow and cognitive impairment. The findings of this report indicate that low cardiac output may directly cause brain atrophy in patients with systolic heart failure.
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Affiliation(s)
- Haruki Sekiguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Comprehensive Sleep Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Issei Ishida
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sekiguchi
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
- Cosmetic Dermatology, UB CLINIC Shinjyuku, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masatoshi Kawana
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yousuke Takemura
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
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Holthaus TA, Sethi S, Cannavale CN, Aguiñaga S, Burd NA, Holscher HD, Khan NA. MIND dietary pattern adherence is inversely associated with visceral adiposity and features of metabolic syndrome. Nutr Res 2023; 116:69-79. [PMID: 37356349 DOI: 10.1016/j.nutres.2023.06.001] [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: 01/12/2023] [Revised: 04/12/2023] [Accepted: 06/03/2023] [Indexed: 06/27/2023]
Abstract
The effects of following the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet on metabolic health remains understudied. This cross-sectional analysis of 163 adults investigated associations between adherence to the MIND, Mediterranean, DASH, and Healthy Eating Index (HEI-2015) diets and metabolic syndrome (MetS) features and visceral adiposity. We hypothesized that the MIND diet would show the most beneficial associations with MetS risk factors. Diet adherence was assessed using the Dietary History Questionnaire II. Visceral adipose was assessed using dual-energy X-ray absorptiometry. Waist circumference and systolic and diastolic blood pressures were obtained. Fasting blood triglycerides, high-density lipoprotein cholesterol, and glucose concentrations were determined. Stepwise regression analyses were applied. Waist circumference was inversely associated with DASH (β = -0.21, P < .01), HEI-2015 (β = -0.18, P = .01), and MIND (β = -0.19, P < .01). Triglycerides were inversely associated with DASH (β = -0.19, P = .01), HEI-2015 (β = -0.18, P = .02), and MIND (β = -0.23, P < .01). High-density lipoprotein cholesterol was positively associated with Mediterranean (β = 0.18, P = .02) and MIND (β = 0.21, P < .01). Systolic blood pressure was inversely associated with Mediterranean (β = -0.18, P = .02), DASH (β = -0.30, P < .01), HEI-2015 (β = -0.24, P < .01), and MIND (β = -0.25, P < .01). Diastolic blood pressure was inversely associated with Mediterranean (β = -0.26, P < .01), DASH (β = -0.34, P < .01), HEI-2015 (β = -0.24, P < .01), and MIND (β = -0.31, P < .01). Fasting glucose was inversely associated with MIND (β = -0.19, P = .02). Visceral adiposity was inversely associated with Mediterranean (β = -0.19, P < .01), DASH (β = -0.22, P < .01), HEI-2015 (β = -0.22, P < .01), and MIND (β = -0.28, P < .01). Although each diet exhibited potential benefits for metabolic outcomes, only greater MIND diet adherence was associated with lower visceral adiposity and each MetS feature in adults.
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Affiliation(s)
- Tori A Holthaus
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Shivani Sethi
- Kinesiology and Community Health, University of Illinois, Urbana, IL 61801, USA
| | - Corinne N Cannavale
- Kinesiology and Community Health, University of Illinois, Urbana, IL 61801, USA
| | - Susan Aguiñaga
- Kinesiology and Community Health, University of Illinois, Urbana, IL 61801, USA
| | - Nicholas A Burd
- Division of Nutritional Sciences; Kinesiology and Community Health, University of Illinois, Urbana, IL 61801, USA
| | - Hannah D Holscher
- Division of Nutritional Sciences, Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL 61801, USA
| | - Naiman A Khan
- Neuroscience Program, Beckman Institute of Advanced Science and Technology, Division of Nutritional Sciences, Kinesiology and Community Health, University of Illinois, Urbana, IL 61801, USA.
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Woldstad C, Rusinek H, Sweeney E, Butler T, Li Y, Tanzi E, Mardy C, Harvey P, de Leon MJ, Glodzik L. Quadratic relationship between systolic blood pressure and white matter lesions in individuals with hypertension. J Hypertens 2023; 41:35-43. [PMID: 36204999 PMCID: PMC9794123 DOI: 10.1097/hjh.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is a well documented relationship between cardiovascular risk factors and the development of brain injury, which can lead to cognitive dysfunction. Hypertension (HTN) is a condition increasing the risk of silent and symptomatic ischemic brain lesions. Although benefits of hypertension treatment are indisputable, the target blood pressure value where the possibility of tissue damage is most reduced remains under debate. METHOD Our group performed a cross-sectional ( n = 376) and longitudinal ( n = 188) study of individuals without dementia or stroke (60% women n = 228, age 68.5 ± 7.4 years; men n = 148, age 70.7 ± 6.9 years). Participants were split into hypertensive ( n = 169) and normotensive ( n = 207) groups. MR images were obtained on a 3T system. Linear modeling was performed in hypertensive and normotensive cohorts to investigate the relationship between systolic (SBP) and diastolic (DBP) blood pressure, white matter lesion (WML), and brain volumes. RESULTS Participants in the hypertensive cohort showed a quadratic relationship between SBP and WML, with the lowest amounts of WML being measured in participants with readings at approximately 124 mmHg. Additionally, the hypertensive cohort also exhibited a quadratic relationship between DBP and mean hippocampal volume; participants with readings at approximately 77 mmHg showing the largest volumes. Longitudinally, all groups experienced WML growth, despite different BP trajectories, further suggesting that WML expansion may occur despite or because of BP reduction in individuals with compromised vascular system. CONCLUSION Overall, our study suggests that in the hypertensive group there is a valley of mid-range blood pressures displaying less pathology in the brain.
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Affiliation(s)
| | | | - Elizabeth Sweeney
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine
| | - Tracy Butler
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Yi Li
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Emily Tanzi
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Christopher Mardy
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Patrick Harvey
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Mony J. de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
| | - Lidia Glodzik
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine
- Department of Psychiatry, NYU School of Medicine, New York, NY, USA
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Tan S, Ho CESM, Teo YN, Teo YH, Chan MYY, Lee CH, Evangelista LKM, Lin W, Chong YF, Yeo TC, Sharma VK, Wong RCC, Tan BYQ, Yeo LLL, Chai P, Sia CH. Prevalence and incidence of stroke, white matter hyperintensities, and silent brain infarcts in patients with chronic heart failure: A systematic review, meta-analysis, and meta-regression. Front Cardiovasc Med 2022; 9:967197. [PMID: 36186994 PMCID: PMC9520068 DOI: 10.3389/fcvm.2022.967197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionHeart failure (HF) is associated with ischemic stroke (IS). However, there are limited studies on the prevalence of IS, white matter hyperintensities (WMHs), and silent brain infarcts (SBIs). Furthermore, interaction with ejection fraction (EF) is unclear.MethodsWe searched three databases (viz., PubMed, Embase, and Cochrane) for studies reporting the incidence or prevalence of IS, WMHs, and SBIs in HF. A total of two authors independently selected included studies. We used random-effects models, and heterogeneity was evaluated with I2 statistic. Meta-regression was used for subgroup analysis.ResultsIn total, 41 articles involving 870,002 patients were retrieved from 15,267 records. Among patients with HF, the pooled proportion of IS was 4.06% (95% CI: 2.94–5.59), and that of WMHs and SBIs was higher at 15.67% (95% CI: 4.11–44.63) and 23.45% (95% CI: 14.53–35.58), respectively. Subgroup analysis of HFpEF and HFrEF revealed a pooled prevalence of 2.97% (95% CI: 2.01–4.39) and 3.69% (95% CI: 2.34–5.77), respectively. Subgroup analysis of WMH Fazekas scores 1, 2, and 3 revealed a decreasing trend from 60.57 % (95% CI: 35.13–81.33) to 11.57% (95% CI: 10.40–12.85) to 3.07% (95% CI: 0.95–9.47). The relative risk and hazard ratio of patients with HF developing IS were 2.29 (95% CI: 1.43–3.68) and 1.63 (95% CI: 1.22–2.18), respectively. Meta-regression showed IS prevalence was positively correlated with decreasing anticoagulant usage.ConclusionWe obtained estimates for the prevalence of IS, WMH, and SBI in HF from systematic review of the literature.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=255126, PROSPERO [CRD42021255126].
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Affiliation(s)
- Sean Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clare Elisabeth Si Min Ho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | | | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Yao-Feng Chong
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Vijay Kumar Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Raymond C. C. Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Benjamin Y. Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Leonard L. L. Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- *Correspondence: Ching-Hui Sia
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Cheng HM, Chuang SY, Ko YT, Liao CF, Pan WH, Liu WL, Hung CY, Chen CH. Education level may modify the association between cardiac index and cognitive function among elders with normal ejection function. Front Cardiovasc Med 2022; 9:844396. [PMID: 36172592 PMCID: PMC9510656 DOI: 10.3389/fcvm.2022.844396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Lower cardiac index (CI) in elders has been associated with incident dementia, and higher CI has protectively effect with brain aging. In the present study, we investigated the modulating effects of education level and arterial stiffness on the association between CI and cognitive function among older adults. Methods A total of 723 elders (≥60 years, 50.1% women) with normal left ventricular ejection fraction (≥50%) were identified from the Cardiovascular Diseases Risk Factor Two-Township Study. CI was calculated from the Doppler-derived stroke volume. We evaluated arterial stiffness by measuring carotid-femoral pulse wave velocity (CFPWV) and global cognitive function by using the Mini-Mental Short Examination (MMSE). Education level was determined by years of formal education. Results In linear regression analysis adjusting for age, sex, formal years of education, and CFPWV, CI was significantly positively associated with MMSE (BETA=0.344±0.130, P = 0.0082). In logistic regression analysis adjusting for age, sex, formal years of education, and CFPWV, subjects with a CI≥75 percentile had a significantly lower risk of low MMSE (<26) (OR = 0.495, 95% CI = 0.274–0.896, P = 0.02). In subgroup analysis, higher CI was significantly associated with higher MMSE and lower risk of low MMSE only in elders with ≤ 9 years of formal education. Causal mediation analysis suggests that higher CI maintains higher MMSE in elders with lower education levels whereas higher CFPWV causes lower MMSE in all the elders. Conclusion In elders with normal ejection fraction, a higher CI was associated with a lower risk of cognitive function impairment, independent of arterial stiffness, mainly in subjects with a lower education level and possibly a smaller cognitive reserve.
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Affiliation(s)
- Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Public Health Sciences Institute, National Health Research Institutes, Zhunan, Taiwan
- *Correspondence: Shao-Yuan Chuang
| | - Yu-Ting Ko
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Feng Liao
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Wen-Harn Pan
- Institutes of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Wen-Ling Liu
- Public Health Sciences Institute, National Health Research Institutes, Zhunan, Taiwan
| | - Chen-Ying Hung
- Department of Internal Medicine, Taipei General Veterans Hospital, Hsinchu, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
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Hsieh SS, Raine LB, Ortega FB, Hillman CH. The Role of Chronic Physical Activity in Alleviating the Detrimental Relationship of Childhood Obesity on Brain and Cognition. JOURNAL OF COGNITIVE ENHANCEMENT 2021. [DOI: 10.1007/s41465-021-00230-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Childhood obesity and its negative relation with children’s brain health has become a growing health concern. Over the last decade, literature has indicated that physical activity attenuates cognitive impairment associated with obesity and excess adiposity in children. However, there is no comprehensive review that considers the extent to which these factors affect different domains of cognition. This narrative review comprehensively summarizes behavioral, neuroimaging, and neuroelectric findings associated with chronic physical activity and fitness on brain and cognition in childhood obesity. Based on the literature reviewed, increased adiposity has a demonstrated relationship with neurocognitive health via mechanisms triggered by central inflammation and insulin resistance, with the most pronounced decrements observed for cognitive domains that are prefrontal- and hippocampal-dependent. Fortunately, physical activity, especially interventions enhancing aerobic fitness and motor coordination, have demonstrated efficacy for attenuating the negative effects of obesity across different subdomains of structural and functional brain imaging, cognition, and multiple academic outcomes in children with overweight or obesity. Such mitigating effects may be accounted for by attenuated central inflammation, improved insulin sensitivity, and increased expression of neurotrophic factors. Lastly, individual differences appear to play a role in this relationship, as the manipulation of physical activity characteristics, the employment of a wide array of cognitive and academic measures, the inclusion of different adiposity measures that are sensitive to neurocognitive function, and the utilization of an inter-disciplinary approach have been found to influence the relationship between physical activity and excess adiposity on brain and cognition.
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Johansen MC, Gottesman RF. Cerebrovascular Disease and Cognitive Outcome in Patients with Cardiac Disease. Semin Neurol 2021; 41:463-472. [PMID: 33851395 DOI: 10.1055/s-0041-1726330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The pace of understanding cognitive decline and dementia has rapidly accelerated over the past decade, with constantly evolving insights into the vascular contributions to cognitive impairment and dementia (VCID). Notably, more overlap has been discovered in the pathophysiology between what was previously understood to be Alzheimer's disease and VCID, leading to a heightened emphasis on disease prevention through early and aggressive control of vascular risk factors. One particularly vulnerable population may be those with cardiac disease, as they are at risk for cerebrovascular disease, which itself can lead to dementia, and increasing evidence supports cognitive impairment in disease processes such as heart failure and atrial fibrillation, independent of ischemic stroke, suggesting other potential mechanisms. In this article, we review the evidence supporting the relationship between cardiac disease, cerebrovascular disease, and cognitive decline and discuss the ongoing and future research efforts aimed at defining the important relationship between these entities.
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Affiliation(s)
- Michelle C Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca F Gottesman
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Freedman B, Kamel H, Van Gelder IC, Schnabel RB. Atrial fibrillation: villain or bystander in vascular brain injury. Eur Heart J Suppl 2020; 22:M51-M59. [PMID: 33664640 PMCID: PMC7916423 DOI: 10.1093/eurheartj/suaa166] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) and stroke are inextricably connected, with classical Virchow pathophysiology explaining thromboembolism through blood stasis in the fibrillating left atrium. This conceptualization has been reinforced by the remarkable efficacy of oral anticoagulant (OAC) for stroke prevention in AF. A number of observations showing that the presence of AF is neither necessary nor sufficient for stroke, cast doubt on the causal role of AF as a villain in vascular brain injury (VBI). The requirement for additional risk factors before AF increases stroke risk; temporal disconnect of AF from a stroke in patients with no AF for months before stroke during continuous ECG monitoring but manifesting AF only after stroke; and increasing recognition of the role of atrial cardiomyopathy and atrial substrate in AF-related stroke, and also stroke without AF, have led to rethinking the pathogenetic model of cardioembolic stroke. This is quite separate from recognition that in AF, shared cardiovascular risk factors can lead both to non-embolic stroke, or emboli from the aorta and carotid arteries. Meanwhile, VBI is now expanded to include dementia and cognitive decline: research is required to see if reduced by OAC. A changed conceptual model with less focus on the arrhythmia, and more on atrial substrate/cardiomyopathy causing VBI both in the presence or absence of AF, is required to allow us to better prevent AF-related VBI. It could direct focus towards prevention of the atrial cardiomyopathy though much work is required to better define this entity before the balance between AF as villain or bystander can be determined.
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Affiliation(s)
- Ben Freedman
- Heart Research Institute, Charles Perkins Centre and Concord Hospital Department of Cardiology, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Renate B Schnabel
- University Heart and Vascular Centre, Department of Cardiology, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Abstract
The view that chronic heart failure was exclusively a disease of the heart dominated the cardiovascular literature until relatively recently. However, over the last 40 years it has increasingly come to be seen as a multisystem disease. Aside from changes in the sympathetic and parasympathetic nervous systems and the renin-angiotensin-aldosterone system, adaptations to the lungs, muscles and gastrointestinal tract have been clearly documented. It is clear that the brain and CNS are also affected in patients with heart failure, although this is often under recognized. The purpose of this review is to summarize the changes in the structure and biochemical function of the CNS in patients with chronic heart failure and to discuss their potential importance.
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Affiliation(s)
- Mark Dayer
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - David H MacIver
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK.,Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, M13 9PL, UK
| | - Stuart D Rosen
- Ealing & Royal Brompton Hospitals, Uxbridge Rd, Southall, UB1 3HW, UK.,Imperial College London, South Kensington, London, SW7 2BU, UK
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Zonneveld MH, Noordam R, van der Grond J, Sabayan B, Mooijaart SP, Mcfarlane PW, Jukema JW, Trompet S. Ventricular Repolarization is Associated with Cognitive Function, but Not with Cognitive Decline and Brain Magnetic Resonance Imaging (MRI) Measurements in Older Adults. J Clin Med 2020; 9:jcm9040911. [PMID: 32225080 PMCID: PMC7230741 DOI: 10.3390/jcm9040911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023] Open
Abstract
We aimed to investigate the cross-sectional and longitudinal associations of electrocardiogram (ECG)-based QT, QTc, JT, JTc, and QRS intervals with cognitive function and brain magnetic resonance imaging (MRI) measurements in a cohort of older individuals at increased risk for cardiovascular disease, but free of known arrhythmias. We studied 4627 participants (54% female, mean age 75 years) enrolled in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Ten-second ECGs were conducted at baseline. Cognitive function was tested at baseline and repeated during a mean follow-up time of 3.2 years. Structural MRIs were conducted in a subgroup of 535 participants. Analyses were performed with multivariable (repeated) linear regression models and adjusted for cardiovascular risk-factors, co-morbidities, and cardiovascular drug use. At baseline, longer QT, JT, JTc—but not QTc and QRS intervals—were associated with a worse cognitive performance. Most notably, on the Stroop Test, participants performed 3.02 (95% CI 0.31; 5.73) seconds worse per standard deviation higher QT interval, independent of cardiovascular risk factors and medication use. There was no association between longer ventricular de- or repolarization and structural brain measurements. Therefore, specifically ventricular repolarization was associated with worse cognitive performance in older individuals at baseline but not during follow-up.
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Affiliation(s)
- Michelle H. Zonneveld
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
- Correspondence:
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Behnam Sabayan
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Simon P. Mooijaart
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
| | - Peter W. Mcfarlane
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G31 2ER, UK;
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.H.Z.); (S.P.M.); (S.T.)
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Fulop GA, Ahire C, Csipo T, Tarantini S, Kiss T, Balasubramanian P, Yabluchanskiy A, Farkas E, Toth A, Nyúl-Tóth Á, Toth P, Csiszar A, Ungvari Z. Cerebral venous congestion promotes blood-brain barrier disruption and neuroinflammation, impairing cognitive function in mice. GeroScience 2019; 41:575-589. [PMID: 31691147 PMCID: PMC6885079 DOI: 10.1007/s11357-019-00110-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is one of the most common co-occurring chronic conditions among elderly heart failure patients (incidence: up to ~ 80%); however, the underlying mechanisms are not completely understood. It is hypothesized that in addition to decreased cardiac output, increases in central-and consequentially, cerebral-venous pressure (backward failure) also contribute significantly to the genesis of cognitive impairment. To test this hypothesis and elucidate the specific pathogenic role of venous congestion in the brain, we have established a novel model of increased cerebral venous pressure: mice with jugular vein ligation (JVL). To test the hypothesis that increased venous pressure in the brain contributes to the development of cognitive deficits by causing blood-brain barrier disruption, dysregulation of blood flow, and/or promoting neuroinflammation, in C57BL/6 mice, the internal and external jugular veins were ligated. Cognitive function (radial arm water maze), gait function (CatWalk), and motor coordination (rotarod) were tested post-JVL. Neurovascular coupling responses were assessed by measuring changes in cerebral blood flow in the whisker barrel cortex in response to contralateral whisker stimulation by laser speckle contrast imaging through a closed cranial window. Blood-brain barrier integrity (IgG extravasation) and microglia activation (Iba1 staining) were assessed in brain slices by immunohistochemistry. Neuroinflammation-related gene expression profile was assessed by a targeted qPCR array. After jugular vein ligation, mice exhibited impaired spatial learning and memory, altered motor coordination, and impaired gait function, mimicking important aspects of altered brain function observed in human heart failure patients. JVL did not alter neurovascular coupling responses. In the brains of mice with JVL, significant extravasation of IgG was detected, indicating blood-brain barrier disruption, which was associated with histological markers of neuroinflammation (increased presence of activated microglia) and a pro-inflammatory shift in gene expression profile. Thus, cerebral venous congestion per se can cause blood-brain barrier disruption and neuroinflammation, which likely contribute to the genesis of cognitive impairment. These findings have relevance to the pathogenesis of cognitive decline associated with heart failure as well as increased cerebal venous pressure due to increased jugular venous reflux in elderly human patients.
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Affiliation(s)
- Gabor A Fulop
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology/Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Chetan Ahire
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology/Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Eszter Farkas
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Attila Toth
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology/Kálmán Laki Doctoral School of Biomedical and Clinical Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ádám Nyúl-Tóth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Institute of Biophysics, Biological Research Centre, Szeged, Hungary
| | - Peter Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Department of Neurosurgery and Szentagothai Research Center, University of Pecs, Medical School, Pecs, Hungary
- Institute for Translational Medicine, University of Pecs, Medical School , Pecs, Hungary
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine, Department of Public Health, Semmelweis University, Budapest, Hungary.
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
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12
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Fulop GA, Tarantini S, Yabluchanskiy A, Molnar A, Prodan CI, Kiss T, Csipo T, Lipecz A, Balasubramanian P, Farkas E, Toth P, Sorond F, Csiszar A, Ungvari Z. Role of age-related alterations of the cerebral venous circulation in the pathogenesis of vascular cognitive impairment. Am J Physiol Heart Circ Physiol 2019; 316:H1124-H1140. [PMID: 30848677 PMCID: PMC6580383 DOI: 10.1152/ajpheart.00776.2018] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 02/07/2023]
Abstract
There has been an increasing appreciation of the role of vascular contributions to cognitive impairment and dementia (VCID) associated with old age. Strong preclinical and translational evidence links age-related dysfunction and structural alterations of the cerebral arteries, arterioles, and capillaries to the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. The low-pressure, low-velocity, and large-volume venous circulation of the brain also plays critical roles in the maintenance of homeostasis in the central nervous system. Despite its physiological importance, the role of age-related alterations of the brain venous circulation in the pathogenesis of vascular cognitive impairment and dementia is much less understood. This overview discusses the role of cerebral veins in the pathogenesis of VCID. Pathophysiological consequences of age-related dysregulation of the cerebral venous circulation are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages of venous origin, altered production of cerebrospinal fluid, impaired function of the glymphatics system, dysregulation of cerebral blood flow, and ischemic neuronal dysfunction and damage. Understanding the age-related functional and phenotypic alterations of the cerebral venous circulation is critical for developing new preventive, diagnostic, and therapeutic approaches to preserve brain health in older individuals.
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Affiliation(s)
- Gabor A Fulop
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andriy Yabluchanskiy
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Andrea Molnar
- Heart and Vascular Center, Semmelweis University , Budapest , Hungary
| | - Calin I Prodan
- Veterans Affairs Medical Center , Oklahoma City, Oklahoma
- Department of Neurology, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Tamas Kiss
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Tamas Csipo
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Agnes Lipecz
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Priya Balasubramanian
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
| | - Eszter Farkas
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Peter Toth
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Cerebrovascular Laboratory, Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School , Pecs , Hungary
| | - Farzaneh Sorond
- Department of Neurology, Northwestern University , Chicago, Illinois
| | - Anna Csiszar
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma
- Vascular Cognitive Impairment Program, Department of Medical Physics and Informatics, University of Szeged , Szeged , Hungary
- Semmelweis University, Department of Pulmonology , Budapest , Hungary
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13
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Lowe CJ, Reichelt AC, Hall PA. The Prefrontal Cortex and Obesity: A Health Neuroscience Perspective. Trends Cogn Sci 2019; 23:349-361. [DOI: 10.1016/j.tics.2019.01.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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14
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Moon C, Bendlin BB, Melah KE, Bratzke LC. The association of sleep-disordered breathing and white matter hyperintensities in heart failure patients. Metab Brain Dis 2018; 33:2019-2029. [PMID: 30218440 PMCID: PMC6408271 DOI: 10.1007/s11011-018-0309-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/26/2018] [Indexed: 01/19/2023]
Abstract
Heart failure patients often manifest white matter hyperintensites on brain magnetic resonance imaging (MRI). White matter hyperintnsities have also been linked with cognitive problems in patients with heart failure. Sleep disordered breathing may contribute to structural brain changes in heart failure. The purpose of this study was to test the extent to which the apnea hypopnea index is associated with global and regional white matter hyperintensities, and is a moderating factor in the relationship between age and white matter hyperintensites. A total of 28 HF patients [mean age (SD) = 67.89 (5.8)] underwent T1-weighted and T2FLAIR MRI and a home sleep monitoring study. The apnea hypopnea index cut off of 10 was used to compare between higher and lower risks of sleep disordered breathing. Regression analysis was used to test the association between apnea hypopnea index and both global and regional white matter hyperintensities. The interaction term was entered to identify the moderation effect. Apnea hypopnea index was associated with higher regional white matter hyperintensities but not global white matter hyperintensities. There was a significant interaction between the apnea hypopnea index and age, such that older participants with the apnea hypopnea index ≥10 showed greater regional white matter hyperintensities than those with the apnea hypopnea index <10. The results of this preliminary study indicate that a higher apnea hypopnea index is associated with more white matter hyperintensities. The age-related white matter hyperintensities appear to be exacerbated by apnea hypopnea index in our individuals with heart failure. Future studies are needed to further investigate the underlying mechanisms.
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Affiliation(s)
- Chooza Moon
- College of Nursing, University of Iowa, 316 CNB, 50 Newton Rd, Iowa City, IA, 52246, USA.
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI, 53705, USA.
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, Wisconsin Alzheimer's Institute, School of Medicine and Public Health, University of Wisconsin-Madison, J5/1 Mezzanine CSC, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kelsey E Melah
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI, 53705, USA
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave, Madison, WI, 53705, USA
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15
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Frey A, Sell R, Homola GA, Malsch C, Kraft P, Gunreben I, Morbach C, Alkonyi B, Schmid E, Colonna I, Hofer E, Müllges W, Ertl G, Heuschmann P, Solymosi L, Schmidt R, Störk S, Stoll G. Cognitive Deficits and Related Brain Lesions in Patients With Chronic Heart Failure. JACC-HEART FAILURE 2018; 6:583-592. [DOI: 10.1016/j.jchf.2018.03.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
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16
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Cardiovascular disease and brain health: Focus on white matter hyperintensities. IJC HEART & VASCULATURE 2018; 19:63-69. [PMID: 29946567 PMCID: PMC6016077 DOI: 10.1016/j.ijcha.2018.04.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Diseases affecting the brain contribute to a substantial proportion of morbidity and mortality in the general population. Conditions such as stroke, dementia and cognitive impairment have a prominent impact on global public health. Despite the heterogeneous clinical manifestations of these conditions and their diverse prognostic implications, current evidence supports a role for cardiovascular disease as a common pathophysiological ground. Brain white matter hyperintensities (WMH) are patchy white matter signal hyperintensity on T2-weighted magnetic resonance imaging sequences commonly found in elderly individuals. WMH appear to have a vascular pathogenesis and have been shown to confer an increased risk of stroke and cognitive decline. Indeed, they were proposed as a marker for central nervous system frailty. Cardiovascular diseases seem to play a key role in the etiology of WMH. Carotid atherosclerosis and atrial fibrillation were shown to be associated with higher WMH burden, while adequate blood pressure control has been reported reducing WMH progression. Aim of the present work is to review the available evidence linking WMH to cardiovascular disease, highlighting the complex interplay between cerebral and cardiovascular health.
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17
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Lefferts WK, Heffernan KS, Barreira TV. Association between pulsatile blood pressure and cognitive performance among older adults: Insight from the National Health and Nutrition Examination Survey 1999-2002. Int J Cardiol 2016; 223:981-984. [PMID: 27591696 DOI: 10.1016/j.ijcard.2016.08.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND High blood pressure (BP) may be associated with impaired cognitive function. BP is comprised of a steady (mean arterial pressure; MAP) and pulsatile (pulse pressure; PP) component. The purpose of this study was to examine the relationship between steady and pulsatile BP and cognition among adults ≥60years old. METHODS 2058 adults age 60-85years from the 1999-2002 NHANES were used in this analysis. MAP and PP were calculated from brachial BP as 1/3 systolic +2/3 diastolic BP, and systolic - diastolic BP, respectively. Cognition was assessed using the digit-symbol substitution test (DSST). RESULTS Unadjusted multiple regression revealed although PP independently predicted DSST score (β=-0.21, p<0.05), MAP was only predictive when entered simultaneously with PP (β=0.06, p<0.05). Further adjustments for sociodemographics and medical history significantly improved prediction of DSST score (∆R2=0.37, p<0.05), and removed the association between MAP and DSST score, although PP remained a significant predictor (β=-0.07, p<0.05). CONCLUSIONS PP, but not MAP, was significantly and inversely related to cognitive function among a representative sample of adults aged ≥60years after controlling for sociodemographic information and medical history.
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18
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Racine AM, Koscik RL, Berman SE, Nicholas CR, Clark LR, Okonkwo OC, Rowley HA, Asthana S, Bendlin BB, Blennow K, Zetterberg H, Gleason CE, Carlsson CM, Johnson SC. Biomarker clusters are differentially associated with longitudinal cognitive decline in late midlife. Brain 2016; 139:2261-74. [PMID: 27324877 DOI: 10.1093/brain/aww142] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/05/2016] [Indexed: 11/12/2022] Open
Abstract
The ability to detect preclinical Alzheimer's disease is of great importance, as this stage of the Alzheimer's continuum is believed to provide a key window for intervention and prevention. As Alzheimer's disease is characterized by multiple pathological changes, a biomarker panel reflecting co-occurring pathology will likely be most useful for early detection. Towards this end, 175 late middle-aged participants (mean age 55.9 ± 5.7 years at first cognitive assessment, 70% female) were recruited from two longitudinally followed cohorts to undergo magnetic resonance imaging and lumbar puncture. Cluster analysis was used to group individuals based on biomarkers of amyloid pathology (cerebrospinal fluid amyloid-β42/amyloid-β40 assay levels), magnetic resonance imaging-derived measures of neurodegeneration/atrophy (cerebrospinal fluid-to-brain volume ratio, and hippocampal volume), neurofibrillary tangles (cerebrospinal fluid phosphorylated tau181 assay levels), and a brain-based marker of vascular risk (total white matter hyperintensity lesion volume). Four biomarker clusters emerged consistent with preclinical features of (i) Alzheimer's disease; (ii) mixed Alzheimer's disease and vascular aetiology; (iii) suspected non-Alzheimer's disease aetiology; and (iv) healthy ageing. Cognitive decline was then analysed between clusters using longitudinal assessments of episodic memory, semantic memory, executive function, and global cognitive function with linear mixed effects modelling. Cluster 1 exhibited a higher intercept and greater rates of decline on tests of episodic memory. Cluster 2 had a lower intercept on a test of semantic memory and both Cluster 2 and Cluster 3 had steeper rates of decline on a test of global cognition. Additional analyses on Cluster 3, which had the smallest hippocampal volume, suggest that its biomarker profile is more likely due to hippocampal vulnerability and not to detectable specific volume loss exceeding the rate of normal ageing. Our results demonstrate that pathology, as indicated by biomarkers, in a preclinical timeframe is related to patterns of longitudinal cognitive decline. Such biomarker patterns may be useful for identifying at-risk populations to recruit for clinical trials.
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Affiliation(s)
- Annie M Racine
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 2 Institute on Aging, University of Wisconsin-Madison, USA, Madison, WI 53706, USA 3 Neuroscience and Public Policy Program, University of Wisconsin-Madison, USA, Madison, WI 53705, USA
| | - Rebecca L Koscik
- 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Sara E Berman
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Christopher R Nicholas
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Lindsay R Clark
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Ozioma C Okonkwo
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Howard A Rowley
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 6 Department of Radiology, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Sanjay Asthana
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Barbara B Bendlin
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA
| | - Kaj Blennow
- 7 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 8 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- 7 Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden 8 Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden 9 Institute of Neurology, University College London, London, UK
| | - Carey E Gleason
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Cynthia M Carlsson
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA
| | - Sterling C Johnson
- 1 Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 4 Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, USA, Madison, WI 53705, USA 5 Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, USA, Madison WI 53705, USA 10 Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, USA, Madison, WI 53705, USA
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19
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van Dalen JW, Mutsaerts HJMM, Nederveen AJ, Vrenken H, Steenwijk MD, Caan MWA, Majoie CBLM, van Gool WA, Richard E. White Matter Hyperintensity Volume and Cerebral Perfusion in Older Individuals with Hypertension Using Arterial Spin-Labeling. AJNR Am J Neuroradiol 2016; 37:1824-1830. [PMID: 27282862 DOI: 10.3174/ajnr.a4828] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/31/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities of presumed vascular origin in elderly patients with hypertension may be part of a general cerebral perfusion deficit, involving not only the white matter hyperintensities but also the surrounding normal-appearing white matter and gray matter. We aimed to study the relation between white matter hyperintensity volume and CBF and assess whether white matter hyperintensities are related to a general perfusion deficit. MATERIALS AND METHODS In 185 participants of the Prevention of Dementia by Intensive Vascular Care trial between 72 and 80 years of age with systolic hypertension, white matter hyperintensity volume and CBF were derived from 3D FLAIR and arterial spin-labeling MR imaging, respectively. We compared white matter hyperintensity CBF, normal-appearing white matter CBF, and GM CBF across quartiles of white matter hyperintensity volume and assessed the continuous relation between these CBF estimates and white matter hyperintensity volume by using linear regression. RESULTS Mean white matter hyperintensity CBF was markedly lower in higher quartiles of white matter hyperintensity volume, and white matter hyperintensity volume and white matter hyperintensity CBF were negatively related (standardized β = -0.248, P = .001) in linear regression. We found no difference in normal-appearing white matter or GM CBF across quartiles of white matter hyperintensity volume or any relation between white matter hyperintensity volume and normal-appearing white matter CBF (standardized β = -0.065, P = .643) or GM CBF (standardized β = -0.035, P = .382) in linear regression. CONCLUSIONS Higher white matter hyperintensity volume in elderly individuals with hypertension was associated with lower perfusion within white matter hyperintensities, but not with lower perfusion in the surrounding normal-appearing white matter or GM. These findings suggest that white matter hyperintensities in elderly individuals with hypertension relate to local microvascular alterations rather than a general cerebral perfusion deficit.
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Affiliation(s)
- J W van Dalen
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.)
| | - H J M M Mutsaerts
- Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A J Nederveen
- Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H Vrenken
- Departments of Radiology and Nuclear Medicine (H.V., M.D.S.).,Physics and Medical Technology (H.V.), Neuroscience Campus Amsterdam, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - M D Steenwijk
- Departments of Radiology and Nuclear Medicine (H.V., M.D.S.)
| | - M W A Caan
- Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - C B L M Majoie
- Radiology (H.J.M.M.M., A.J.N., M.W.A.C., C.B.L.M.M.), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - W A van Gool
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.)
| | - E Richard
- From the Departments of Neurology (J.W.v.D., W.A.v.G., E.R.).,Department of Neurology (E.R.), Radboud University Medical Center, Nijmegen, the Netherlands
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20
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Berman SE, Wang X, Mitchell CC, Kundu B, Jackson DC, Wilbrand SM, Varghese T, Hermann BP, Rowley HA, Johnson SC, Dempsey RJ. The relationship between carotid artery plaque stability and white matter ischemic injury. NEUROIMAGE-CLINICAL 2015; 9:216-22. [PMID: 26448914 PMCID: PMC4572385 DOI: 10.1016/j.nicl.2015.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/17/2015] [Accepted: 08/17/2015] [Indexed: 12/12/2022]
Abstract
Higher local carotid artery strain has previously been shown to be a characteristic of unstable carotid plaques. These plaques may be characterized by microvascular changes that predispose to intraplaque hemorrhage, increasing the likelihood of embolization. Little is known however, about how these strain indices correspond with imaging markers of brain health and metrics of brain structure. White matter hyperintensities (WMHs), which are bright regions seen on T2-weighted brain MRI imaging, are postulated to result from cumulative ischemic vascular injury. Consequently, we hypothesized that plaques that are more prone to microvascular changes and embolization, represented by higher strain indices on ultrasound, would be associated with an increased amount of WMH lesion volume. This relationship would suggest not only emboli as a cause for the brain degenerative changes, but more importantly, a common microvascular etiology for large and small vessel contributions to this process. Subjects scheduled to undergo a carotid endarterectomy were recruited from a neurosurgery clinic. Prior to surgery, participating subjects underwent both ultrasound strain imaging and brain MRI scans as part of a larger clinical study on vascular health and cognition. A linear regression found that maximum absolute strain and peak to peak strain in the surgical side carotid artery were predictive of WMH burden. Furthermore, the occurrence of microembolic signals monitored using transcranial Doppler (TCD) ultrasound examinations also correlated with increasing lesion burden. It is becoming increasingly recognized that cognitive decline is often multifactorial in nature. One contributing extra-brain factor may be changes in the microvasculature that produce unstable carotid artery plaques. In this study, we have shown that higher strain indices in carotid artery plaques are significantly associated with an increased WMH burden, a marker of vascular mediated brain damage. We examine how carotid artery plaque strain indices correspond with MRI metrics. Strain in the ICA predicts increased white matter hyperintensity lesion burden. Subjects with embolizing plaques have greater white matter lesion burden.
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Affiliation(s)
- Sara E Berman
- Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA ; Neuroscience Training Program, University of Wisconsin - Madison, Madison, WI 53705, USA ; Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Xiao Wang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Carol C Mitchell
- Department of Medicine, Cardiovascular Medicine Section, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Bornali Kundu
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Howard A Rowley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Sterling C Johnson
- Geriatric Research Education and Clinical Center, Wm. S. Middleton Veterans Hospital, Madison, WI 53705, USA ; Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA ; Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin - Madison, Madison, WI 53705, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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21
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Abstract
Patients with heart failure (HF) exhibit a wide range of symptoms, including dyspnea, sleep-disordered breathing, autonomic abnormalities, cognitive dysfunction, and neuropsychological disturbances. These symptoms, which affect quality of life and morbidity and mortality in the condition, are largely related to structural and functional changes in the brain. There are increasing reports of brain abnormalities in HF, but often the linkages between brain injury and common HF clinical symptomatology are not clearly described. In this review, we will discuss the current evidence of brain injury and the associated clinical symptoms in HF, focusing on those brain regions that are commonly damaged in the condition. We will also provide a brief exploration of some potential mechanisms for brain injury in HF.
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Affiliation(s)
- Jennifer A Ogren
- UCLA School of Nursing, 700 Tiverton Ave., Los Angeles, CA, 90095-1702, USA,
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22
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Alosco ML, Spitznagel MB, Sweet LH, Josephson R, Hughes J, Gunstad J. Atrial fibrillation exacerbates cognitive dysfunction and cerebral perfusion in heart failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:178-86. [PMID: 25492027 DOI: 10.1111/pace.12543] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/04/2014] [Accepted: 10/19/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure (HF) increases risk for cognitive impairment in part due to the negative effects of cardiac dysfunction on cerebral perfusion. Atrial fibrillation (AF), an independent risk factor for cognitive impairment, often accompanies HF and is associated with lower systemic perfusion. However, no study has examined the associations among AF, cognitive function, and cerebral perfusion in patients with HF. METHODS A total of 187 HF patients completed neuropsychological testing and underwent transcranial Doppler ultrasonography. Cerebral blood flow velocity of the middle cerebral artery (CBF-V) operationalized cerebral perfusion. A medical chart review ascertained AF. RESULTS History of AF was found in 32.1% of HF patients. HF patients with AF exhibited worse global cognition, memory, and CBF-V relative to patients without AF. These effects remained after HF severity and other demographic and medical factors were taken into account. Partial correlations controlling for possible confounds showed decreased CBF-V predicted worse cognition in multiple domains in the overall sample (r = 0.13 to 0.15, P < 0.05) and in the subgroup of HF patients with AF (r = 0.26 to r = 0.28, P < 0.05), but not among HF patients without AF. CONCLUSIONS AF exacerbates cognitive deficits in HF, possibly through its association with decreased cerebral perfusion. Longitudinal studies are needed to determine whether AF accelerates cognitive decline in HF and whether medical (e.g., ablation) and lifestyle interventions (e.g., exercise programs) that target cerebral perfusion improve cognitive outcomes in patients with HF and AF.
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Affiliation(s)
- Michael L Alosco
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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23
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Katulska K, Wykrętowicz M, Minczykowski A, Krauze T, Milewska A, Piskorski J, Marciniak R, Stajgis M, Wysocki H, Guzik P, Wykrętowicz A. Gray matter volume in relation to cardio-vascular stiffness. J Neurol Sci 2014; 343:100-4. [DOI: 10.1016/j.jns.2014.05.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/18/2014] [Accepted: 05/19/2014] [Indexed: 01/09/2023]
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24
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Alosco ML, Spitznagel MB, Cohen R, Sweet LH, Josephson R, Hughes J, Rosneck J, Gunstad J. Obesity and cognitive dysfunction in heart failure: the role of hypertension, type 2 diabetes, and physical fitness. Eur J Cardiovasc Nurs 2014; 14:334-41. [PMID: 24829294 DOI: 10.1177/1474515114535331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 04/22/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cognitive impairment is common in heart failure. Obesity is a known risk factor for cognitive dysfunction in heart failure, though the mechanisms remain unclear. Obesity increases risk for conditions like hypertension and type 2 diabetes mellitus (T2DM) as well as poor fitness levels, and this may serve as one possible pathway accounting for association between obesity and cognitive dysfunction. AIMS We used structural equation modeling to test whether the combination of hypertension, T2DM, and reduced fitness mediate the association between obesity and cognitive dysfunction. METHODS Two hundred heart failure patients completed neuropsychological testing and a physical fitness assessment. Hypertension and T2DM were ascertained via self-report and medical records. Body mass index (BMI) was calculated. RESULTS Forty-three percent of the sample was obese. Hypertension (70%) and T2DM (36%) were common, and fitness levels were reduced. The structural equation model with these factors as mediators between BMI and cognitive function demonstrated excellent fit (comparative fit index = 0.98; root mean-square error of approximations = 0.03). Higher BMI correlated with hypertension, T2DM, and poorer fitness. Each of these factors predicted worse cognition. Models that isolated medical comorbidities and physical fitness as the mediator were weaker than the full model. CONCLUSIONS Increased risk for medical comorbidities and reduced fitness levels helped to explain the negative effects of obesity on cognitive dysfunction in heart failure. Prospective studies should confirm this pattern and examine how weight loss benefits cognitive function in heart failure.
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Affiliation(s)
| | - Mary Beth Spitznagel
- Department of Psychology, Kent State University, USA Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - Ronald Cohen
- Departments of Neurology Psychiatry and the Institute on Aging, Center for Cognitive Aging and Memory, University of Florida, Gainesville, USA
| | | | - Richard Josephson
- University Hospitals Case Medical Center and Department of Medicine, Cleveland, USA Harrington Heart and Vascular Institute, Cleveland, USA Case Western Reserve University School of Medicine, Cleveland, USA
| | - Joel Hughes
- Department of Psychology, Kent State University, USA Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - Jim Rosneck
- Department of Psychiatry, Summa Health System, Akron City Hospital, USA
| | - John Gunstad
- Department of Psychology, Kent State University, USA
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25
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Brickman AM. Contemplating Alzheimer's disease and the contribution of white matter hyperintensities. Curr Neurol Neurosci Rep 2013; 13:415. [PMID: 24190781 PMCID: PMC3874404 DOI: 10.1007/s11910-013-0415-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
As the older adult segment of the population increases, Alzheimer's disease (AD) has emerged as a significant public health epidemic. Over the past 3 decades, advances in the understanding of the biology of AD have led to a somewhat unified hypothesis of disease pathogenesis that emphasizes the precipitating role of beta amyloid protein. However, several lines of evidence suggest that multiple pathologies are necessary for clinical manifestation of the disease. Our focus over the past several years has been on the contribution of small vessel cerebrovascular disease, visualized as white matter hyperintensities (WMH) on magnetic resonance imaging, to AD. White matter hyperintensity volume, particularly in parietal regions, is elevated among individuals with and at risk for AD, predicts future diagnosis of AD, predicts the rate of progression of cognitive symptoms among individuals with AD, and increases over time among individuals destined to develop AD. White matter hyperintensities may represent an independent source of impairment and/or may interact more fundamentally with "primary" AD pathology. Future work should focus on more inclusive models of that better define "normal" vs "pathological" aging.
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Affiliation(s)
- Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, PS Box 16, 630 West 168th Street, New York, NY, 10032, USA,
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