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Kaur A, Fouad MH, Pozzebon C, Behlouli H, Rajah MN, Pilote L. Sex Differences in the Association Between Vascular Risk Factors and Cognitive Decline: A UK Biobank Study. JACC. ADVANCES 2024; 3:100930. [PMID: 39130034 PMCID: PMC11312777 DOI: 10.1016/j.jacadv.2024.100930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 08/13/2024]
Abstract
Background Age-related cognitive decline is accelerated by vascular risk factors for cerebral small vessel disease. However, the association of vascular risk factors with cerebral small vessel disease contributing to the sex differences in cognitive decline remains unclear. Objectives The purpose of this study was to evaluate sex differences in cognitive decline and the association between vascular risk factors and cognitive decline by sex. Methods We used data from the UK Biobank (>55 years of age; n = 19,067) to assess cognitive tests (executive function, processing speed, and memory) while adjusting for baseline measurements to examine how vascular risk factors affect cognition. A univariate regression analysis was used to assess sex differences at the first time point (2014). A repeated measure analysis with a mixed effect model was used to determine cognitive decline (between 2014 and 2019). Any significant interaction between vascular risk factors and sex was investigated. Results Females had lower scores in all 3 domains at the first cognitive tests (2014). We found a significant sex-by-time interaction over a 5-year period in matrix pattern completion (P = 0.03). After adjusting for vascular risk factors, this interaction was reduced (P = 0.08). High low-density lipoprotein, low education, and high blood pressure had a greater effect on the rate of cognitive decline in the executive function for females compared to males for the sex∗vascular risk factor interaction (P < 0.05). Conclusions The rate of cognitive decline did not differ significantly between males and females. However, the impact of several vascular risk factors on cognitive decline was greater in females than in males.
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Affiliation(s)
- Amanpreet Kaur
- Department of Medicine, McGill University Health center, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
| | - Moustafa H. Fouad
- Department of Medicine, McGill University Health center, Montreal, Canada
| | - Chelsea Pozzebon
- Department of Medicine, McGill University Health center, Montreal, Canada
| | - Hassan Behlouli
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
| | - M. Natasha Rajah
- Department of Psychology, Faculty of Arts, Toronto Metropolitan University, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine & Health Sciences, McGill University, Montreal, Canada
| | - Louise Pilote
- Department of Medicine, McGill University Health center, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute, McGill University Health Centre, Montreal, Canada
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Avorio F, Sparacia G, Russelli G, Seidita A, Mamone G, Alduino R, Tuzzolino F, Gruttadauria S, Miraglia R, Bulati M, Lo Re V. Neurological Screening in Elderly Liver Transplantation Candidates: A Single Center Experience. Neurol Int 2022; 14:245-255. [PMID: 35324575 PMCID: PMC8954213 DOI: 10.3390/neurolint14010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Cerebral small vessels disease (cSVD) is an age-related disorder and risk factor for stroke and cognitive/motor impairments. Neurological complications (NCs) are among the causes of adverse outcomes in older liver transplant recipients. This study sought to determine whether cSVD predicts acute NCs in over 65-year-old liver transplant patients. Methods: Data were collected, from a retrospective medical chart review, of 22 deceased donor liver transplant recipients aged 65 years or older with a pre-operative brain magnetic resonance imaging (MRI). We used the Fazekas score (0–3) as a quantitative measurement of the vascular lesion load seen in the MRI. We analyzed all post-operative acute NCs occurring during the hospital stay and any other non-NC. Results: cSVD was recognized in all patients. Neurological complications (NCs) occurred in 18.1% of patients with toxic-metabolic encephalopathy the most frequent diagnosis (13.64%). More severe cSVD was associated with seizures (p = 0.0362), longer hospital stay (p 0.0299), and disability (p 0.0134). In our elderly cohort, hepatic encephalopathy (HE) (p 0.0287) and ascites (p 0.0270) were predictors of NCs after liver transplantation. Ascites and/or variceal bleeding and severity of liver disease were associated with adverse post-operative outcomes. The small sample size limited the statistical analysis power. Conclusions: We present the preliminary data of a single-center retrospective study aimed at understanding the cSVD role on NCs and non-NCs after a liver transplantation in elderly patients. This would encourage a more appropriate multicenter prospective study that will definitely confirm if a neurological screening in old age liver transplant candidates is appropriate.
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Affiliation(s)
- Federica Avorio
- Neurology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
| | - Gianvincenzo Sparacia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.S.); (G.M.); (R.M.)
- Radiology Service, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, 90100 Palermo, Italy
| | - Giovanna Russelli
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.R.); (R.A.); (F.T.); (M.B.)
| | - Aurelio Seidita
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (A.S.); (S.G.)
| | - Giuseppe Mamone
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.S.); (G.M.); (R.M.)
| | - Rossella Alduino
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.R.); (R.A.); (F.T.); (M.B.)
| | - Fabio Tuzzolino
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.R.); (R.A.); (F.T.); (M.B.)
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (A.S.); (S.G.)
- Department of Surgery and Surgical and Medical Specialties, University of Catania, 95124 Catania, Italy
| | - Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.S.); (G.M.); (R.M.)
| | - Matteo Bulati
- Research Department, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; (G.R.); (R.A.); (F.T.); (M.B.)
| | - Vincenzina Lo Re
- Neurology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy;
- Correspondence:
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Nelson JW, Phillips SC, Ganesh BP, Petrosino JF, Durgan DJ, Bryan RM. The gut microbiome contributes to blood-brain barrier disruption in spontaneously hypertensive stroke prone rats. FASEB J 2021; 35:e21201. [PMID: 33496989 PMCID: PMC8238036 DOI: 10.1096/fj.202001117r] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022]
Abstract
In recent years, it has become apparent that the gut microbiome can influence the functioning and pathological states of organs and systems throughout the body. In this study, we tested the hypothesis that the gut microbiome has a major role in the disruption of the blood-brain barrier (BBB) in the spontaneously hypertensive stroke prone rats (SHRSP), an animal model for hypertensive cerebral small vessel disease (CSVD). Loss of BBB is thought to be an early and initiating component to the full expression of CSVD in animal models and humans. To test this hypothesis, newly born SHRSP pups were placed with foster dams of the SHRSP strain or dams of the WKY strain, the control strain that does not demonstrate BBB dysfunction or develop hypertensive CSVD. Similarly, WKY pups were placed with foster dams of the same or opposite strain. The rationale for cross fostering is that the gut microbiomes are shaped by environmental bacteria of the foster dam and the nesting surroundings. Analysis of the bacterial genera in feces, using 16S rRNA analysis, demonstrated that the gut microbiome in the rat pups was influenced by the foster dam. SHRSP offspring fostered on WKY dams had systolic blood pressures (SBPs) that were significantly decreased by 26 mmHg (P < .001) from 16-20 weeks, compared to SHRSP offspring fostered on SHRSP dams. Similarly WKY offspring fostered on SHRSP dams had significantly increased SBP compared to WKY offspring fostered on WKY dams, although the magnitude of SBP change was not as robust. At ~20 weeks of age, rats fostered on SHRSP dams showed enhanced inflammation in distal ileum regardless of the strain of the offspring. Disruption of BBB integrity, an early marker of CSVD onset, was improved in SHRSPs that were fostered on WKY dams when compared to the SHRSP rats fostered on SHRSP dams. Although SHRSP is a genetic model for CSVD, environmental factors such as the gut microbiota of the foster dam have a major influence in the loss of BBB integrity.
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Affiliation(s)
- James W. Nelson
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- Integrated Molecular and Biomedical Sciences Graduate Program, Baylor College of Medicine, Houston, TX, USA
| | - Sharon C. Phillips
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Bhanu P. Ganesh
- Department of Neurology, University of Texas Health Sciences Center, Houston, TX, USA
| | - Joseph F. Petrosino
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
- The Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - David J. Durgan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Robert M. Bryan
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
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Borges SQ, Corrêa TX, Trindade IOA, Amorim RFB, Toledo MADV. Cognitive impairment in bipolar disorder Neuroprogression or behavioral variant frontotemporal dementia? Dement Neuropsychol 2019; 13:475-480. [PMID: 31844503 PMCID: PMC6907706 DOI: 10.1590/1980-57642018dn13-040016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patients with Bipolar Disorder (BD) usually display cognitive deficits with aging. However, the correlation between BD and dementia syndromes is inconclusive, despite the similarity with behavioral variant frontotemporal dementia. We report a 78-year-old female patient who had bipolar type 1 disorder since adolescence. Her symptoms ranged from apathy to psychotic mania. She had had three hospitalizations, and since her last stay 10 years ago, her symptoms had remained stable. However, in the past 2 years, she displayed different symptoms, such as irritability manifested as verbal and physical aggression, cognitive impairment, repetitive pattern of behavior, perambulation, persecutory delusions, disorientation, and hyporexia. Treatment with anticholinesterases or mood stabilizers promoted no improvement. She scored 17/30 points on the Mini-Mental State Examination. Neuropsychological assessment suggested deficits in executive function, attention, and memory. Neuroimaging tests revealed frontotemporal degeneration and hypoperfusion. Diagnostic and therapeutic approaches for this type of patient represent a significant challenge for clinicians.
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Affiliation(s)
- Saulo Queiroz Borges
- MD, Universidade de Brasília (UnB), Hospital Universitário de Brasília (HUB), Brasília, DF, Brazil
| | - Thiago Xavier Corrêa
- MD, Universidade de Brasília (UnB), Hospital Universitário de Brasília (HUB), Brasília, DF, Brazil
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Maksimovich IV. Intracerebral Transcatheter Laser Photobiomodulation Therapy in the Treatment of Binswanger's Disease and Vascular Parkinsonism: Research and Clinical Experience. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:606-614. [PMID: 31390288 DOI: 10.1089/photob.2019.4649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: This research is devoted to intracerebral transcatheter laser photobiomodulation therapy (PBMT) in the treatment of ischemic and neurodegenerative lesions of cerebral white matter in patients with Binswanger's disease (BD) and vascular parkinsonism (VP) in comparison with conservative treatment methods. Background: Recent studies have shown PBMT high potential in the treatment of various cerebral lesions. Materials and methods: Twenty-seven patients with BD, 58-81 years of age (mean age 78), 17 (62.96%) men, and 10 (27.04%) women. Of these, test group 1-14 (51.85%) patients-underwent intracerebral transcatheter laser PBMT, and control group 1-13 (48.15%) patients-had conservative treatment. Besides, 62 patients with VP, 52-80 years of age (mean age 77), 48 (77.42%) men, and 14 (22.58%) women. Of these, test group 2-37 (59.68%) patients-underwent intracerebral transcatheter laser PBMT, and control group 2-25 (40.32%) patients-had conservative treatment. Results: Good and satisfactory clinical results were obtained in Test group 1 and Test group 2 patients in 49 (92.45%) cases, with a persistent decrease of dementia and motor impairment, and recovery of cognitive functions and daily life activity. Control group 1 and Control group 2 patients showed a satisfactory clinical result in 6 (15.79%) cases. Persistent positive dynamics was not observed. Conclusions: Intracerebral transcatheter laser PBMT is a pathogenetically justified, effective treatment for BD and VP; it restores cerebral collateral and capillary blood supply, improves microcirculation, restores cellular and tissue metabolism, stimulates neurogenesis, and causes regenerative processes in the brain.
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Affiliation(s)
- Ivan V Maksimovich
- Clinic of Cardiovascular Diseases named after Most Holy John Tobolsky, Moscow, Russia
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Shulginova A, Konoplya A, Bystrova N. Disorders of the immune status in patients with chronic cerebral ischemia; differentiated pharmacological correction. RESEARCH RESULTS IN PHARMACOLOGY 2018. [DOI: 10.3897/rrpharmacology.4.28304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Chronic cerebral ischemia (CCI) accounts for 60-75% of all cerebrovascular diseases in Russia and around the world. The problem: the issues concerning the role of immunity in the pathogenesis of CCI depending on the main etiologic factor and stage of the disease are hardly elaborated, which makes the main pharmacological correction impossible. The objective of the study is to establish the immune disorder patterns in patients with CCI I-II associated with arterial hypertension and to develop differentiated pharmacological methods for their correction.
Material and methods: The results of treatment of 104 patients of Kursk Regional Clinical Hospital with CCI associated with II-stage arterial hypertension were analyzed: 52 patients were with CCI I stage (2th-4th groups of 12-14 patients) and 52 patients were with CCI II stage (5th -7th groups of 12-14 patients), aged 50±5, who received the basic pharmacological therapy (enalapril and vinpocetine). The patients of the 2nd and 5th groups additionally received ceraxon and mexicor, those of the 3rd and the 6th groups additionally received immunomodulator glutoxim, and those from the 4th and 7th groups received polyoxidonium. Twenty-two healthy donors were in the control group. Immune disorders were assessed by the parameters of the functional activity of neutrophils, levels of cytokines in plasma, components of the complement and inhibitors.
Results and discussion: In the case of CCI I and II stages similar proinflamatory immune disorders were detected, which is indicative of immune inflammation. The inclusion of glutoxime and polyoxidonium in a complex pharmacotherapy helps reduce the severity of immune and neuropsychic status indicators, which are more evident in case of stage II.
Conclusions: In case of CCI I stage, the medications used can be arranged according to their clinico-immunological efficacy in ascending order: ceraxon+mexicore ® ceraxon+mexicor+glutoxim ® ceraxon+mexicor+polyoxidonium, and in case of CCI II stage: ceraxon+mexicor ® ceraxon+mexicor+polyoxidonium = ceraxon+mexicor+glutoxim.
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Maksimovich IV. Differences in Cerebral Angioarchitectonics in Alzheimer's Disease in Comparison with Other Neurodegenerative and Ischemic Lesions. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/wjns.2018.84036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Sakiev K, Battakova S, Namazbaeva Z, Ibrayeva L, Otarbayeva M, Sabirov Z. Neuropsychological state of the population living in the Aral Sea region (zone of ecological crisis). INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2017; 23:87-93. [PMID: 29359636 PMCID: PMC6060854 DOI: 10.1080/10773525.2018.1425655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
Background The Aral Sea crisis has led to harmful effects on human habitat. In recent years, mild cognitive impairment is a growing problem. Objectives This article provides the results of studying the neuropsychological state of residents living in the crisis zone of the Aral Sea region in the case of Shalkar city. We have provided an assessment of the neuropsychological state of examined population and determined the leading pathology in this region. Methods The survey sample included 344 persons of reproductive age from 21 to 45 years. We have obtained results in biochemical studies, indicating perturbations of proteometabolism and lipid metabolism. Results A correlation analysis showed dependence between a decrease of albumin and high-density lipoproteins, an increase of low-density lipoproteins and parameters of cognitive function. Conclusions The research suggests a high prevalence of cerebrovascular pathology among the population, changes in cognitive function parameters, long-term and short-term memory problems and high levels of depression.
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Affiliation(s)
- Kanat Sakiev
- Laboratory Occupational Physiology and Ergonomics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Sharbanu Battakova
- Professional Laboratory of Neurology Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Zulkiya Namazbaeva
- Laboratory of Ecological Biochemistry, Biophysics and Genetics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Lyazat Ibrayeva
- Department of Laboratory Eco-Industrial Diseases, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Maral Otarbayeva
- Service Management Research and Innovation Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
| | - Zhanbol Sabirov
- Laboratory of Ecological Biochemistry, Biophysics and Genetics Department, National Center of Labor Hygiene and Occupational Diseases, Karaganda, Kazakhstan
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Edrissi H, Schock SC, Cadonic R, Hakim AM, Thompson CS. Cilostazol reduces blood brain barrier dysfunction, white matter lesion formation and motor deficits following chronic cerebral hypoperfusion. Brain Res 2016; 1646:494-503. [PMID: 27350079 DOI: 10.1016/j.brainres.2016.06.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 01/01/2023]
Abstract
Cerebral small vessel disease (CSVD) is a pathological process leading to lacunar infarcts, leukoaraiosis and cerebral microbleeds. Dysfunction of the blood brain barrier (BBB) has been proposed as a mechanism in the progression cerebral small vessel disease. A rodent model commonly used to study some aspects of CSVD is bilateral common carotid artery occlusion (BCCAO) in the rat. In the present study it was determined that gait impairment, as determined by a tapered beam test, and BBB permeability increased following BCCAO. Cilostazol, a type III phosphodiesterase inhibitor, has been shown to have anti-apoptotic effects and prevent white matter vacuolation and rarefaction induced by BCCAO in rats. In this study the protective effect of cilostazol administration on the increase BBB permeability following BCCAO was determined as well as the effect on plasma levels of circulating microparticles (MPs), cerebral white matter rarefaction, glial activation and gait disturbance. The effect of cilostazol on in vitro endothelial barriers was also evaluated. Cilostazol treatment improved BBB permeability and reduced gait disturbance, visual impairment and microglial activation in optic tract following BCCAO in vivo. It also reduced the degree of cell death and the reduction in trans-endothelial electrical resistance (TEER) in artificial endothelial barriers in vitro induced by MP treatment of in vitro barriers.
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Affiliation(s)
- Hamidreza Edrissi
- Universiy of Ottawa, Neuroscience Graduate Program, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Sarah C Schock
- Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Robert Cadonic
- Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Antoine M Hakim
- Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
| | - Charlie S Thompson
- Ottawa Hospital Research Institute, Neuroscience, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5.
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Cai Z, Wang C, He W, Tu H, Tang Z, Xiao M, Yan LJ. Cerebral small vessel disease and Alzheimer's disease. Clin Interv Aging 2015; 10:1695-704. [PMID: 26604717 PMCID: PMC4629951 DOI: 10.2147/cia.s90871] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a group of pathological processes with multifarious etiology and pathogenesis that are involved into the small arteries, arterioles, venules, and capillaries of the brain. CSVD mainly contains lacunar infarct or lacunar stroke, leukoaraiosis, Binswanger's disease, and cerebral microbleeds. CSVD is an important cerebral microvascular pathogenesis as it is the cause of 20% of strokes worldwide and the most common cause of cognitive impairment and dementia, including vascular dementia and Alzheimer's disease (AD). It has been well identified that CSVD contributes to the occurrence of AD. It seems that the treatment and prevention for cerebrovascular diseases with statins have such a role in the same function for AD. So far, there is no strong evidence-based medicine to support the idea, although increasing basic studies supported the fact that the treatment and prevention for cerebrovascular diseases will benefit AD. Furthermore, there is still lack of evidence in clinical application involved in specific drugs to benefit both AD and CSVD.
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Affiliation(s)
- Zhiyou Cai
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Chuanling Wang
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Wenbo He
- Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Hanjun Tu
- Department of Basic Research Center, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Zhengang Tang
- Department of Neurosurgery, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, People’s Republic of China
| | - Ming Xiao
- Department of Anatomy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Liang-Jun Yan
- Department of Pharmaceutical Sciences, UNT System College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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Lambert C, Sam Narean J, Benjamin P, Zeestraten E, Barrick TR, Markus HS. Characterising the grey matter correlates of leukoaraiosis in cerebral small vessel disease. Neuroimage Clin 2015; 9:194-205. [PMID: 26448913 PMCID: PMC4564392 DOI: 10.1016/j.nicl.2015.07.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 01/05/2023]
Abstract
Cerebral small vessel disease (SVD) is a heterogeneous group of pathological disorders that affect the small vessels of the brain and are an important cause of cognitive impairment. The ischaemic consequences of this disease can be detected using MRI, and include white matter hyperintensities (WMH), lacunar infarcts and microhaemorrhages. The relationship between SVD disease severity, as defined by WMH volume, in sporadic age-related SVD and cortical thickness has not been well defined. However, regional cortical thickness change would be expected due to associated phenomena such as underlying ischaemic white matter damage, and the observation that widespread cortical thinning is observed in the related genetic condition CADASIL (Righart et al., 2013). Using MRI data, we have developed a semi-automated processing pipeline for the anatomical analysis of individuals with cerebral small vessel disease and applied it cross-sectionally to 121 subjects diagnosed with this condition. Using a novel combined automated white matter lesion segmentation algorithm and lesion repair step, highly accurate warping to a group average template was achieved. The volume of white matter affected by WMH was calculated, and used as a covariate of interest in a voxel-based morphometry and voxel-based cortical thickness analysis. Additionally, Gaussian Process Regression (GPR) was used to assess if the severity of SVD, measured by WMH volume, could be predicted from the morphometry and cortical thickness measures. We found significant (Family Wise Error corrected p < 0.05) volumetric decline with increasing lesion load predominately in the parietal lobes, anterior insula and caudate nuclei bilaterally. Widespread significant cortical thinning was found bilaterally in the dorsolateral prefrontal, parietal and posterio-superior temporal cortices. These represent distinctive patterns of cortical thinning and volumetric reduction compared to ageing effects in the same cohort, which exhibited greater changes in the occipital and sensorimotor cortices. Using GPR, the absolute WMH volume could be significantly estimated from the grey matter density and cortical thickness maps (Pearson's coefficients 0.80 and 0.75 respectively). We demonstrate that SVD severity is associated with regional cortical thinning. Furthermore a quantitative measure of SVD severity (WMH volume) can be predicted from grey matter measures, supporting an association between white and grey matter damage. The pattern of cortical thinning and volumetric decline is distinctive for SVD severity compared to ageing. These results, taken together, suggest that there is a phenotypic pattern of atrophy associated with SVD severity.
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Affiliation(s)
- Christian Lambert
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Janakan Sam Narean
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Philip Benjamin
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Eva Zeestraten
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Thomas R. Barrick
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
| | - Hugh S. Markus
- Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, United Kingdom
- Stroke Research Group, Division of Clinical Neurosciences, University of Cambridge, United Kingdom
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Gold BT. Lifelong bilingualism and neural reserve against Alzheimer's disease: a review of findings and potential mechanisms. Behav Brain Res 2015; 281:9-15. [PMID: 25496781 PMCID: PMC4305453 DOI: 10.1016/j.bbr.2014.12.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 12/01/2022]
Abstract
Alzheimer's disease (AD) is a progressive brain disorder that initially affects medial temporal lobe circuitry and memory functions. Current drug treatments have only modest effects on the symptomatic course of the disease. In contrast, a growing body of evidence suggests that lifelong bilingualism may delay the onset of clinical AD symptoms by several years. The purpose of the present review is to summarize evidence for bilingualism as a reserve variable against AD and discuss potential underlying neurocognitive mechanisms. Evidence is reviewed suggesting that bilingualism may delay clinical AD symptoms by protecting frontostriatal and frontoparietal executive control circuitry rather than medial temporal lobe memory circuitry. Cellular and molecular mechanisms that may contribute to bilingual cognitive reserve effects are discussed, including those that may affect neuronal metabolic functions, dynamic neuronal-glial interactions, vascular factors, myelin structure and neurochemical signaling. Future studies that may test some of these potential mechanisms of bilingual CR effects are proposed.
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Affiliation(s)
- Brian T Gold
- Department of Anatomy and Neurobiology, University of Kentucky, Lexington, KY 40536, USA; Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY 40536, USA; Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY 40536, USA.
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13
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Huijts M, Duits A, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Staals J. Accumulation of MRI Markers of Cerebral Small Vessel Disease is Associated with Decreased Cognitive Function. A Study in First-Ever Lacunar Stroke and Hypertensive Patients. Front Aging Neurosci 2013; 5:72. [PMID: 24223555 PMCID: PMC3818574 DOI: 10.3389/fnagi.2013.00072] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/21/2013] [Indexed: 12/04/2022] Open
Abstract
Background: White matter lesions (WMLs), asymptomatic lacunar infarcts, brain microbleeds (BMBs), and enlarged perivascular spaces (EPVS) have been identified as silent lesions due to cerebral small vessel disease (cSVD). All these markers have been individually linked to cognitive functioning, but are also strongly correlated with each other. The combined effect of these markers on cognitive function has never been studied and would possibly provide more useful information on the effect on cognitive function. Methods: Brain MRI and extensive neuropsychological assessment were performed in 189 patients at risk for cSVD (112 hypertensive patients and 77 first-ever lacunar stroke patients). We rated the presence of any asymptomatic lacunar infarct, extensive WMLs, any deep BMB, and moderate to extensive EPVS in the basal ganglia. The presence of each marker was summed to an ordinal score between 0 and 4. Associations with domains of cognitive function (memory, executive function, information processing speed, and overall cognition) were analyzed with correlation analyses. Results: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001). Results remained significant for information processing speed (r = −0.181, p = 0.013) and overall cognition (r = −0.178, p = 0.017), after correction for age and sex. Testing of trend using linear regression analyses revealed the same results. Discussion: We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.
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Affiliation(s)
- Marjolein Huijts
- Department of Neurology, Maastricht University , Maastricht , Netherlands ; School for Mental Health and Neuroscience (MHeNS), Maastricht University , Maastricht , Netherlands ; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , Netherlands
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14
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Papma JM, de Groot M, de Koning I, Mattace-Raso FU, van der Lugt A, Vernooij MW, Niessen WJ, van Swieten JC, Koudstaal PJ, Prins ND, Smits M. Cerebral small vessel disease affects white matter microstructure in mild cognitive impairment. Hum Brain Mapp 2013; 35:2836-51. [PMID: 24115179 DOI: 10.1002/hbm.22370] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 06/12/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
Microstructural white matter deterioration is a frequent finding in mild cognitive impairment (MCI), potentially underlying default mode network (DMN) dysfunctioning. Thus far, microstructural damage in MCI has been attributed to Alzheimer's disease pathophysiology. A cerebrovascular role, in particular the role of cerebral small vessel disease (CSVD), received less interest. Here, we used diffusion tensor imaging (DTI) to examine the role of CSVD in microstructural deterioration within the normal appearing white matter (NAWM) in MCI. MCI patients were subdivided into those with (n = 20) and without (n = 31) macrostructural CSVD evidence on MRI. Using TBSS we performed microstructural integrity comparisons within the whole brain NAWM. Secondly, we segmented white matter tracts interconnecting DMN brain regions by means of automated tractography segmentation. We used NAWM DTI measures from these tracts as dependent variables in a stepwise-linear regression analysis, with structural and demographical predictors. Our results indicated microstructural deterioration within the anterior corpus callosum, internal and external capsule and periventricular white matter in MCI patients with CSVD, while in MCI patients without CSVD, deterioration was restricted to the right perforant path, a tract along the hippocampus. Within the full cohort of MCI patients, microstructure within the NAWM of the DMN fiber tracts was affected by the presence of CSVD. Within the cingulum along the hippocampal cortex we found a relationship between microstructural integrity and ipsilateral hippocampal volume and the extent of white matter hyperintensity. In conclusion, we found evidence of CSVD-related microstructural damage in fiber tracts subserving the DMN in MCI.
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Affiliation(s)
- Janne M Papma
- Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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15
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Chen YJ, Deutsch G, Satya R, Liu HG, Mountz JM. A semi-quantitative method for correlating brain disease groups with normal controls using SPECT: Alzheimer's disease versus vascular dementia. Comput Med Imaging Graph 2012; 37:40-7. [PMID: 23273615 DOI: 10.1016/j.compmedimag.2012.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 10/07/2012] [Accepted: 11/29/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To demonstrate the utility of semi-quantitative circumferential-profile analysis of regional cerebral blood flow (rCBF) SPECT in Alzheimer's disease (AD) versus white matter vascular dementia (WM-VaD). METHODS Subjects underwent dementia evaluation, MRI and Tc-99m HMPAO SPECT. rCBF patterns from 11 AD and 20 WM-VaD patients were compared to 17 controls using semi-quantitative circumferential-profile analysis. RESULTS AD patients showed more significant semi-quantitative circumferential-profile reductions in the posterior temporo-parietal regions, whereas WM-VaD patients demonstrated greater reductions involving the frontal regions of the brain. CONCLUSION Semi-quantitative circumferential-profile analysis provides a practical semi-quantitative method to evaluate brain SPECT scans in AD versus WM-VaD patients.
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Affiliation(s)
- Yin J Chen
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
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16
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Baker ML, Wang JJ, Liew G, Hand PJ, De Silva DA, Lindley RI, Mitchell P, Wong MC, Rochtchina E, Wong TY, Wardlaw JM, Hankey GJ. Differential Associations of Cortical and Subcortical Cerebral Atrophy With Retinal Vascular Signs in Patients With Acute Stroke. Stroke 2010; 41:2143-50. [DOI: 10.1161/strokeaha.110.594317] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michelle L. Baker
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Jie Jin Wang
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Gerald Liew
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Peter J. Hand
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Deidre A. De Silva
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Richard I. Lindley
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Paul Mitchell
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Meng-Cheong Wong
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Elena Rochtchina
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Tien Y. Wong
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Joanna M. Wardlaw
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
| | - Graeme J. Hankey
- From the Centre for Eye Research Australia (M.L.B., J.J.W., T.Y.W.), University of Melbourne, Melbourne, Australia; the Centre for Vision Research (J.J.W., G.L., P.M., E.R.), Westmead Millennium Institute, University of Sydney, Sydney, Australia; the Department of Neurology (P.J.H.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Singapore General Hospital Campus (D.D.S.), National Neuroscience Institute, Singapore; the Discipline of Medicine (R.I.L.), Sydney Medical
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Reid AT, van Norden AGW, de Laat KF, van Oudheusden LJB, Zwiers MP, Evans AC, de Leeuw FE, Kötter R. Patterns of cortical degeneration in an elderly cohort with cerebral small vessel disease. Hum Brain Mapp 2010; 31:1983-92. [PMID: 20336684 DOI: 10.1002/hbm.20994] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Emerging noninvasive neuroimaging techniques allow for the morphometric analysis of patterns of gray and white matter degeneration in vivo, which may help explain and predict the occurrence of cognitive impairment and Alzheimer's disease. A single center prospective follow-up study (Radboud University Nijmegen Diffusion tensor and Magnetic resonance imaging Cohort study (RUN DMC)) was performed involving 503 nondemented elderly individuals (50-85 years) with a history of symptomatic cerebral small vessel disease (SVD). Age was associated with a global reduction in cortical thickness, and this relationship was strongest for ventrolateral prefrontal cortex, auditory cortex, Wernicke's area, superior temporal lobe, and primary visual cortex. Right and left hemispheres differed in the thickness of language-related areas. White matter (WM) lesions were generally negatively correlated with cortical thickness, primarily in individuals over the age of 60, with the notable exception of Brodmann areas 4 and 5, which were positively correlated in age groups 50-60 and 60-70, respectively. The observed pattern of age-related decline may explain problems in memory and executive functions, which are already well documented in individuals with SVD. The additional gray matter loss affecting visual and auditory cortex, and specifically the head region of primary motor cortex, may indicate morphological correlates of impaired sensory and motor functions. The paradoxical positive relationship between WM lesion volume and cortical thickness in some areas may reflect early compensatory hypertrophy. This study raises a further interest in the mechanisms underlying cerebral gray and white matter degeneration in association with SVD, which will require further investigation with diffusion weighted and longitudinal MR studies.
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Affiliation(s)
- Andrew T Reid
- Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Section Neurophysiology and Neuroinformatics (NeuroPI, 126), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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18
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Grau-Olivares M, Arboix A. Mild cognitive impairment in stroke patients with ischemic cerebral small-vessel disease: a forerunner of vascular dementia? Expert Rev Neurother 2009; 9:1201-17. [PMID: 19673608 DOI: 10.1586/ern.09.73] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ischemic cerebral small-vessel disease accounts for a third of acute cerebral ischemic events and contributes to the development of cognitive decline and dementia. Cerebral small-vessel disease can be visualized on MRI studies as lacunar infarcts, white matter lesions and cerebral microbleeds. In general, the short-term prognosis of ischemic cerebral small-vessel disease compared with other stroke subtypes is more favorable, with almost negligible early mortality, absence of neuropsychological impairment and excellent neurological recovery. However, it has been shown recently that the proportion of dementia caused by small-vessel disease ranges from 36 to 67%. On the other hand, patients with a first-ever lacunar infarction present with cognitive impairment (mainly executive dysfunction) in more than half of cases and more than 55% of patients fulfil the criteria of mild cognitive impairment of the vascular type. Moreover, patients with small-vessel disease have an increase in the mid- and long-term risk of death, stroke recurrence and dementia. Neuropsychological abnormalities in small-vessel disease occurred more frequently than previously recognized. Ischemic cerebral small-vessel disease should be regarded as a potentially severe condition prodrome of subcortical vascular dementia rather than a relatively benign disorder.
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Affiliation(s)
- Marta Grau-Olivares
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, E-08029 Barcelona, Spain.
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19
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Theocharakis P, Glotsos D, Kalatzis I, Kostopoulos S, Georgiadis P, Sifaki K, Tsakouridou K, Malamas M, Delibasis G, Cavouras D, Nikiforidis G. Pattern recognition system for the discrimination of multiple sclerosis from cerebral microangiopathy lesions based on texture analysis of magnetic resonance images. Magn Reson Imaging 2009; 27:417-22. [DOI: 10.1016/j.mri.2008.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 06/17/2008] [Accepted: 07/24/2008] [Indexed: 11/15/2022]
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20
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Rossi R, Geroldi C, Bresciani L, Testa C, Binetti G, Zanetti O, Frisoni GB. Clinical and neuropsychological features associated with structural imaging patterns in patients with mild cognitive impairment. Dement Geriatr Cogn Disord 2007; 23:175-83. [PMID: 17220628 DOI: 10.1159/000098543] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Indexed: 11/19/2022] Open
Abstract
AIM To describe the clinical and neuropsychological features of mild cognitive impairment (MCI) patients with medial temporal atrophy (MTA), white matter hyperintensities (WMH), both, and neither and to assess whether the rate of progression differs among groups. METHODS Ninety-five MCI patients were divided into 4 groups based on the presence of MTA and WMH: 29 were MTA- WMH-, 11 MTA- WMH+, 23 MTA+ WMH-, and 32 MTA+ WMH+. MCI patients were compared with 30 normal subjects. MTA and WMH were assessed with MR-based visual rating scales. Subjects underwent an extensive clinical and neuropsychological investigation. Fifty-six underwent follow-up evaluation. RESULTS MTA- WMH- had relatively good neuropsychological performance, little vascular and physical comorbidity. MTA- WMH+ performed poorly only on executive neuropsychological tests. MTA+ WMH- patients had poor neuropsychological performances (mainly on memory tests), high physical and vascular comorbidity. MTA+ WMH+ were impaired in neuropsychological performances, had a high number of physical diseases and severe vascular comorbidity. On follow-up, 25% of MTA+ WMH- and 32% of MTA+ WMH+ and none in MTA- WMH- and in MTA- WMH+ converted to dementia (p = 0.05, log rank test). CONCLUSION Structural neuroimaging can identify subgroups of MCI patients with specific clinical and neuropsychological features.
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Affiliation(s)
- Roberta Rossi
- Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS San Giovanni di Dio FBF, Brescia, Italy
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21
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Jellinger KA. The enigma of vascular cognitive disorder and vascular dementia. Acta Neuropathol 2007; 113:349-88. [PMID: 17285295 DOI: 10.1007/s00401-006-0185-2] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 12/08/2006] [Accepted: 12/08/2006] [Indexed: 12/20/2022]
Abstract
The prevalence, morphology and pathogenesis of vascular dementia (VaD), recently termed vascular cognitive impairment, are a matter of discussion, and currently used clinical diagnostic criteria show moderate sensitivity (average 50%) and variable specificity (range 64-98%). In Western clinic-based series, VaD is suggested in 8-10% of cognitively impaired aged subjects. Its prevalence in autopsy series varies from 0.03 to 58%, with reasonable values of 8-15%, while in Japan it is seen in 22-35%. Neuropathologic changes associated with cognitive impairment include multifocal and/or diffuse disease and focal lesions: multi-infarct encephalopathy, white matter lesions or arteriosclerotic subcortical (leuko)encephalopathy, multilacunar state, mixed cortico-subcortical type, borderline/watershed lesions, rare granular cortical atrophy, post-ischemic encephalopathy and hippocampal sclerosis. They result from systemic, cardiac and local large or small vessel disease. Recent data indicate that cognitive decline is commonly associated with widespread small ischemic/vascular lesions (microinfarcts, lacunes) throughout the brain with predominant involvement of subcortical and functionally important brain areas. Their pathogenesis is multifactorial, and their pathophysiology affects neuronal networks involved in cognition, memory, behavior and executive functioning. Vascular lesions often coexist with Alzheimer disease (AD) and other pathologies. Minor cerebrovascular lesions, except for severe amyloid angiopathy, appear not essential for cognitive decline in full-blown AD, while both mild Alzheimer pathology and small vessel disease may interact synergistically. The lesion pattern of "pure" VaD, related to arteriosclerosis and microangiopathies, differs from that in mixed-type dementia (AD with vascular encephalopathy), more often showing large infarcts, which suggests different pathogenesis of both types of lesions. Due to the high variability of cerebrovascular pathology and its causative factors, no validated neuropathologic criteria for VaD are available, and a large variability across laboratories still exists in the procedures for morphologic examination and histology techniques.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070, Vienna, Austria.
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Gold G, Kovari E, Hof PR, Bouras C, Giannakopoulos P. Sorting out the clinical consequences of ischemic lesions in brain aging: a clinicopathological approach. J Neurol Sci 2007; 257:17-22. [PMID: 17321551 DOI: 10.1016/j.jns.2007.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vascular lesions are particularly common in the aged brain. However, it is still unclear whether all such lesions affect cognition. OBJECTIVES To better explore relationships between specific characteristics of vascular lesions (type, size and location) and cognitive status. METHODS We performed a review of currently available neuroimaging and post-mortem studies taking into account several recent clinicopathological reports in elderly individuals with varying levels of cognitive impairment. RESULTS New data reveals the significant impact of cortical microinfarcts on intellectual function, in contrast to focal cortical and white matter gliosis which are not significantly associated with cognitive status. Structural neuroimaging studies show inconsistent data regarding the cognitive consequences of WML. Neuropathological analyses reveal that both periventricular and subcortical demyelination are associated with cognitive status in the absence of macrovascular pathology. When lacunes are present, these microvascular lesions have no independent effect on intellectual impairment. The relationship between lacunes and cognition is highly dependent on localization. Basal ganglia and thalamic lacunes correlate with cognitive decline but not lacunes in the frontal, temporal and parietal deep white matter. CONCLUSION Recent studies suggest that some cases of dementia might be misclassified: 1. Cases with typical Alzheimer course and moderate lacunes in subcortical white matter should probably be considered pure Alzheimer's disease. 2. The presence of microscopic infarcts can markedly impact cognition but is not detectable by currently available neuroimaging techniques and the vascular component of such mixed cases may go undiagnosed. The development of urgently needed new criteria for vascular dementia should take into account the relative contribution of various types of vascular lesions that can impact cognitive function.
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Affiliation(s)
- Gabriel Gold
- Department of Geriatrics, University of Geneva School of Medicine, Geneva, Switzerland.
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Rockwood K, Moorhouse PK, Song X, MacKnight C, Gauthier S, Kertesz A, Montgomery P, Black S, Hogan DB, Guzman A, Bouchard R, Feldman H. Disease progression in vascular cognitive impairment: Cognitive, functional and behavioural outcomes in the Consortium to Investigate Vascular Impairment of Cognition (CIVIC) cohort study. J Neurol Sci 2007; 252:106-12. [PMID: 17189642 DOI: 10.1016/j.jns.2006.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 10/06/2006] [Accepted: 10/30/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Empirical studies to clarify the outcomes in Vascular Cognitive Impairment (VCI) are needed. We compared cognitive, functional, and behavioural outcomes in patients with VCI to patients with no cognitive impairment (NCI), and Alzheimer's disease (AD). METHODS Secondary analysis of the Consortium to Investigate Vascular Impairment of Cognition (CIVIC), a multi-centre Canadian memory clinic 30-month cohort study. RESULTS Of 1347 patients, 938 were eligible for follow-up, of whom 239 (24.5%) were lost and 29 (3%) had died. Of the remaining 697 patients, 125 had NCI, 229 had VCI, and 343 had AD at baseline. Compared to people with NCI, of whom 20-40% showed progression based on cognitive and functional measures, those with VCI were more likely to progress (50-65%), as were people with AD (50-80%) (p<0.01). More people with VCI showed progression of affective symptoms (30%) than those with NCI (12%) or AD (15% p<0.01). Progression of impaired judgment (rated clinically) in VCI (15%) was similar to AD (11%) but more common than in NCI (4%, p<0.01). CONCLUSIONS Most people with VCI show readily detectable progression by 30 months. Depressive symptoms were more common and more progressive in VCI than in Alzheimer's disease, whereas clinical evidence of progressive executive dysfunction was common in both AD and VCI.
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Selnes OA, Vinters HV. Vascular cognitive impairment. ACTA ACUST UNITED AC 2006; 2:538-47. [PMID: 16990827 DOI: 10.1038/ncpneuro0294] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/21/2006] [Indexed: 11/09/2022]
Abstract
Cognitive impairment commonly accompanies clinical syndromes associated with vascular disease of the brain. Because of evolving definitional criteria, however, the frequency of cognitive impairment attributable to cerebrovascular disease is difficult to determine. Dementia occurs in up to one-third of elderly patients with stroke, a subset of whom have Alzheimer's disease (AD) rather than a pure vascular dementia syndrome. In fact, pure vascular dementia has been shown to be uncommon in most large autopsy series. A mixed etiology of AD and cerebrovascular disease is thought to become more common with increasing age, although no clinical criteria for the diagnosis of AD with cerebrovascular disease are currently available. Epidemiological studies have implicated subcortical small-vessel disease as a risk factor for cognitive impairment and dementia, but the cognitive expression and clinical significance of MRI white matter changes in individual patients is difficult to establish. The frequency of specific neuropathologic features of vascular cognitive impairment depends largely on study inclusion criteria. Cerebral meningocortical microangiopathies with distinctive clinicopathological profiles are associated with dementia in both sporadic cases and familial syndromes. In patients with AD, the contribution of amyloid-beta protein to the degree of cognitive impairment has not been clearly defined.
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Affiliation(s)
- Ola A Selnes
- Cognitive Neuroscience Division, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-1910, USA.
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