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You TY, Dong Q, Cui M. Emerging Links between Cerebral Blood Flow Regulation and Cognitive Decline: A Role for Brain Microvascular Pericytes. Aging Dis 2023:AD.2022.1204. [PMID: 37163446 PMCID: PMC10389833 DOI: 10.14336/ad.2022.1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/04/2022] [Indexed: 05/12/2023] Open
Abstract
Cognitive impairment associated with vascular etiology has been of considerable interest in the development of dementia. Recent studies have started to uncover cerebral blood flow deficits in initiating cognitive deterioration. Brain microvascular pericytes, the only type of contractile cells in capillaries, are involved in the precise modulation of vascular hemodynamics due to their ability to regulate resistance in the capillaries. They exhibit potential in maintaining the capillary network geometry and basal vascular tone. In addition, pericytes can facilitate better blood flow supply in response to neurovascular coupling. Their dysfunction is thought to disturb cerebral blood flow causing metabolic imbalances or structural injuries, leading to consequent cognitive decline. In this review, we summarize the characteristics of microvascular pericytes in brain blood flow regulation and outline the framework of a two-hit hypothesis in cognitive decline, where we emphasize how pericytes serve as targets of cerebral blood flow dysregulation that occurs with neurological challenges, ranging from genetic factors, aging, and pathological proteins to ischemic stress.
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Affiliation(s)
- Tong-Yao You
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Carter KJ, Ward AT, Kellawan JM, Harrell JW, Peltonen GL, Roberts GS, Al-Subu A, Hagen SA, Serlin RC, Eldridge MW, Wieben O, Schrage WG. Reduced basal macrovascular and microvascular cerebral blood flow in young adults with metabolic syndrome: potential mechanisms. J Appl Physiol (1985) 2023; 135:94-108. [PMID: 37199780 PMCID: PMC10292973 DOI: 10.1152/japplphysiol.00688.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/26/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
Ninety-million Americans suffer metabolic syndrome (MetSyn), increasing the risk of diabetes and poor brain outcomes, including neuropathology linked to lower cerebral blood flow (CBF), predominantly in anterior regions. We tested the hypothesis that total and regional CBF is lower in MetSyn more so in the anterior brain and explored three potential mechanisms. Thirty-four controls (25 ± 5 yr) and 19 MetSyn (30 ± 9 yr), with no history of cardiovascular disease/medications, underwent four-dimensional flow magnetic resonance imaging (MRI) to quantify macrovascular CBF, whereas arterial spin labeling quantified brain perfusion in a subset (n = 38/53). Contributions of cyclooxygenase (COX; n = 14), nitric oxide synthase (NOS, n = 17), or endothelin receptor A signaling (n = 13) were tested with indomethacin, NG-monomethyl-L-arginine (L-NMMA), and Ambrisentan, respectively. Total CBF was 20 ± 16% lower in MetSyn (725 ± 116 vs. 582 ± 119 mL/min, P < 0.001). Anterior and posterior brain regions were 17 ± 18% and 30 ± 24% lower in MetSyn; reductions were not different between regions (P = 0.112). Global perfusion was 16 ± 14% lower in MetSyn (44 ± 7 vs. 36 ± 5 mL/100 g/min, P = 0.002) and regionally in frontal, occipital, parietal, and temporal lobes (range 15-22%). The decrease in CBF with L-NMMA (P = 0.004) was not different between groups (P = 0.244, n = 14, 3), and Ambrisentan had no effect on either group (P = 0.165, n = 9, 4). Interestingly, indomethacin reduced CBF more in Controls in the anterior brain (P = 0.041), but CBF decrease in posterior was not different between groups (P = 0.151, n = 8, 6). These data indicate that adults with MetSyn exhibit substantially reduced brain perfusion without regional differences. Moreover, this reduction is not due to loss of NOS or gain of ET-1 signaling but rather a loss of COX vasodilation.NEW & NOTEWORTHY We tested the impact of insulin resistance (IR) on resting cerebral blood flow (CBF) in adults with metabolic syndrome (MetSyn). Using MRI and research pharmaceuticals to study the role of NOS, ET-1, or COX signaling, we found that adults with MetSyn exhibit substantially lower CBF that is not explained by changes in NOS or ET-1 signaling. Interestingly, adults with MetSyn show a loss of COX-mediated vasodilation in the anterior but not posterior circulation.
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Affiliation(s)
- Katrina J Carter
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - Aaron T Ward
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
| | - J Mikhail Kellawan
- Department of Health and Exercise Science, University of Oklahoma, Norman, Oklahoma, United States
| | - John W Harrell
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, Ohio, United States
| | - Garrett L Peltonen
- School of Nursing and Kinesiology, Western New Mexico University, Silver City, New Mexico, United States
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
| | - Awni Al-Subu
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Scott A Hagen
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Ronald C Serlin
- Department of Educational Psychology, University of Wisconsin, Madison, Wisconsin, United States
| | - Marlowe W Eldridge
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, United States
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, United States
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, United States
| | - William G Schrage
- Department of Kinesiology, University of Wisconsin, Madison, Wisconsin, United States
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İlik İ, Arslan H, Yokuş A, Batur M, Üçler R, Akdeniz H. Cerebral perfusion in type 2 diabetes mellitus: A preliminary study with MR perfusion. Clin Neurol Neurosurg 2023; 231:107816. [PMID: 37327716 DOI: 10.1016/j.clineuro.2023.107816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with altered cerebral vasoreactivity, cognitive impairment, and functional decline. Magnetic Resonance (MR) perfusion can be used to assess cerebral blood flow (CBF). The aim of this study is to analyze the association between diabetes mellitus and cerebral perfusion. METHODS The study included 52 patients diagnosed with T2DM and 39 healthy individuals. The diabetic patients were classified into three groups (PRP: proliferative retinopathy, NPRP: non-proliferative retinopathy, Non-RP: non-retinopathy DM). The rCBF measurements of cortical gray matter and thalami were carried out using the region of interest. Reference quantitative measurements were performed from ipsilateral white matter. RESULTS The comparison between the T2DM group and the control group revealed that rCBF values of bilateral frontal lobes, cingulate gyrus, medial temporal lobe, thalami and right occipital lobe were measured to be significantly lower in the T2DM group (p < 0.05). No significant difference was detected between the two groups in terms of rCBF values of the left occipital lobe and anterior aspect of the left temporal lobe (p > 0.05). The rCBF values were lower in the anterior aspect of the right temporal lobe and the difference showed borderline statistical significance (p = 0.058). No significant difference was detected regarding mean rCBF values measured in the regions of cerebral hemispheres among the three patient groups with T2DM (p˃0.05). CONCLUSION Regional hypoperfusion was encountered in most of the lobes in the T2DM group when compared with the healthy group. However, in terms of rCBF values, there was no significant difference among the three groups with T2DM.
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Affiliation(s)
- İbrahim İlik
- Van Training and Research Hospital, Department of Radiology, Van, Turkey.
| | - Harun Arslan
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Radiology, Van, Turkey.
| | - Adem Yokuş
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Radiology, Van, Turkey.
| | - Muhammed Batur
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Ophthalmology, Van, Turkey.
| | - Rıfkı Üçler
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Endocrinology, Van, Turkey.
| | - Hüseyin Akdeniz
- Van Yüzüncü Yıl University, Faculty of Medicine, Department of Radiology, Van, Turkey.
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Windham BG, Griswold ME, Ranadive R, Sullivan KJ, Mosley TH, Mielke MM, Jack CR, Knopman D, Petersen R, Vemuri P. Relationships of Cerebral Perfusion With Gait Speed Across Systolic Blood Pressure Levels and Age: A Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:514-520. [PMID: 35640170 PMCID: PMC9977228 DOI: 10.1093/gerona/glac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aimed to examine if the association of cerebral perfusion with gait speed differs across systolic blood pressure (SBP) and age. METHODS Cerebral perfusion was measured via arterial spin labeled (ASL)-MRI among community-dwelling adults aged 31-94 years in the population-based Mayo Clinic Study of Aging. Usual gait speed was assessed over 5.6 meters on an electronic mat. Sex- and body mass index (BMI)-adjusted linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP using 3-way and 2-way interaction terms between continuous age, SBP, and ASL. Results report estimated differences in gait speed per standard deviation (SD) lower ASL for exemplar SBPs and ages. RESULTS Among 479 participants (mean age 67.6 years; 44% women; mean gait speed 1.17 m/s), ASL relations to gait speed varied by age (ASL-x-age interaction: p = .001) and SBP (ASL-x-SBP interaction: p = .009). At an SBP of 120 mmHg, each SD lower ASL was associated with a 0.04 m/s (95% confidence interval [CI]: 0.01, 0.07) slower gait speed at 65 years, 0.07 m/s (0.04, 0.10) at 75 years, and 0.09 m/s (0.05, 0.13) at 85 years. At an SBP of 140 mmHg, ASL associations with gait speed were attenuated to 0.01 (-0.01, 0.04), 0.04 (0.02, 0.06), and 0.06 (0.04, 0.09) m/s slower gait speed at ages 65, 75, and 85, respectively. CONCLUSION Poorer cerebral perfusion is associated with clinically meaningful slower gait speeds, particularly with older age, while higher perfusion markedly attenuates age differences in gait speed.
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Affiliation(s)
- B Gwen Windham
- Address correspondence to: B. Gwen Windham, MD, MHS, Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, USA. E-mail:
| | - Michael E Griswold
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Radhikesh Ranadive
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kevin J Sullivan
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas H Mosley
- Department of Medicine/Geriatrics, The Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michelle M Mielke
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dave Knopman
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ron Petersen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthi Vemuri
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Aranyi SC, Képes Z, Nagy M, Opposits G, Garai I, Káplár M, Emri M. Topological dissimilarities of hierarchical resting networks in type 2 diabetes mellitus and obesity. J Comput Neurosci 2023; 51:71-86. [PMID: 36056275 PMCID: PMC9840595 DOI: 10.1007/s10827-022-00833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 07/29/2022] [Accepted: 08/23/2022] [Indexed: 01/18/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is reported to cause widespread changes in brain function, leading to cognitive impairments. Research using resting-state functional magnetic resonance imaging data already aims to understand functional changes in complex brain connectivity systems. However, no previous studies with dynamic causal modelling (DCM) tried to investigate large-scale effective connectivity in diabetes. We aimed to examine the differences in large-scale resting state networks in diabetic and obese patients using combined DCM and graph theory methodologies. With the participation of 70 subjects (43 diabetics, 27 obese), we used cross-spectra DCM to estimate connectivity between 36 regions, subdivided into seven resting networks (RSN) commonly recognized in the literature. We assessed group-wise connectivity of T2DM and obesity, as well as group differences, with parametric empirical Bayes and Bayesian model reduction techniques. We analyzed network connectivity globally, between RSNs, and regionally. We found that average connection strength was higher in T2DM globally and between RSNs, as well. On the network level, the salience network shows stronger total within-network connectivity in diabetes (8.07) than in the obese group (4.02). Regionally, we measured the most significant average decrease in the right middle temporal gyrus (-0.013 Hz) and the right inferior parietal lobule (-0.01 Hz) relative to the obese group. In comparison, connectivity increased most notably in the left anterior prefrontal cortex (0.01 Hz) and the medial dorsal thalamus (0.009 Hz). In conclusion, we find the usage of complex analysis of large-scale networks suitable for diabetes instead of focusing on specific changes in brain function.
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Affiliation(s)
- Sándor Csaba Aranyi
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zita Képes
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marianna Nagy
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Opposits
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ildikó Garai
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary ,Translational Research Centre, ScanoMed Ltd., Debrecen, Hungary
| | - Miklós Káplár
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Cui Y, Tang TY, Lu CQ, Ju S. Insulin Resistance and Cognitive Impairment: Evidence From Neuroimaging. J Magn Reson Imaging 2022; 56:1621-1649. [PMID: 35852470 DOI: 10.1002/jmri.28358] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 01/04/2023] Open
Abstract
Insulin is a peptide well known for its role in regulating glucose metabolism in peripheral tissues. Emerging evidence from human and animal studies indicate the multifactorial role of insulin in the brain, such as neuronal and glial metabolism, glucose regulation, and cognitive processes. Insulin resistance (IR), defined as reduced sensitivity to the action of insulin, has been consistently proposed as an important risk factor for developing neurodegeneration and cognitive impairment. Although the exact mechanism of IR-related cognitive impairment still awaits further elucidation, neuroimaging offers a versatile set of novel contrasts to reveal the subtle cerebral abnormalities in IR. These imaging contrasts, including but not limited to brain volume, white matter (WM) microstructure, neural function and brain metabolism, are expected to unravel the nature of the link between IR, cognitive decline, and brain abnormalities, and their changes over time. This review summarizes the current neuroimaging studies with multiparametric techniques, focusing on the cerebral abnormalities related to IR and therapeutic effects of IR-targeting treatments. According to the results, brain regions associated with IR pathophysiology include the medial temporal lobe, hippocampus, prefrontal lobe, cingulate cortex, precuneus, occipital lobe, and the WM tracts across the globe. Of these, alterations in the temporal lobe are highly reproducible across different imaging modalities. These structures have been known to be vulnerable to Alzheimer's disease (AD) pathology and are critical in cognitive processes such as memory and executive functioning. Comparing to asymptomatic subjects, results are more mixed in patients with metabolic disorders such as type 2 diabetes and obesity, which might be attributed to a multifactorial mechanism. Taken together, neuroimaging, especially MRI, is beneficial to reveal early abnormalities in cerebral structure and function in insulin-resistant brain, providing important evidence to unravel the underlying neuronal substrate that reflects the cognitive decline in IR. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ying Cui
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tian-Yu Tang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chun-Qiang Lu
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Novak V, Mantzoros CS, Novak P, McGlinchey R, Dai W, Lioutas V, Buss S, Fortier CB, Khan F, Aponte Becerra L, Ngo LH. MemAID: Memory advancement with intranasal insulin vs. placebo in type 2 diabetes and control participants: a randomized clinical trial. J Neurol 2022; 269:4817-4835. [PMID: 35482079 PMCID: PMC9046533 DOI: 10.1007/s00415-022-11119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study aimed at assessing the long-term effects of intranasal insulin (INI) on cognition and gait in older people with and without type 2 diabetes mellitus (T2DM). METHODS Phase 2 randomized, double-blinded trial consisted of 24 week treatment with 40 IU of INI (Novolin® R, off-label use) or placebo (sterile saline) once daily and 24 week follow-up. Primary outcomes were cognition, normal (NW), and dual-task (DTW) walking speeds. Of 244 randomized, 223 completed baseline (51 DM-INI, 55 DM-Placebo, 58 Control-INI, 59 Control-Placebo; 109 female, 65.8 ± 9.1; 50-85 years old); 174 completed treatment (84 DM, 90 Controls); 156 completed follow-up (69 DM). RESULTS DM-INI had faster NW (~ 7 cm/s; p = 0.025) and DTW on-treatment (p = 0.007; p = 0.812 adjusted for baseline difference) than DM-Placebo. Control-INI had better executive functioning on-treatment (p = 0.008) and post-treatment (p = 0.007) and verbal memory post-treatment (p = 0.004) than Control-Placebo. DM-INI increased cerebral blood flow in medio-prefrontal cortex (p < 0.001) on MRI. Better vasoreactivity was associated with faster DTW (p < 0.008). In DM-INI, plasma insulin (p = 0.006) and HOMA-IR (p < 0.013) decreased post-treatment. Overall INI effect demonstrated faster walking (p = 0.002) and better executive function (p = 0.002) and verbal memory (p = 0.02) (combined DM-INI and Control-INI cohort, hemoglobin A1c-adjusted). INI was not associated with serious adverse events, hypoglycemic episodes, or weight gain. CONCLUSION There is evidence for positive INI effects on cognition and gait. INI-treated T2DM participants walked faster, showed increased cerebral blood flow and decreased plasma insulin, while controls improved executive functioning and verbal memory. The MemAID trial provides proof-of-concept for preliminary safety and efficacy and supports future evaluation of INI role to treat T2DM and age-related functional decline.
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Affiliation(s)
- Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Boston, MA, 02215, USA.
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston VA Healthcare System, Boston, MA, USA
| | - Peter Novak
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research Educational and Clinical Research Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Weiying Dai
- Department of Computer Science, State University of New York (SUNY), Binghamton, NY, USA
| | - Vasileios Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Boston, MA, 02215, USA
| | - Stephanie Buss
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Boston, MA, 02215, USA
| | - Catherine B Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research Educational and Clinical Research Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Faizan Khan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Boston, MA, 02215, USA
| | - Laura Aponte Becerra
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd, Boston, MA, 02215, USA
| | - Long H Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center and School of Public Health, Harvard Medical School, Boston, MA, USA
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Barloese MCJ, Bauer C, Petersen ET, Hansen CS, Madsbad S, Siebner HR. Neurovascular Coupling in Type 2 Diabetes With Cognitive Decline. A Narrative Review of Neuroimaging Findings and Their Pathophysiological Implications. Front Endocrinol (Lausanne) 2022; 13:874007. [PMID: 35860697 PMCID: PMC9289474 DOI: 10.3389/fendo.2022.874007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/17/2022] [Indexed: 01/21/2023] Open
Abstract
Type 2 diabetes causes substantial long-term damage in several organs including the brain. Cognitive decline is receiving increased attention as diabetes has been established as an independent risk factor along with the identification of several other pathophysiological mechanisms. Early detection of detrimental changes in cerebral blood flow regulation may represent a useful clinical marker for development of cognitive decline for at-risk persons. Technically, reliable evaluation of neurovascular coupling is possible with several caveats but needs further development before it is clinically convenient. Different modalities including ultrasound, positron emission tomography and magnetic resonance are used preclinically to shed light on the many influences on vascular supply to the brain. In this narrative review, we focus on the complex link between type 2 diabetes, cognition, and neurovascular coupling and discuss how the disease-related pathology changes neurovascular coupling in the brain from the organ to the cellular level. Different modalities and their respective pitfalls are covered, and future directions suggested.
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Affiliation(s)
- Mads C. J. Barloese
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Imaging, Center for Functional and Diagnostic Imaging, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Christian Bauer
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Radiography, Department of Technology, University College Copenhagen, Copenhagen, Denmark
| | - Esben Thade Petersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Center for Magnetic Resonance, Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | | | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital - Bispebjerg and Fredriksberg, Copenhagen, Denmark
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Faaitiiti KL, Jupiter DC. Diabetes-Specific Dementia: A Structured Literature Review of Cognitive Assessment Methods. J Foot Ankle Surg 2022; 61:401-409. [PMID: 34893425 PMCID: PMC8936078 DOI: 10.1053/j.jfas.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
Diabetes mellitus is a known risk factor for the development of multiple subtypes of dementia and mild cognitive impairment. Recent research identifies a cause-specific diabetes-related dementia with a unique set of characteristics. Currently, there is no standard cognitive assessment battery recommended to specifically assess dementia that is a direct consequence of chronic diabetes, and some evaluations have been used for decades with minimal revisions, regardless of appropriateness. We performed a systematic review of the dementia/cognition evaluation methods most commonly used in the literature for assessing diabetic patients and identified which cognitive domains are typically assessed in this setting, and whether cognitive changes were more reflective of a vascular pathology, Alzheimer's pathology, or something else entirely. Search results yielded 1089 articles. After screening for appropriateness, a total of 11 full-text articles were assessed. In general, subjects in the reviewed studies were assessed using a variety of testing methods, examining different combinations of cognitive domains. A standard, clear definition of which cognitive domains are the most important to assess in diabetic patients is needed in order to determine what combination of assessment tools are most pertinent. Given the growing subset of the US population, careful reconsideration of cognitive assessment methods is needed to create self-care plans that take into account a specific collection of cognitive challenges for those with diabetes.
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Affiliation(s)
- Kelli L Faaitiiti
- Medical Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX; Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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10
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Ahmad R, Chowdhury K, Kumar S, Irfan M, Reddy GS, Akter F, Jahan D, Haque M. Diabetes Mellitus: A Path to Amnesia, Personality, and Behavior Change. BIOLOGY 2022; 11:biology11030382. [PMID: 35336756 PMCID: PMC8945557 DOI: 10.3390/biology11030382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Diabetes Mellitus (DM) is a metabolic disorder resulting from a disturbance of insulin secretion, action, or both. Hyperglycemia and overproduction of superoxide induce the development and progression of chronic complications of DM. The impact of DM and its complication on the central nervous system (CNS) such as dementia and Alzheimer’s Disease (AD) still remain obscure. In dementia, there is a gradual decline in cognitive function. The incidence of dementia increases with age, and patient become socially, physically, and mentally more vulnerable and dependent. The symptoms often emerge decades after the onset of pathophysiology, thus impairing early therapeutic intervention. Most diabetic subjects who develop dementia are above the age of 65, but diabetes may also cause an increased risk of developing dementia before 65 years. Vascular dementia is the second most common form of dementia after AD. Type 2 DM (T2DM) increases the incidence of vascular dementia (since its covers the vascular system) and AD. The functional and structural integrity of the CNS is altered in T2DM due to increased synthesis of Aβ. Additionally, hyperphosphorylation of Tau protein also results from dysregulation of various signaling cascades in T2DM, thereby causing neuronal damage and AD. There is the prospect for development of a therapy that may help prevent or halt the progress of dementia resulting from T2DM. Abstract Type 2 diabetes mellitus is increasingly being associated with cognition dysfunction. Dementia, including vascular dementia and Alzheimer’s Disease, is being recognized as comorbidities of this metabolic disorder. The progressive hallmarks of this cognitive dysfunction include mild impairment of cognition and cognitive decline. Dementia and mild impairment of cognition appear primarily in older patients. Studies on risk factors, neuropathology, and brain imaging have provided important suggestions for mechanisms that lie behind the development of dementia. It is a significant challenge to understand the disease processes related to diabetes that affect the brain and lead to dementia development. The connection between diabetes mellitus and dysfunction of cognition has been observed in many human and animal studies that have noted that mechanisms related to diabetes mellitus are possibly responsible for aggravating cognitive dysfunction. This article attempts to narrate the possible association between Type 2 diabetes and dementia, reviewing studies that have noted this association in vascular dementia and Alzheimer’s Disease and helping to explain the potential mechanisms behind the disease process. A Google search for “Diabetes Mellitus and Dementia” was carried out. Search was also done for “Diabetes Mellitus”, “Vascular Dementia”, and “Alzheimer’s Disease”. The literature search was done using Google Scholar, Pubmed, Embase, ScienceDirect, and MEDLINE. Keeping in mind the increasing rate of Diabetes Mellitus, it is important to establish the Type 2 diabetes’ effect on the brain and diseases of neurodegeneration. This narrative review aims to build awareness regarding the different types of dementia and their relationship with diabetes.
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Affiliation(s)
- Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka 1230, Bangladesh;
| | - Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College and Hospital, Dhaka 1344, Bangladesh;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, 907/A, Uvarsad Gandhinagar, Gujarat 382422, India;
| | - Mohammed Irfan
- Department of Forensics, Federal University of Pelotas, Pelotas 96020-010, RS, Brazil;
| | - Govindool Sharaschandra Reddy
- Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY 14214, USA;
| | - Farhana Akter
- Department of Endocrinology, Chittagong Medical College, Chattogram 4203, Bangladesh;
| | - Dilshad Jahan
- Department of Hematology, Asgar Ali Hospital, 111/1/A Distillery Road, Gandaria Beside Dhupkhola, Dhaka 1204, Bangladesh;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia
- Correspondence: or
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Liu J, Yang X, Li Y, Xu H, Ren J, Zhou P. Cerebral Blood Flow Alterations in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Arterial Spin Labeling Studies. Front Aging Neurosci 2022; 14:847218. [PMID: 35250549 PMCID: PMC8888831 DOI: 10.3389/fnagi.2022.847218] [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: 01/01/2022] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveArterial spin labeling (ASL) studies have revealed inconsistent regional cerebral blood flow (CBF) alterations in patients with type 2 diabetes mellitus (T2DM). The aim of this systematic review and meta-analysis was to identify concordant regional CBF alterations in T2DM.MethodsA systematic review was conducted to the published literatures comparing cerebral perfusion between patients with T2DM and healthy controls using ASL. The seed-based d mapping (SDM) was further used to perform quantitative meta-analysis on voxel-based literatures and to estimate the regional CBF alterations in patients with T2DM. Metaregression was performed to explore the associations between clinical characteristics and cerebral perfusion alterations.ResultsA total of 13 studies with 14 reports were included in the systematic review and 7 studies with 7 reports were included in the quantitative meta-analysis. The qualitative review found widespread CBF reduction in cerebral lobes in T2DM. The meta-analysis found increased regional CBF in right supplementary motor area and decreased regional CBF in bilateral middle occipital gyrus, left caudate nucleus, right superior parietal gyrus, and left calcarine fissure/surrounding cortex in T2DM.ConclusionThe patterns of cerebral perfusion alterations, characterized by the decreased CBF in occipital and parietal lobes, might be the neuropathology of visual impairment and cognitive aging in T2DM.
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12
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Kleinloog JPD, Tischmann L, Mensink RP, Adam TC, Joris PJ. Longer-term soy nut consumption improves cerebral blood flow and psychomotor speed: results of a randomized, controlled crossover trial in older men and women. Am J Clin Nutr 2021; 114:2097-2106. [PMID: 34510189 PMCID: PMC8634607 DOI: 10.1093/ajcn/nqab289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Effects of soy foods on cerebral blood flow (CBF)-a marker of cerebrovascular function-may contribute to the beneficial effects of plant-based diets on cognitive performance. OBJECTIVES We aimed to investigate longer-term effects of soy nut consumption on CBF in older adults. Changes in 3 different domains of cognitive performance were also studied. METHODS Twenty-three healthy participants (age: 60-70 y; BMI: 20-30 kg/m2) participated in a randomized, controlled, single-blinded crossover trial with an intervention (67 g/d of soy nuts providing ∼25.5 g protein and 174 mg isoflavones) and control period (no nuts) of 16 wk, separated by an 8-wk washout period. Adults followed the Dutch food-based dietary guidelines. At the end of each period, CBF was assessed with arterial spin labeling MRI. Psychomotor speed, executive function, and memory were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). RESULTS No serious adverse events were reported, and soy nut intake was well tolerated. Body weights remained stable during the study. Serum isoflavone concentrations increased (daidzein mean difference ± SD: 128 ± 113 ng/mL, P < 0.001; genistein: 454 ± 256 ng/mL, P < 0.001), indicating excellent compliance. Regional CBF increased in 4 brain clusters located in the left occipital and temporal lobes (mean ± SD increase: 11.1 ± 12.4 mL · 100 g-1 · min-1, volume: 11,296 mm3, P < 0.001), bilateral occipital lobe (12.1 ± 15.0 mL · 100 g-1 · min-1, volume: 2632 mm3, P = 0.002), right occipital and parietal lobes (12.7 ± 14.3 mL · 100 g-1 · min-1, volume: 2280 mm3, P = 0.005), and left frontal lobe (12.4 ± 14.5 mL · 100 g-1 · min-1, volume: 2120 mm3, P = 0.009) which is part of the ventral network. These 4 regions are involved in psychomotor speed performance, which improved as the movement time reduced by (mean ± SD) 20 ± 37 ms (P = 0.005). Executive function and memory did not change. CONCLUSIONS Longer-term soy nut consumption may improve cerebrovascular function of older adults, because regional CBF increased. Effects may underlie observed improvements in psychomotor speed.This trial was registered at clinicaltrials.gov as NCT03627637.
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Affiliation(s)
- Jordi P D Kleinloog
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Lea Tischmann
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Hoscheidt S, Sanderlin AH, Baker LD, Jung Y, Lockhart S, Kellar D, Whitlow C, Hanson AJ, Friedman S, Register T, Leverenz JB, Craft S. Mediterranean and Western diet effects on Alzheimer's disease biomarkers, cerebral perfusion, and cognition in mid-life: A randomized trial. Alzheimers Dement 2021; 18:457-468. [PMID: 34310044 PMCID: PMC9207984 DOI: 10.1002/alz.12421] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
Introduction Mid‐life dietary patterns are associated with Alzheimer's disease (AD) risk, although few controlled trials have been conducted. Methods Eighty‐seven participants (age range: 45 to 65) with normal cognition (NC, n = 56) or mild cognitive impairment (MCI, n = 31) received isocaloric diets high or low in saturated fat, glycemic index, and sodium (Western‐like/West‐diet vs. Mediterranean‐like/Med‐diet) for 4 weeks. Diet effects on cerebrospinal fluid (CSF) biomarkers, cognition, and cerebral perfusion were assessed to determine whether responses differed by cognitive status. Results CSF amyloid beta (Aβ)42/40 ratios increased following the Med‐diet, and decreased after West‐diet for NC adults, whereas the MCI group showed the reverse pattern. For the MCI group, the West‐diet reduced and the Med‐diet increased total tau (t‐tau), whereas CSF Aβ42/t‐tau ratios increased following the West‐diet and decreased following the Med‐diet. For NC participants, the Med‐diet increased and the West‐diet decreased cerebral perfusion. Discussion Diet response during middle age may highlight early pathophysiological processes that increase AD risk.
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Affiliation(s)
| | | | - Laura D Baker
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Youngkyoo Jung
- University of California-Davis, Sacramento, California, USA
| | - Samuel Lockhart
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Derek Kellar
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Angela J Hanson
- University of Washington Medical Center, Seattle, Washington, USA
| | - Seth Friedman
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Thomas Register
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - James B Leverenz
- Cleveland Clinic Lou Ruovo Center for Brain Health, Cleveland, Ohio, USA
| | - Suzanne Craft
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Sharma S. High fat diet and its effects on cognitive health: alterations of neuronal and vascular components of brain. Physiol Behav 2021; 240:113528. [PMID: 34260890 DOI: 10.1016/j.physbeh.2021.113528] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023]
Abstract
It has been well recognized that intake of diets rich in saturated fats could result in development of metabolic disorders such as type 2 diabetes mellitus, obesity and cardiovascular diseases. Recent studies have suggested that intake of high fat diet (HFD) is also associated with cognitive dysfunction. Various preclinical studies have demonstrated the impact of short and long term HFD feeding on the biochemical and behavioural alterations. This review summarizes studies and the protocols used to assess the impacts of HFD feeding on cognitive performance in rodents. Further, it discuss the key mechanisms that are altered by HFD feeding, such as, insulin resistance, oxidative stress, neuro-inflammation, transcriptional dysregulation and loss of synaptic plasticity. Along with these, HFD feeding also alters the vascular components of brain such as loss of BBB integrity and reduced cerebral blood flow. It is highly possible that these factors are responsible for the development of cognitive deficits as a result of HFD feeding.
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Affiliation(s)
- Sorabh Sharma
- Division of Medical Sciences, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W2Y2, Canada.
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15
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Wang Y, Sun L, He G, Gang X, Zhao X, Wang G, Ning G. Cerebral perfusion alterations in type 2 diabetes mellitus - a systematic review. Front Neuroendocrinol 2021; 62:100916. [PMID: 33957174 DOI: 10.1016/j.yfrne.2021.100916] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/04/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is related to abnormal brain structure and function, increasing the risk of cognitive impairment and dementia. We systematically reviewed the published literature focusing on cerebral perfusion in patients with T2DM. Although no significant difference was found in global cerebral blood flow (CBF) between the T2DM group and the healthy control group, the regional cerebral perfusion in T2DM was significantly reduced in multiple locations, including the occipital lobe, domains involved in the default mode network and the cerebellum. The decline in regional CBF was associated with a wide range of cognitive disorders in T2DM, including learning, memory, attention, and executive processing, as well as visual function. In addition, diabetes-related biochemical indicators, such as glycated hemoglobin and insulin resistance, were negatively correlated with regional CBF. In general, these functional perfusion imaging studies indicate that decreased CBF in T2DM may be a potential cause of cognitive impairment.
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Affiliation(s)
- Yaqiong Wang
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China
| | - Lin Sun
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China
| | - Guangyu He
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China.
| | - Guixia Wang
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China.
| | - Guang Ning
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, Jilin, China; National Clinical Research Center for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Liu J, Li Y, Yang X, Xu H, Ren J, Zhou P. Regional Spontaneous Neural Activity Alterations in Type 2 Diabetes Mellitus: A Meta-Analysis of Resting-State Functional MRI Studies. Front Aging Neurosci 2021; 13:678359. [PMID: 34220486 PMCID: PMC8245688 DOI: 10.3389/fnagi.2021.678359] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: Resting-state functional magnetic resonance imaging (rs-fMRI) studies have revealed inconsistent regional spontaneous neural activity alterations in patients with type 2 diabetes mellitus (T2DM). The aim of our meta-analysis was to identify concordant regional spontaneous neural activity abnormalities in patients with T2DM. Methods: A systematic search was conducted to identify voxel-based rs-fMRI studies comparing T2DM patients with healthy controls. The permutation of subject images seed-based d mapping (SDM) was used to quantitatively estimate the regional spontaneous neural activity abnormalities in patients with T2DM. Metaregression was conducted to examine the associations between clinical characteristics and functional alterations. Results: A total of 16 studies with 19 datasets including 434 patients with T2DM and 391 healthy controls were included. Patients with T2DM showed hypoactivity in the right medial superior frontal gyrus, right superior temporal gyrus, and left lingual gyrus, whereas hyperactivity in the right cerebellum. Metaregression analysis identified negative correlation between regional activity in the medial superior frontal and anterior cingulate gyri and illness duration of patients with T2DM. Conclusion: The patterns of regional spontaneous neural activity alterations, characterized by hypoactivity in the medial pre-frontal cortex, visual cortex, and superior temporal gyrus, whereas hyperactivity in the cerebellum, might represent the underlying neuropathological mechanisms of T2DM.
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Affiliation(s)
- Jieke Liu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Yang
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jing Ren
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Duan W, Sehrawat P, Balachandrasekaran A, Bhumkar AB, Boraste PB, Becker JT, Kuller LH, Lopez OL, Gach HM, Dai W. Cerebral Blood Flow Is Associated with Diagnostic Class and Cognitive Decline in Alzheimer's Disease. J Alzheimers Dis 2021; 76:1103-1120. [PMID: 32597803 DOI: 10.3233/jad-200034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reliable cerebral blood flow (CBF) biomarkers using a noninvasive imaging technique are sought to facilitate early diagnosis and intervention in early Alzheimer's disease (AD). OBJECTIVE We aim to identify brain regions in which CBF values are affected and related to cognitive decline in early AD using a large cohort. METHODS Perfusion MRIs using continuous arterial spin labeling were acquired at 1.5 T in 58 normal controls (NC), 50 mild cognitive impairments (MCI), and 40 AD subjects from the Cardiovascular Health Study Cognition Study. Regional absolute CBF and normalized CBF (nCBF) values, without and with correction of partial volume effects, were compared across three groups. Association between regional CBF values and Modified Mini-Mental State Examination (3MSE) were investigated by multiple linear regression analyses adjusted for cardiovascular risk factors. RESULTS After correcting for partial volume effects and cardiovascular risk factors, ADs exhibited decreased nCBF with the strongest reduction in the bilateral posterior cingulate & precuneus region (p < 0.001) compared to NCs, and the strongest reduction in the bilateral superior medial frontal region (p < 0.001) compared to MCIs. MCIs exhibited the strongest nCBF decrease in the left hippocampus and nCBF increase in the right inferior frontal and insular region. The 3MSE scores within the symptomatic subjects were significantly associated with nCBF in the bilateral posterior and middle cingulate and parietal (p < 0.001), bilateral superior medial frontal (p < 0.001), bilateral temporoparietal (p < 0.02), and right hippocampus (p = 0.02) regions. CONCLUSION Noninvasive perfusion MRI can detect functional changes across diagnostic class and serve as a staging biomarker of cognitive status.
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Affiliation(s)
- Wenna Duan
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Parshant Sehrawat
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | | | - Ashish B Bhumkar
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Paresh B Boraste
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - James T Becker
- Departments of Psychiatry, Psychology, and Neurology, University of Pittsburgh, PA, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Departments of Neurology and Psychiatry, University of Pittsburgh, PA, USA
| | - H Michael Gach
- Departments of Radiation Oncology, Radiology, and Biomedical Engineering, Washington University, Saint Louis, MO, USA
| | - Weiying Dai
- Department of Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
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18
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Revascularization for asymptomatic carotid artery stenosis improves balance and mobility. J Vasc Surg 2021; 74:1272-1280. [PMID: 34019991 DOI: 10.1016/j.jvs.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Balance and mobility function worsen with age, more so for those with underlying chronic diseases. We recently found that asymptomatic carotid artery stenosis (ACAS) restricts blood flow to the brain and might also contribute to balance and mobility impairment. In the present study, we tested the hypothesis that ACAS is a modifiable risk factor for balance and mobility impairment. Our goal was to assess the effect of restoring blood flow to the brain by carotid revascularization on the balance and mobility of patients with high-grade ACAS (≥70% diameter-reducing stenosis). METHODS Twenty adults (age, 67.0 ± 9.4 years) undergoing carotid endarterectomy for high-grade stenosis were enrolled. Balance and mobility assessments were performed before and 6 weeks after revascularization. These included the Short Physical Performance Battery, the Berg Balance Scale, the Four Square Step Test, the Dynamic Gait Index (DGI), the Timed Up and Go test, gait speed, the Mini-Balance Evaluation Systems Test (Mini-BESTest), and the Walking While Talking complex test. RESULTS Consistent with our previous findings, patients demonstrated reduced scores on the Short Physical Performance Battery, Berg Balance Scale, DGI, and Timed Up and Go test and in gait speed. Depending on the outcome measure, 25% to 90% of the patients had scored in the impaired range at baseline. After surgery, significant improvements were observed in the outcome measures that combined walking with dynamic movements, including the DGI (P = .02) and Mini-BESTest (P = .002). The proportion of patients with Mini-BESTest scores indicating a high fall risk had decreased significantly from 90% (n = 18) at baseline to 40% (n = 8) after surgery (P = .02). We used Pearson's correlations to examine the relationship between balance and mobility before surgery and the change after surgery. Patients with lower baseline DGI and Mini-BESTest scores demonstrated the most improvement after surgery (r = -0.59, P = .006; and r = -0.70, P = .001, respectively). CONCLUSIONS Carotid revascularization improved patients' balance and mobility, especially for measures that combine walking and dynamic movements. The greatest improvements were observed for the patients who had been most impaired at baseline.
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Duan W, Zhou GD, Balachandrasekaran A, Bhumkar AB, Boraste PB, Becker JT, Kuller LH, Lopez OL, Gach HM, Dai W. Cerebral Blood Flow Predicts Conversion of Mild Cognitive Impairment into Alzheimer's Disease and Cognitive Decline: An Arterial Spin Labeling Follow-up Study. J Alzheimers Dis 2021; 82:293-305. [PMID: 34024834 DOI: 10.3233/jad-210199] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This is the first longitudinal study to assess regional cerebral blood flow (rCBF) changes during the progression from normal control (NC) through mild cognitive impairment (MCI) and Alzheimer's disease (AD). OBJECTIVE We aim to determine if perfusion MRI biomarkers, derived from our prior cross-sectional study, can predict the onset and cognitive decline of AD. METHODS Perfusion MRIs using arterial spin labeling (ASL) were acquired in 15 stable-NC, 14 NC-to-MCI, 16 stable-MCI, and 18 MCI/AD-to-AD participants from the Cardiovascular Health Study (CHS) cognition study. Group comparisons, predictions of AD conversion and time to conversion, and Modified Mini-Mental State Examination (3MSE) from rCBF were performed. RESULTS Compared to the stable-NC group: 1) the stable-MCI group exhibited rCBF decreases in the right temporoparietal (p = 0.00010) and right inferior frontal and insula (p = 0.0094) regions; and 2) the MCI/AD-to-AD group exhibited rCBF decreases in the bilateral temporoparietal regions (p = 0.00062 and 0.0035). Compared to the NC-to-MCI group, the stable-MCI group exhibited a rCBF decrease in the right hippocampus region (p = 0.0053). The baseline rCBF values in the posterior cingulate cortex (PCC) (p = 0.0043), bilateral superior medial frontal regions (BSMF) (p = 0.012), and left inferior frontal (p = 0.010) regions predicted the 3MSE scores for all the participants at follow-up. The baseline rCBF in the PCC and BSMF regions predicted the conversion and time to conversion from MCI to AD (p < 0.05; not significant after multiple corrections). CONCLUSION We demonstrated the feasibility of ASL in detecting rCBF changes in the typical AD-affected regions and the predictive value of baseline rCBF on AD conversion and cognitive decline.
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Affiliation(s)
- Wenna Duan
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Grace D Zhou
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | | | - Ashish B Bhumkar
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - Paresh B Boraste
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
| | - James T Becker
- Psychiatry, Psychology, and Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oscar L Lopez
- Neurology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - H Michael Gach
- Radiation Oncology, Radiology, and Biomedical Engineering, Washington University in St. Louis, Saint Louis, MO, USA
| | - Weiying Dai
- Computer Science, State University of New York at Binghamton, Binghamton, NY, USA
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Guo X, Zhu Y, Li X, Lu Z, Cao Z, Yi X, Zhu X. Increased insulin resistance is associated with vascular cognitive impairment in Chinese patients with cerebral small vessel disease. Psychogeriatrics 2021; 21:342-349. [PMID: 33641231 DOI: 10.1111/psyg.12675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/30/2021] [Accepted: 02/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association between insulin resistance (IR) and vascular cognitive impairment (VCI) in patients with cerebral small vessel disease (CSVD). METHODS A total of 275 CSVD patients were enrolled in this retrospective case-control study. The homeostatic model assessment of insulin resistance (HOMA-IR) was used to measure the index of insulin resistance. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Spearman's correlation coefficient was used to evaluate the correlation between HOMA-IR and MoCA score. The variance inflation factor (VIF) was used to detect collinearity between variables. Multivariate logistic regression analysis was employed to confirm whether HOMA-IR is an independent risk factor for VCI in CVSD. Finally, receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic value of HOMA-IR in VCI. RESULTS Of the 275 patients, 164 displayed VCI. VCI patients showed a significantly higher level of HOMA-IR compared to non-VCI patients (P < 0.001). HOMA-IR was negatively correlated with the MoCA score (r = -0.593, P < 0.001). After adjusting for potential confounding variables, using HOMA-IR quartile 1 (<1.11) as the reference, HOMA-IR quartile 3 (1.71-2.50) and quartile 4 (≥2.50) were independently associated with the occurrence of VCI; for each one unit increase in the HOMA-IR, the risk of VCI increased by 177.3% (odds ratio 2.773, 95% confidence interval: 1.050-7.324, P = 0.040) and 444.3% (odds ratio 5.443, 95% confidence interval: 2.109-14.050, P < 0.001), respectively. According to the ROC curve, the optimal cut-off point of HOMA-IR in predicting VCI was 1.55, and the area under the curve was 0.744, with a sensitivity of 71.3% and a specificity of 69.4%. CONCLUSION This study demonstrated that increased IR is significantly associated with VCI in CSVD patients.
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Affiliation(s)
- Xiaoming Guo
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yuting Zhu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xinling Li
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Zhenhui Lu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Zhiyong Cao
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoyi Yi
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiangyang Zhu
- Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong, China
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Huang X, Wen Z, Tong Y, Qi CX, Shen Y. Altered resting cerebral blood flow specific to patients with diabetic retinopathy revealed by arterial spin labeling perfusion magnetic resonance imaging. Acta Radiol 2021; 62:524-532. [PMID: 32551803 DOI: 10.1177/0284185120932391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous neuroimaging studies have shown that patients with diabetic retinopathy (DR) were accompanied by abnormalities in cerebral functional and structural architecture, whereas the resting cerebral blood flow (CBF) alterations in patients with DR are not well understood. PURPOSE To explore CBF alterations in patients with DR using pseudo-continuous arterial spin labeling (pCASL) imaging. MATERIAL AND METHODS Thirty-one individuals with DR (15 men, 16 women; mean age = 53.38 ± 9.12 years) and 33 healthy controls (HC) (12 men, 21 women; mean age = 51.61 ± 9.84 years) closely matched for age, sex, and education, underwent pCASL imaging scans. Two-sample T test was conducted to compare different CBF values between two groups. RESULTS Patients with DR exhibited significantly increased CBF values in the left middle temporal gyrus (Brodmann's area, BA 22) and the bilateral supplementary motor area (BA3) and decreased CBF values in the bilateral calcarine (BA17,18) and bilateral caudate relative to HC group (two-tailed, voxel level at P < 0.01, Gaussian random field (GRF), cluster level at P < 0.05). Moreover, the HbA1c (%) level showed a positive correlation with CBF values in the bilateral caudate (r = 0.473, P = 0.007) in patients with DR. CONCLUSION Our results highlighted that patients with DR had abnormal CBF values in the visual cortices, caudate, middle temporal gyrus, and supplementary motor area, which might reflect vision and sensorimotor and cognition dysfunction in patients with DR. These findings might help us to understanding the neural mechanism of patients with DR.
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Affiliation(s)
- Xin Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
- Medical Research Institute, Wuhan University, Wuhan, Hubei, PR China
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22
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Zhang D, Qi F, Gao J, Yan X, Wang Y, Tang M, Zhe X, Cheng M, Wang M, Xie Q, Su Y, Zhang X. Altered Cerebellar-Cerebral Circuits in Patients With Type 2 Diabetes Mellitus. Front Neurosci 2020; 14:571210. [PMID: 33071743 PMCID: PMC7541847 DOI: 10.3389/fnins.2020.571210] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
The role of the cerebellum in type 2 diabetes mellitus (T2DM) has been receiving increased attention. However, the functional connectivity (FC) between the cerebellar subregions and the cerebral cortex has not been investigated in T2DM. Therefore, the purpose of this study was to investigate cerebellar-cerebral FC and the relationship between FC and clinical/cognitive variables in patients with T2DM. A total of 34 patients with T2DM and 30 healthy controls were recruited for this study to receive a neuropsychological assessment and undergo resting-state FC. We selected four subregions of the cerebellum (bilateral lobules IX, right and left Crus I/II, and left lobule VI) as regions of interest (ROIs) to examine the differences in cerebellar-cerebral circuits in patients with T2DM compared to healthy controls. Correlation analysis was performed to examine the relationship between FC and clinical/cognitive variables in the patients. Compared to healthy controls, patients with T2DM showed significantly decreased cerebellar-cerebral FC in the default-mode network (DMN), executive control network (ECN), and visuospatial network (VSN). In the T2DM group, the FC between the left cerebellar lobule VI and the right precuneus was negatively correlated with the Trail Making Test A (TMT-A) score (r = −0.430, P = 0.013), after a Bonferroni correction. In conclusion, patients with T2DM have altered FC between the cerebellar subregions and the cerebral networks involved in cognitive and emotional processing. This suggests that a range of cerebellar-cerebral circuits may be involved in the neuropathology of T2DM cognitive dysfunction.
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Affiliation(s)
- Dongsheng Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Fei Qi
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Jie Gao
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xuejiao Yan
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yarong Wang
- Department of Diagnostic Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xia Zhe
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Miao Cheng
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Man Wang
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Qingming Xie
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Yu Su
- Department of Graduate, Xi'an Medical University, Xi'an, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People's Hospital, Xi'an, China
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23
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Li Y, Liang Y, Tan X, Chen Y, Yang J, Zeng H, Qin C, Feng Y, Ma X, Qiu S. Altered Functional Hubs and Connectivity in Type 2 Diabetes Mellitus Without Mild Cognitive Impairment. Front Neurol 2020; 11:1016. [PMID: 33071928 PMCID: PMC7533640 DOI: 10.3389/fneur.2020.01016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM)-related cognitive decline is associated with neuroimaging changes. However, only a few studies have focused on early functional alteration in T2DM prior to mild cognitive impairment (MCI). This study aimed to investigate the early changes of global connectivity patterns in T2DM by using a resting-state functional magnetic resonance imaging (rs-fMRI) technique. Methods: Thirty-four T2DM subjects and 38 age-, sex-, and education-matched healthy controls (HCs) underwent rs-fMRI in a 3T MRI scanner. Degree centrality (DC) was used to identify the functional hubs of the whole brain in T2DM without MCI. Then the functional connectivity (FC) between hubs and the rest of the brain was assessed by using the hub-based approach. Results: Compared with HCs, T2DM subjects showed increased DC in the right cerebellum lobules III-V. Hub-based FC analysis found that the right cerebellum lobules III-V of T2DM subjects had increased FC with the right cerebellum crus II and lobule VI, the right temporal inferior/middle gyrus, and the right hippocampus. Conclusions: Increased DC in the right cerebellum regions III-V, as well as increased FC within cerebellar regions and ipsilateral cerebrocerebellar regions, may indicate an important pathophysiological mechanism for compensation in T2DM without MCI.
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Affiliation(s)
- Yifan Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Liang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Tan
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuna Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinquan Yang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Zeng
- Department of Radiology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Chunhong Qin
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Feng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaomeng Ma
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shijun Qiu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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24
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Song J, Cui S, Chen Y, Ye X, Huang X, Su H, Zhou Y, Liu X, Chen W, Shan X, Yan Z, Liu K. Disrupted Regional Cerebral Blood Flow in Children With Newly-Diagnosed Type 1 Diabetes Mellitus: An Arterial Spin Labeling Perfusion Magnetic Resonance Imaging Study. Front Neurol 2020; 11:572. [PMID: 32636800 PMCID: PMC7316953 DOI: 10.3389/fneur.2020.00572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
Object: Diabetes is associated with cerebral vascular dysfunction and increased vascular cognitive impairment. The objective of this study was to use arterial spin labeling (ASL) perfusion-weighted magnetic resonance imaging to investigate whether cerebral perfusion was changed in newly-diagnosed children with type 1 diabetes mellitus (T1DM) and the possible relationship between aberrant cerebral blood flow (CBF) with cognitive as well as clinical variables. Methods: Between January 2017 and February 2018, 34 children with newly-diagnosed T1DM and 34 age, gender, and education-matched healthy controls were included. Three dimensional pseudo-continuous ASL perfusion MRI was used to evaluate CBF. A conventional T2WI sequence was added to exclude intracranial disease. Regions with CBF differences between T1DM children and the controls were detected via voxel-wise comparisons in REST software. Associations among the result of neuropsychological test, clinical variables, and CBF values of different brains were investigated by using partial correlation analysis. Results: Compared with the controls, T1DM children show decreased CBF in the left calcarine and postcentral gyrus, and right precentral gyrus. The perfusion in the postcentral gyrus was positively correlated with IQ performance. No significant correlations were found between CBF and HbA1c, blood glucose level before imaging and IQ in other brain regions in T1DM children. Conclusion: There is an abnormal cerebral perfusion in children with newly diagnosed T1DM. The visual and sensorimotor areas are brain areas where perfusion is prone to change at the beginning of T1DM. Our study provided clues for cerebral pathophysiological changes in the initial stage of T1DM.
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Affiliation(s)
- Jiawen Song
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shihan Cui
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yaomeng Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinjian Ye
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyan Huang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiyan Su
- Department of Pediatric Endocrine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongjin Zhou
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaozheng Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoou Shan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kun Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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25
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Chau ACM, Cheung EYW, Chan KH, Chow WS, Shea YF, Chiu PKC, Mak HKF. Impaired cerebral blood flow in type 2 diabetes mellitus - A comparative study with subjective cognitive decline, vascular dementia and Alzheimer's disease subjects. NEUROIMAGE-CLINICAL 2020; 27:102302. [PMID: 32521474 PMCID: PMC7284123 DOI: 10.1016/j.nicl.2020.102302] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/27/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
CBF impairment is found in T2DM and SCD individuals, which might suggest a preclinical stage of dementia. Comparing to HC, lower CBF in T2DM was due to higher rate of multiple cerebrovascular risk factors. Unlike T2DM, CBF reduction in AD and VD was due to amyloid deposition and microangiopathy respectively. Significant negative correlation between adjusted CBF and HbA1c in all cortical regions in healthy control and T2DM.
The link between non-demented type 2 diabetes mellitus (T2DM) and different types of cognitive impairment is controversial. By controlling for co-morbidities such as cerebral macrovascular and microvascular changes, cerebral atrophy, amyloid burden, hypertension or hyperlipidemia, the current study investigated the cerebral blood flow of T2DM individuals as compared to cognitively impaired subjects recruited from a memory clinic. 15 healthy control (71.8 ± 6.1 years), 18 T2DM (62.5 ± 3.7 years), as well as 8 Subjective Cognitive Decline (69.5 ± 7.5 years), 12 Vascular Dementia (79.3 ± 4.2 years) and 17 Alzheimer’s Disease (75.1 ± 8.2 years) underwent multi-parametric MRI brain scanning. Subjects with T2DM and from the memory clinic also had 18-F Flutametamol PET-CT scanning to look for any amyloid burden. Pseudocontinuous Arterial Spin Labeling (PCASL), MR Angiography Head, 3D FLAIR and 3D T1-weighted sequences were used to quantify cerebral blood flow, cerebrovascular changes, white matter hyperintensities and brain atrophy respectively. Vascular risk factors were retrieved from the medical records. The 37 subjects from memory clinic were classified into subjective cognitive decline (SCD), vascular dementia (VD) and Alzheimer’s disease (AD) subgroups by a multi-disciplinary panel consisting of a neuroradiologist, and 2 geriatricians. Absolute cortical CBF in our cohort of T2DM, SCD, VD and AD was significantly decreased (p < 0.01) as compared to healthy controls (HC) in both whole brain and eight paired brain regions, after age, normalized grey matter volume and gender adjustment and Bonferroni correction. Subgroup analysis between T2DM, SCD, VD, and AD revealed that CBF of T2DM was not significantly different from AD, VD or SCD. By controlling for co-morbidities, impaired cortical CBF in T2DM was not related to microangiopathy or amyloid deposition, but to the interaction of triple risk factors (such as diabetes mellitus, hypertension, and hyperlipidemia). There was statistically significant negative correlation (p ≤ 0.05) between adjusted CBF and HbA1c in all brain regions of T2DM and HC (with partial correlation ranging from −0.30 to −0.46). Taken together, altered cerebral blood flow in T2DM might be related to disruption of cerebrovascular autoregulation related to vascular risk factors, and such oligemia occurred before clinical manifestation due to altered glycemic control.
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Affiliation(s)
- Anson C M Chau
- The University of Hong Kong (Shenzhen) Teaching Hospital Limited, The University of Hong Kong, Pokfulam Road, Hong Kong.
| | - Eva Y W Cheung
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, K406, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - K H Chan
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, 405B, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong.
| | - W S Chow
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, 405B, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong.
| | - Y F Shea
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, 405B, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Patrick K C Chiu
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, 405B, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Henry K F Mak
- Department of Diagnostic Radiology, LKS Faculty of Medicine, The University of Hong Kong, K406, Queen Mary Hospital, Pokfulam Road, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Alzheimer's Disease Research Network, The University of Hong Kong, Hong Kong.
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26
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Nickel NP, Yuan K, Dorfmuller P, Provencher S, Lai YC, Bonnet S, Austin ED, Koch CD, Morris A, Perros F, Montani D, Zamanian RT, de Jesus Perez VA. Beyond the Lungs: Systemic Manifestations of Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2020; 201:148-157. [PMID: 31513751 DOI: 10.1164/rccm.201903-0656ci] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease characterized by progressive loss and remodeling of the pulmonary arteries, resulting in right heart failure and death. Until recently, PAH was seen as a disease restricted to the pulmonary circulation. However, there is growing evidence that patients with PAH also exhibit systemic vascular dysfunction, as evidenced by impaired brachial artery flow-mediated dilation, abnormal cerebral blood flow, skeletal myopathy, and intrinsic kidney disease. Although some of these anomalies are partially due to right ventricular insufficiency, recent data support a mechanistic link to the genetic and molecular events behind PAH pathogenesis. This review serves as an introduction to the major systemic findings in PAH and the evidence that supports a common mechanistic link with PAH pathophysiology. In addition, it discusses recent studies describing morphological changes in systemic vessels and the possible role of bronchopulmonary anastomoses in the development of plexogenic arteriopathy. On the basis of available evidence, we propose a paradigm in which metabolic abnormalities, genetic injury, and systemic vascular dysfunction contribute to systemic manifestations in PAH. This concept not only opens exciting research possibilities but also encourages clinicians to consider extrapulmonary manifestations in their management of patients with PAH.
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Affiliation(s)
- Nils P Nickel
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
| | - Ke Yuan
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
| | - Peter Dorfmuller
- Department of Pathology, University of Giessen, Giessen, Germany
| | - Steeve Provencher
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Yen-Chun Lai
- Division of Pulmonary and Critical Care Medicine, Indiana University, Bloomington, Indiana
| | - Sebastien Bonnet
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada
| | - Eric D Austin
- Division of Pediatric Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville Tennessee
| | - Carl D Koch
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alison Morris
- Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frédéric Perros
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Quebec, Canada.,Inserm Université Paris Sud-Centre chirurgical Marie Lannelongue 999, Université Paris Sud-Paris Saclay, Hôpital Marie Lannelongue, Le Plessis Robinson, France; and
| | - David Montani
- Inserm Université Paris Sud-Centre chirurgical Marie Lannelongue 999, Université Paris Sud-Paris Saclay, Hôpital Marie Lannelongue, Le Plessis Robinson, France; and.,Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, California
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27
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Ferris JK, Inglis JT, Madden KM, Boyd LA. Brain and Body: A Review of Central Nervous System Contributions to Movement Impairments in Diabetes. Diabetes 2020; 69:3-11. [PMID: 31862690 DOI: 10.2337/db19-0321] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/20/2019] [Indexed: 11/13/2022]
Abstract
Diabetes is associated with a loss of somatosensory and motor function, leading to impairments in gait, balance, and manual dexterity. Data-driven neuroimaging studies frequently report a negative impact of diabetes on sensorimotor regions in the brain; however, relationships with sensorimotor behavior are rarely considered. The goal of this review is to consider existing diabetes neuroimaging evidence through the lens of sensorimotor neuroscience. We review evidence for diabetes-related disruptions to three critical circuits for movement control: the cerebral cortex, the cerebellum, and the basal ganglia. In addition, we discuss how central nervous system (CNS) degeneration might interact with the loss of sensory feedback from the limbs due to peripheral neuropathy to result in motor impairments in individuals with diabetes. We argue that our understanding of movement impairments in individuals with diabetes is incomplete without the consideration of disease complications in both the central and peripheral nervous systems. Neuroimaging evidence for disrupted central sensorimotor circuitry suggests that there may be unrecognized behavioral impairments in individuals with diabetes. Applying knowledge from the existing literature on CNS contributions to motor control and motor learning in healthy individuals provides a framework for hypothesis generation for future research on this topic.
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Affiliation(s)
- Jennifer K Ferris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - J Timothy Inglis
- Department of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Kenneth M Madden
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lara A Boyd
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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28
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Kleinloog JPD, Mensink RP, Ivanov D, Adam JJ, Uludağ K, Joris PJ. Aerobic Exercise Training Improves Cerebral Blood Flow and Executive Function: A Randomized, Controlled Cross-Over Trial in Sedentary Older Men. Front Aging Neurosci 2019; 11:333. [PMID: 31866855 PMCID: PMC6904365 DOI: 10.3389/fnagi.2019.00333] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/19/2019] [Indexed: 12/31/2022] Open
Abstract
Background Physical activity may attenuate age-related cognitive decline by improving cerebrovascular function. The aim of this study was therefore to investigate effects of aerobic exercise training on cerebral blood flow (CBF), which is a sensitive physiological marker of cerebrovascular function, in sedentary older men. Methods Seventeen apparently healthy men, aged 60–70 years and with a BMI between 25 and 35 kg/m2, were included in a randomized, controlled cross-over trial. Study participants were randomly allocated to a fully-supervised, progressive, aerobic exercise training or no-exercise control period for 8 weeks, separated by a 12-week wash-out period. Measurements at the end of each period included aerobic fitness evaluated using peak oxygen consumption during incremental exercise (VO2peak), CBF measured with pseudo-continuous arterial spin labeling magnetic resonance imaging, and post-load glucose responses determined using an oral glucose tolerance test (OGTT). Furthermore, cognitive performance was assessed in the domains of executive function, memory, and psychomotor speed. Results VO2peak significantly increased following aerobic exercise training compared to no-exercise control by 262 ± 236 mL (P < 0.001). CBF was increased by 27% bilaterally in the frontal lobe, particularly the subcallosal and anterior cingulate gyrus (cluster volume: 1008 mm3; P < 0.05), while CBF was reduced by 19% in the right medial temporal lobe, mainly temporal fusiform gyrus (cluster volume: 408 mm3; P < 0.05). Mean post-load glucose concentrations determined using an OGTT decreased by 0.33 ± 0.63 mmol/L (P = 0.049). Furthermore, executive function improved as the latency of response was reduced by 5% (P = 0.034), but no changes were observed in memory or psychomotor speed. Conclusion Aerobic exercise training improves regional CBF in sedentary older men. These changes in CBF may underlie exercise-induced beneficial effects on executive function, which could be partly mediated by improvements in glucose metabolism. This clinical trial is registered on ClinicalTrials.gov as NCT03272061.
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Affiliation(s)
- Jordi P D Kleinloog
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Dimo Ivanov
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Jos J Adam
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Kamil Uludağ
- Department of Biomedical Engineering, N Center, Sungkyunkwan University, Suwon, South Korea.,Techna Institute & Koerner Scientist in MR Imaging, University Health Network, Toronto, ON, Canada
| | - Peter J Joris
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
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Yu Y, Yan LF, Sun Q, Hu B, Zhang J, Yang Y, Dai YJ, Cui WX, Xiu SJ, Hu YC, Heng CN, Liu QQ, Hou JF, Pan YY, Zhai LH, Han TH, Cui GB, Wang W. Neurovascular decoupling in type 2 diabetes mellitus without mild cognitive impairment: Potential biomarker for early cognitive impairment. Neuroimage 2019; 200:644-658. [PMID: 31252056 DOI: 10.1016/j.neuroimage.2019.06.058] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a significant risk factor for mild cognitive impairment (MCI) and the acceleration of MCI to dementia. The high glucose level induce disturbance of neurovascular (NV) coupling is suggested to be one potential mechanism, however, the neuroimaging evidence is still lacking. To assess the NV decoupling pattern in early diabetic status, 33 T2DM without MCI patients and 33 healthy control subjects were prospectively enrolled. Then, they underwent resting state functional MRI and arterial spin labeling imaging to explore the hub-based networks and to estimate the coupling of voxel-wise cerebral blood flow (CBF)-degree centrality (DC), CBF-mean amplitude of low-frequency fluctuation (mALFF) and CBF- mean regional homogeneity (mReHo). We further evaluated the relationship between NV coupling pattern and cognitive performance (false discovery rate corrected). T2DM without MCI patients displayed significant decrease in the absolute CBF-mALFF, CBF-mReHo coupling of CBFnetwork and in the CBF-DC coupling of DCnetwork. Besides, networks which involved CBF and DC hubs mainly located in the default mode network (DMN). Furthermore, less severe disease and better cognitive performance in T2DM patients were significantly correlated with higher coupling of CBF-DC, CBF-mALFF or CBF-mReHo, especially for the cognitive dimensions of general function and executive function. Thus, coupling of CBF-DC, CBF-mALFF and CBF-mReHo may serve as promising indicators to reflect NV coupling state and to explain the T2DM related early cognitive impairment.
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Affiliation(s)
- Ying Yu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Qian Sun
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Bo Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Jin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), 15 West Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Wu-Xun Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Si-Jie Xiu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Chun-Ni Heng
- Department of Endocrinology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Qing-Quan Liu
- Department of Endocrinology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Jun-Feng Hou
- Department of Endocrinology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Yu-Yun Pan
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Liang-Hao Zhai
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Teng-Hui Han
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 Changle Road, Xi'an, 710032, Shaanxi, China.
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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30
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Abstract
Given current lack of therapies for dementia, there is substantial interest in identifying potentially modifiable risk factors. Clarifying the potential of these factors to mitigate risk as well as determining the mechanisms that link these factors to dementia is expected to lead to new approaches for both preventing and treating neurodegenerative diseases such as Alzheimer disease. Modifiable factors include cardiovascular risks as well as related lifestyle-centric factors such as diet and physical activity (reviewed in this issue). Given reports that type 2 diabetes and associated features increase the risk for developing dementia, there has been tremendous interest in exploring whether use of antidiabetic medications may impact the risk of dementia, as well as whether antidiabetic medications could be used to prevent or treat dementia, particularly Alzheimer disease. This review will briefly cover the known links between diabetes and risk for dementia, the state of evidence linking antidiabetic treatments with either protection against dementia or possibly increased risk for cognitive dysfunction, and provide a brief overview of what has been learned from clinical trials testing antidiabetic treatments in Alzheimer disease.
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31
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Shrestha S, Poudel RS, Pradhan S, Adhikari A, Giri A, Poudel A. Factors predicting home medication management practices among chronically ill older population of selected districts of Nepal. BMC Geriatr 2019; 19:55. [PMID: 30813908 PMCID: PMC6391813 DOI: 10.1186/s12877-019-1081-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older population often have multiple and complex needs that are consequently challenged by the presence of polypharmacy, adverse drug reactions and drug-drug interaction. We aimed to determine home medication management practices (MMP) and its associated factors among chronically ill older population of selected districts of Nepal. METHODS A community based cross-sectional survey was conducted among 386 chronically ill older individuals from selected areas of Nepal between April to September 2016. Appropriateness of MMP was assessed through scores of questions using interview method. Multivariate logistic regression analysis using potential variables from bivariate analysis were used to determine factors affecting MMP. RESULTS The overall home MMP was mostly inappropriate (80.1%). Most participants had multiple prescribers for single disease (202, 52.3%) and inappropriate medication storage (188, 48.7%). Though the majority of them had drug administration schedule (378, 97.9%), expired medicines were also used (2, 0.5%). Regression analysis showed less than one year duration of disease (odds ratio [OR] = 3.901, 95% confidence interval [CI] = 1.528 to 9.959, P = 0.004), 1-2 years duration of disease (OR = 2.415, 95% CI = 1.210 to 4.821, P = 0.012) and smokers (OR = 2.025, 95% CI = 1.036 to 3.956, P = 0.039) as the major factors affecting appropriate home MMP. CONCLUSIONS The home MMP was associated with duration of disease and smoking status among chronically ill older patients living in selected districts of Nepal. Proper counselling and monitoring of such patients might be necessary to improve the practice.
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Affiliation(s)
- Shakti Shrestha
- Department of Pharmacy, Shree Medical and Technical College, Main Block, Bharatpur-12, Chitwan, Nepal. .,School of Pharmacy, University of Queensland, Brisbane, QLD, Australia.
| | - Ramesh Sharma Poudel
- Hospital Pharmacy, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal.,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Saroj Pradhan
- Department of Pharmacy, Shree Medical and Technical College, Main Block, Bharatpur-12, Chitwan, Nepal
| | - Aashutosh Adhikari
- Department of Pharmacy, Shree Medical and Technical College, Main Block, Bharatpur-12, Chitwan, Nepal
| | - Arjun Giri
- Department of Pharmacy, Shree Medical and Technical College, Main Block, Bharatpur-12, Chitwan, Nepal
| | - Arjun Poudel
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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32
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Bangen KJ, Werhane ML, Weigand AJ, Edmonds EC, Delano-Wood L, Thomas KR, Nation DA, Evangelista ND, Clark AL, Liu TT, Bondi MW. Reduced Regional Cerebral Blood Flow Relates to Poorer Cognition in Older Adults With Type 2 Diabetes. Front Aging Neurosci 2018; 10:270. [PMID: 30250430 PMCID: PMC6139361 DOI: 10.3389/fnagi.2018.00270] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/22/2018] [Indexed: 12/27/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) increases risk for dementia, including Alzheimer's disease (AD). Many previous studies of brain changes underlying cognitive impairment in T2DM have applied conventional structural magnetic resonance imaging (MRI) to detect macrostructural changes associated with cerebrovascular disease such as white matter hyperintensities or infarcts. However, such pathology likely reflects end-stage manifestations of chronic decrements in cerebral blood flow (CBF). MRI techniques that measure CBF may (1) elucidate mechanisms that precede irreversible parenchymal damage and (2) serve as a marker of risk for cognitive decline. CBF measured with arterial spin labeling (ASL) MRI may be a useful marker of perfusion deficits in T2DM and related conditions. We examined associations among T2DM, CBF, and cognition in a sample of 49 well-characterized nondemented older adults. Along with a standard T1-weighted scan, a pseudocontinuous ASL sequence optimized for older adults (by increasing post-labeling delays to allow more time for the blood to reach brain tissue) was obtained on a 3T GE scanner to measure regional CBF in FreeSurfer derived regions of interest. Participants also completed a neuropsychological assessment. Results showed no significant differences between individuals with and without T2DM in terms of cortical thickness or regional brain volume. However, adjusting for age, sex, comorbid vascular risk factors, and reference CBF (postcentral gyrus) older adults with T2DM demonstrated reduced CBF in the hippocampus, and inferior temporal, inferior parietal, and frontal cortices. Lower CBF was associated with poorer memory and executive function/processing speed. When adjusting for diabetes, the significant associations between lower regional CBF and poorer executive function/processing speed remained. Results demonstrate that CBF is reduced in older adults with T2DM, and suggest that CBF alterations likely precede volumetric changes. Notably, relative to nondiabetic control participants, those with T2DM showed lower CBF in predilection sites for AD pathology (medial temporal lobe and inferior parietal regions). Findings augment recent research suggesting that perfusion deficits may underlie cognitive decrements frequently observed among older adults with T2DM. Results also suggest that CBF measured with ASL MRI may reflect an early and important marker of risk of cognitive impairment in T2DM and related conditions.
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Affiliation(s)
- Katherine J Bangen
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Madeleine L Werhane
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Alexandra J Weigand
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Emily C Edmonds
- Research Service, VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Lisa Delano-Wood
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Kelsey R Thomas
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Daniel A Nation
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | | | - Alexandra L Clark
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Thomas T Liu
- Department of Radiology and Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Mark W Bondi
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Psychology Service, VA San Diego Healthcare System, San Diego, CA, United States
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33
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Chen Y, Duan W, Sehrawat P, Chauhan V, Alfaro FJ, Gavrieli A, Qiao X, Novak V, Dai W. Improved perfusion pattern score association with type 2 diabetes severity using machine learning pipeline: Pilot study. J Magn Reson Imaging 2018; 49:834-844. [PMID: 30079560 DOI: 10.1002/jmri.26256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 06/26/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with alterations in the blood-brain barrier, neuronal damage, and arterial stiffness, thus affecting cerebral metabolism and perfusion. There is a need to implement machine-learning methodologies to identify a T2DM-related perfusion pattern and possible relationship between the pattern and cognitive performance/disease severity. PURPOSE To develop a machine-learning pipeline to investigate the method's discriminative value between T2DM patients and normal controls, the T2DM-related network pattern, and association of the pattern with cognitive performance/disease severity. STUDY TYPE A cross-sectional study and prospective longitudinal study with a 2-year time interval. POPULATION Seventy-three subjects (41 T2DM patients and 32 controls) aged 50-85 years old at baseline, and 42 subjects (19 T2DM and 23 controls) aged 53-88 years old at 2-year follow-up. FIELD STRENGTH/SEQUENCE 3T pseudocontinuous arterial spin-labeling MRI. ASSESSMENT Machine-learning-based pipeline (principal component analysis, feature selection, and logistic regression classifier) to generate the T2DM-related network pattern and the individual scores associated with the pattern. STATISTICAL TESTS Linear regression analysis with gray matter volume and education years as covariates. RESULTS The machine-learning-based method is superior to the widely used univariate group comparison method with increased test accuracy, test area under the curve, test positive predictive value, adjusted McFadden's R square of 4%, 12%, 7%, and 24%, respectively. The pattern-related individual scores are associated with diabetes severity variables, mobility, and cognitive performance at baseline (P < 0.05, |r| > 0.3). More important, the longitudinal change of individual pattern scores is associated with the longitudinal change of HbA1c (P = 0.0053, r = 0.64), and baseline cholesterol (P = 0.037, r = 0.51). DATA CONCLUSION The individual perfusion diabetes pattern score is a highly promising perfusion imaging biomarker for tracing the disease progression of individual T2DM patients. Further validation is needed from a larger study. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:834-844.
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Affiliation(s)
- Yuheng Chen
- Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA
| | - Wenna Duan
- Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA
| | - Parshant Sehrawat
- Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA
| | - Vaibhav Chauhan
- Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA
| | - Freddy J Alfaro
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Gavrieli
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Xingye Qiao
- Department of Mathematical Sciences, State University of New York at Binghamton, Binghamton, New York, USA
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Weiying Dai
- Department of Computer Science, State University of New York at Binghamton, Binghamton, New York, USA
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34
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Shen Y, Zhao B, Yan L, Jann K, Wang G, Wang J, Wang B, Pfeuffer J, Qian T, Wang DJJ. Cerebral Hemodynamic and White Matter Changes of Type 2 Diabetes Revealed by Multi-TI Arterial Spin Labeling and Double Inversion Recovery Sequence. Front Neurol 2017; 8:717. [PMID: 29312135 PMCID: PMC5743674 DOI: 10.3389/fneur.2017.00717] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/12/2017] [Indexed: 01/07/2023] Open
Abstract
Diabetes has been reported to affect the microvasculature and lead to cerebral small vessel disease (SVD). Past studies using arterial spin labeling (ASL) at single post-labeling delay reported reduced cerebral blood flow (CBF) in patients with type 2 diabetes. The purpose of this study was to characterize cerebral hemodynamic changes of type 2 diabetes using a multi-inversion-time 3D GRASE pulsed ASL (PASL) sequence to simultaneously measure CBF and bolus arrival time (BAT). Thirty-six patients with type 2 diabetes (43-71 years, 17 male) and 36 gender- and age-matched control subjects underwent MRI scans at 3 T. Mean CBF/BAT values were computed for gray and white matter (GM and WM) of each subject, while a voxel-wise analysis was performed for comparison of regional CBF and BAT between the two groups. In addition, white matter hyperintensities (WMHs) were detected by a double inversion recovery (DIR) sequence with relatively high sensitivity and spatial resolution. Mean CBF of the WM, but not GM, of the diabetes group was significantly lower than that of the control group (p < 0.0001). Regional CBF decreases were detected in the left middle occipital gyrus (p = 0.0075), but failed to reach significance after correction of partial volume effects. BAT increases were observed in the right calcarine fissure (p < 0.0001), left middle occipital gyrus (p < 0.0001), and right middle occipital gyrus (p = 0.0011). Within the group of diabetic patients, BAT in the right middle occipital gyrus was positively correlated with the disease duration (r = 0.501, p = 0.002), BAT in the left middle occipital gyrus was negatively correlated with the binocular visual acuity (r = -0.408, p = 0.014). Diabetic patients also had more WMHs than the control group (p = 0.0039). Significant differences in CBF, BAT, and more WMHs were observed in patients with diabetes, which may be related to impaired vision and risk of SVD of type 2 diabetes.
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Affiliation(s)
- Yelong Shen
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.,Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Bin Zhao
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Lirong Yan
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
| | - Guangbin Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Junli Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Bao Wang
- School of Medicine, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | | | - Tianyi Qian
- Siemens Healthcare, MR Collaborations NE Asia, Beijing, China
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Keck School of Medicine, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California (USC), Los Angeles, CA, United States
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