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Droś J, Klimkowicz-Mrowiec A. Current view on post-stroke dementia. Psychogeriatrics 2021; 21:407-417. [PMID: 33608997 DOI: 10.1111/psyg.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Dementia is one of the leading complications after stroke affecting about one third of survivors. Prevalence of post-stroke dementia (PSD) differs between studies due to variability in methodology, characteristics of included patients, type of stroke, diagnostic tools used to identify patients with dementia, or time when the assessment was performed. Patients diagnosed with PSD are at higher risk of mortality, disability, and institutionalization. Aetiology of PSD may include mixed overlapping processes such as vascular brain pathology or Alzheimer's disease. Several risk factors have been found to increase PSD incidence, involving demographics, vascular factors, stroke characteristics, abnormalities on neuroimaging, and stroke complications. However, the influence of some other factors still remains unclear. PSD may coexist with other neuropsychiatric disorders and its association with post-stroke depression seems to be the most significant. There is a strong need for further research on possible genetic, biological, and inflammatory biomarkers. Also, there are no unambiguously efficacious methods of management. Continuing to address these issues will help to find more effective interventions directly targeting prevention and treatment of PSD in the future.
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Affiliation(s)
- Jakub Droś
- Doctoral School in Medical and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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2
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Abstract
Alzheimer's disease (AD) is the most common cause of dementia and accounts for approximately 50% to 80% of all cases of dementia. The diagnosis of probable AD is based on clinical criteria and overlapping clinical features pose a challenge to accurate diagnosis. However, neuroimaging has been included as a biomarker in various published criteria for the diagnosis of probable AD, in the absence of a confirmatory diagnostic test during life. Advances in neuroimaging techniques and their inclusion in diagnostic and research criteria for the diagnosis of AD includes the use of positron emission tomography (PET) imaging as a biomarker in various therapeutic and prognostic studies in AD. The development and application of a range of PET tracers will allow more detailed assessment of people with AD and will improve diagnostic specificity and targeted therapy of AD. The aim of this review is to summarize current evidence on PET imaging using the non-specific tracer [18F]fluorodeoxyglucose and specific tracers that target amyloid and tau pathology in people with AD.
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Affiliation(s)
- Shailendra Mohan Tripathi
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Alison D Murray
- Aberdeen Biomedical Imaging Centre, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Kandasamy M, Anusuyadevi M, Aigner KM, Unger MS, Kniewallner KM, de Sousa DMB, Altendorfer B, Mrowetz H, Bogdahn U, Aigner L. TGF-β Signaling: A Therapeutic Target to Reinstate Regenerative Plasticity in Vascular Dementia? Aging Dis 2020; 11:828-850. [PMID: 32765949 PMCID: PMC7390515 DOI: 10.14336/ad.2020.0222] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/22/2020] [Indexed: 12/11/2022] Open
Abstract
Vascular dementia (VaD) is the second leading form of memory loss after Alzheimer's disease (AD). Currently, there is no cure available. The etiology, pathophysiology and clinical manifestations of VaD are extremely heterogeneous, but the impaired cerebral blood flow (CBF) represents a common denominator of VaD. The latter might be the result of atherosclerosis, amyloid angiopathy, microbleeding and micro-strokes, together causing blood-brain barrier (BBB) dysfunction and vessel leakage, collectively originating from the consequence of hypertension, one of the main risk factors for VaD. At the histopathological level, VaD displays abnormal vascular remodeling, endothelial cell death, string vessel formation, pericyte responses, fibrosis, astrogliosis, sclerosis, microglia activation, neuroinflammation, demyelination, white matter lesions, deprivation of synapses and neuronal loss. The transforming growth factor (TGF) β has been identified as one of the key molecular factors involved in the aforementioned various pathological aspects. Thus, targeting TGF-β signaling in the brain might be a promising therapeutic strategy to mitigate vascular pathology and improve cognitive functions in patients with VaD. This review revisits the recent understanding of the role of TGF-β in VaD and associated pathological hallmarks. It further explores the potential to modulate certain aspects of VaD pathology by targeting TGF-β signaling.
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Affiliation(s)
- Mahesh Kandasamy
- Laboratory of Stem Cells and Neuroregeneration, Department of Animal Science, School of Life Sciences, Bharathidasan University, Tiruchirappalli, Tamil Nadu, India.
- Faculty Recharge Programme, University Grants Commission (UGC-FRP), New Delhi, India.
| | - Muthuswamy Anusuyadevi
- Molecular Gerontology Group, Department of Biochemistry, School of Life Sciences, Bharathidhasan University, Tiruchirappalli, Tamil Nadu, India.
| | - Kiera M Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Michael S Unger
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Kathrin M Kniewallner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Diana M Bessa de Sousa
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Heike Mrowetz
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Ulrich Bogdahn
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Velvio GmbH, Regensburg, Germany.
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Salzburg, Paracelsus Medical University.
- Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Paracelsus Medical University, Salzburg, Austria.
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Hameed S, Fuh JL, Senanarong V, Ebenezer EGM, Looi I, Dominguez JC, Park KW, Karanam AK, Simon O. Role of Fluid Biomarkers and PET Imaging in Early Diagnosis and its Clinical Implication in the Management of Alzheimer's Disease. J Alzheimers Dis Rep 2020; 4:21-37. [PMID: 32206755 PMCID: PMC7081089 DOI: 10.3233/adr-190143] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
Clinical diagnosis of Alzheimer's disease (AD) is based on symptoms; however, the challenge is to diagnose AD at the preclinical stage with the application of biomarkers and initiate early treatment (still not widely available). Currently, cerebrospinal fluid (CSF) amyloid-β 42 (Aβ42) and tau are used in the clinical diagnosis of AD; nevertheless, blood biomarkers (Aβ42 and tau) are less predictive. Amyloid-positron emission tomography (PET) imaging is an advancement in technology that uses approved radioactive diagnostic agents (florbetapir, flutemetamol, or florbetaben) to estimate Aβ neuritic plaque density in adults with cognitive impairment evaluated for AD and other causes of cognitive decline. There is no cure for AD to date-the disease progression cannot be stopped or reversed; approved pharmacological agents (donepezil, galantamine, and rivastigmine; memantine) provide symptomatic treatment. However, the disease-modifying therapies are promising; aducanumab and CAD106 are in phase III trials for the early stages of AD. In conclusion, core CSF biomarkers reflect pathophysiology of AD in the early and late stages; the application of approved radiotracers have potential in amyloid-PET brain imaging to detect early AD.
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Affiliation(s)
- Shahul Hameed
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore
- Duke NUS Medical School, Singapore
| | - Jong-Ling Fuh
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Vorapun Senanarong
- Division of Neurology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Penang, Malaysia
- Department of Medicine, Hospital Seberang Jaya, Penang, Malaysia
| | | | - Kyung Won Park
- Department of Neurology and Cognitive Disorders and Dementia Center, Institute of Convergence Bio-Health, Dong-A University College of Medicine, Busan, Republic of Korea
| | | | - Oliver Simon
- Novartis (Singapore) Pte. Ltd., Singapore, Singapore
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Functional magnetic resonance imaging responses in CADASIL. J Neurol Sci 2017; 375:248-254. [DOI: 10.1016/j.jns.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/22/2022]
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Park M, Moon WJ. Structural MR Imaging in the Diagnosis of Alzheimer's Disease and Other Neurodegenerative Dementia: Current Imaging Approach and Future Perspectives. Korean J Radiol 2016; 17:827-845. [PMID: 27833399 PMCID: PMC5102911 DOI: 10.3348/kjr.2016.17.6.827] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/26/2016] [Indexed: 11/29/2022] Open
Abstract
With the rise of aging population, clinical concern and research attention has shifted towards neuroimaging of dementia. The advent of 3T, magnetic resonance imaging (MRI) has permitted the anatomical imaging of neurodegenerative disease, specifically dementia, with improved resolution. Furthermore, more powerful techniques such as diffusion tensor imaging, quantitative susceptibility mapping, and magnetic transfer imaging have successfully emerged for the detection of micro-structural abnormalities. In the present review article, we provide a brief overview of Alzheimer's disease and explore recent neuroimaging developments in the field of dementia with an emphasis on structural MR imaging in order to propose a simple and easily applicable systematic approach to the imaging diagnosis of dementia.
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Affiliation(s)
- Mina Park
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
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Multimodality Imaging of Neurodegenerative Processes: Part 1, The Basics and Common Dementias. AJR Am J Roentgenol 2016; 207:871-882. [PMID: 27505704 DOI: 10.2214/ajr.14.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Multimodality imaging plays an important role in the structural and functional characterization of neurodegenerative conditions. This article illustrates the basic concepts of anatomic, metabolic, and amyloid imaging and describes the application of a multimodality approach in the evaluation of patients with the more common neurodegenerative dementia processes. Proper utilization of clinically available imaging techniques allows greater insight into these common disease processes. CONCLUSION Recognizing the strength of combined anatomic, metabolic, and amyloid imaging can allow a more complete and confident assessment of patients with common degenerative dementias. This added knowledge can improve clinical care, allow initiation of appropriate therapies and counseling, and improve prognostication.
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Kim YH. Understanding the Role of Neurorehabilitationist in Managing Patients with Dementia. BRAIN & NEUROREHABILITATION 2015. [DOI: 10.12786/bn.2015.8.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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Nelson JW, Young JM, Borkar RN, Woltjer RL, Quinn JF, Silbert LC, Grafe MR, Alkayed NJ. Role of soluble epoxide hydrolase in age-related vascular cognitive decline. Prostaglandins Other Lipid Mediat 2014; 113-115:30-7. [PMID: 25277097 DOI: 10.1016/j.prostaglandins.2014.09.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/21/2014] [Accepted: 09/19/2014] [Indexed: 01/20/2023]
Abstract
P450 eicosanoids are important regulators of the cerebral microcirculation, but their role in cerebral small vessel disease is unclear. We tested the hypothesis that vascular cognitive impairment (VCI) is linked to reduced cerebral microvascular eicosanoid signaling. We analyzed human brain tissue from individuals formerly enrolled in the Oregon Brain Aging Study, who had a history of cognitive impairment histopathological evidence of microvascular disease. VCI subjects had significantly higher lesion burden both on premortem MRI and postmortem histopathology compared to age- and sex-matched controls. Mass spectrometry-based eicosanoid analysis revealed that 14,15-dihydroxyeicosatrienoic acid (DHET) was elevated in cortical brain tissue from VCI subjects. Immunoreactivity of soluble epoxide hydrolase (sEH), the enzyme responsible for 14,15-DHET formation, was localized to cerebral microvascular endothelium, and was enhanced in microvessels of affected tissue. Finally, we evaluated the genotype frequency of two functional single nucleotide polymorphisms of sEH gene EPHX2 in VCI and control groups. Our findings support a role for sEH and a potential benefit from sEH inhibitors in age-related VCI.
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Affiliation(s)
- Jonathan W Nelson
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA; The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Jennifer M Young
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Rohan N Borkar
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Randy L Woltjer
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Joseph F Quinn
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Lisa C Silbert
- Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Marjorie R Grafe
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA; Department of Pathology, Oregon Health & Science University, Portland, OR 97239-3098, USA
| | - Nabil J Alkayed
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA; Layton Aging and Alzheimer's Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA; The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR 97239-3098, USA.
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