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Huang WQ, Lin Q, Tzeng CM. Leukoaraiosis: Epidemiology, Imaging, Risk Factors, and Management of Age-Related Cerebral White Matter Hyperintensities. J Stroke 2024; 26:131-163. [PMID: 38836265 PMCID: PMC11164597 DOI: 10.5853/jos.2023.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Leukoaraiosis (LA) manifests as cerebral white matter hyperintensities on T2-weighted magnetic resonance imaging scans and corresponds to white matter lesions or abnormalities in brain tissue. Clinically, it is generally detected in the early 40s and is highly prevalent globally in individuals aged >60 years. From the imaging perspective, LA can present as several heterogeneous forms, including punctate and patchy lesions in deep or subcortical white matter; lesions with periventricular caps, a pencil-thin lining, and smooth halo; as well as irregular lesions, which are not always benign. Given its potential of having deleterious effects on normal brain function and the resulting increase in public health burden, considerable effort has been focused on investigating the associations between various risk factors and LA risk, and developing its associated clinical interventions. However, study results have been inconsistent, most likely due to potential differences in study designs, neuroimaging methods, and sample sizes as well as the inherent neuroimaging heterogeneity and multi-factorial nature of LA. In this article, we provided an overview of LA and summarized the current knowledge regarding its epidemiology, neuroimaging classification, pathological characteristics, risk factors, and potential intervention strategies.
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Affiliation(s)
- Wen-Qing Huang
- Department of Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Lin
- Department of Neurology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Fujian Provincial Clinical Research Center for Brain Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Chi-Meng Tzeng
- Translational Medicine Research Center, School of Pharmaceutical Sciences, Xiamen University, Xiamen, Fujian, China
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Melazzini L, Vitali P, Olivieri E, Bolchini M, Zanardo M, Savoldi F, Di Leo G, Griffanti L, Baselli G, Sardanelli F, Codari M. White Matter Hyperintensities Quantification in Healthy Adults: A Systematic Review and Meta-Analysis. J Magn Reson Imaging 2020; 53:1732-1743. [PMID: 33345393 DOI: 10.1002/jmri.27479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although white matter hyperintensities (WMH) volumetric assessment is now customary in research studies, inconsistent WMH measures among homogenous populations may prevent the clinical usability of this biomarker. PURPOSE To determine whether a point estimate and reference standard for WMH volume in the healthy aging population could be determined. STUDY TYPE Systematic review and meta-analysis. POPULATION In all, 9716 adult subjects from 38 studies reporting WMH volume were retrieved following a systematic search on EMBASE. FIELD STRENGTH/SEQUENCE 1.0T, 1.5T, or 3.0T/fluid-attenuated inversion recovery (FLAIR) and/or proton density/T2 -weighted fast spin echo sequences or gradient echo T1 -weighted sequences. ASSESSMENT After a literature search, sample size, demographics, magnetic field strength, MRI sequences, level of automation in WMH assessment, study population, and WMH volume were extracted. STATISTICAL TESTS The pooled WMH volume with 95% confidence interval (CI) was calculated using the random-effect model. The I2 statistic was calculated as a measure of heterogeneity across studies. Meta-regression analysis of WMH volume on age was performed. RESULTS Of the 38 studies analyzed, 17 reported WMH volume as the mean and standard deviation (SD) and were included in the meta-analysis. Mean and SD of age was 66.11 ± 10.92 years (percentage of men 50.45% ± 21.48%). Heterogeneity was very high (I2 = 99%). The pooled WMH volume was 4.70 cm3 (95% CI: 3.88-5.53 cm3 ). At meta-regression analysis, WMH volume was positively associated with subjects' age (β = 0.358 cm3 per year, P < 0.05, R2 = 0.27). DATA CONCLUSION The lack of standardization in the definition of WMH together with the high technical variability in assessment may explain a large component of the observed heterogeneity. Currently, volumes of WMH in healthy subjects are not comparable between studies and an estimate and reference interval could not be determined. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Luca Melazzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Paolo Vitali
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Olivieri
- Medicine and Surgery Medical School, Università degli Studi di Milano, Milano, Italy
| | - Marco Bolchini
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Moreno Zanardo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiology, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ludovica Griffanti
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging (WIN), University of Oxford, Oxford, UK
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Rushia SN, Shehab AAS, Motter JN, Egglefield DA, Schiff S, Sneed JR, Garcon E. Vascular depression for radiology: A review of the construct, methodology, and diagnosis. World J Radiol 2020; 12:48-67. [PMID: 32549954 PMCID: PMC7288775 DOI: 10.4329/wjr.v12.i5.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Vascular depression (VD) as defined by magnetic resonance imaging (MRI) has been proposed as a unique subtype of late-life depression. The VD hypothesis posits that cerebrovascular disease, as characterized by the presence of MRI-defined white matter hyperintensities, contributes to and increases the risk for depression in older adults. VD is also accompanied by cognitive impairment and poor antidepressant treatment response. The VD diagnosis relies on MRI findings and yet this clinical entity is largely unfamiliar to neuroradiologists and is rarely, if ever, discussed in radiology journals. The primary purpose of this review is to introduce the MRI-defined VD construct to the neuroradiology community. Case reports are highlighted in order to illustrate the profile of VD in terms of radiological, clinical, and neuropsychological findings. A secondary purpose is to elucidate and elaborate on the measurement of cerebrovascular disease through visual rating scales and semi- and fully-automated volumetric methods. These methods are crucial for determining whether lesion burden or lesion severity is the dominant pathological contributor to VD. Additionally, these rating methods have implications for the growing field of computer assisted diagnosis. Since VD has been found to have a profile that is distinct from other types of late-life depression, neuroradiologists, in conjunction with psychiatrists and psychologists, should consider VD in diagnosis and treatment planning.
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Affiliation(s)
- Sara N Rushia
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Al Amira Safa Shehab
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Jeffrey N Motter
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | - Dakota A Egglefield
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Sophie Schiff
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Joel R Sneed
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | - Ernst Garcon
- Department of Radiology, Columbia University Medical Center, New York, NY 10032, United States
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Guo C, Niu K, Luo Y, Shi L, Wang Z, Zhao M, Wang D, Zhu W, Zhang H, Sun L. Intra-Scanner and Inter-Scanner Reproducibility of Automatic White Matter Hyperintensities Quantification. Front Neurosci 2019; 13:679. [PMID: 31354406 PMCID: PMC6635556 DOI: 10.3389/fnins.2019.00679] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate white matter hyperintensities (WMH) quantification reproducibility from multiple aspects of view and examine the effects of scan-rescan procedure, types of scanner, imaging protocols, scanner software upgrade, and automatic segmentation tools on WMH quantification results using magnetic resonance imaging (MRI). Methods: Six post-stroke subjects (4 males; mean age = 62.8, range = 58-72 years) were scanned and rescanned with both 3D T1-weighted, 2D and 3D T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MRI across four different MRI scanners within 12 h. Two automated WMH segmentation and quantification tools were used to measure WMH volume based on each MR scan. Robustness was assessed using the coefficient of variation (CV), Dice similarity coefficient (DSC), and intra-class correlation (ICC). Results: Experimental results show that the best reproducibility was achieved by using 3D T2-FLAIR MRI under intra-scanner setting with CV ranging from 2.69 to 2.97%, while the largest variability resulted from comparing WMH volumes measured based on 2D T2-FLAIR MRI with those of 3D T2-FLAIR MRI, with CV values in the range of 15.62%-29.33%. The WMH quantification variability based on 2D MRIs is larger than 3D MRIs due to their large slice thickness. The DSC of WMH segmentation labels between intra-scanner MRIs ranges from 0.63 to 0.77, while that for inter-scanner MRIs is in the range of 0.63-0.65. In addition to image acquisition, the choice of automatic WMH segmentation tool also has a large impact on WMH quantification. Conclusion: WMH reproducibility is one of the primary issues to be considered in multicenter and longitudinal studies. The study provides solid guidance in assisting multicenter and longitudinal study design to achieve meaningful results with enough power.
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Affiliation(s)
- Chunjie Guo
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Kai Niu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yishan Luo
- BrainNow Medical Technology Limited, Sha Tin, Hong Kong
| | - Lin Shi
- BrainNow Medical Technology Limited, Sha Tin, Hong Kong.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Zhuo Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Meng Zhao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Defeng Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Wan'an Zhu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Li Sun
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Deng Y, McQuoid DR, Potter GG, Steffens DC, Albert K, Riddle M, Beyer JL, Taylor WD. Predictors of recurrence in remitted late-life depression. Depress Anxiety 2018; 35:658-667. [PMID: 29749006 PMCID: PMC6035781 DOI: 10.1002/da.22772] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-life depression (LLD) is associated with a fragile antidepressant response and high recurrence risk. This study examined what measures predict recurrence in remitted LLD. METHODS Individuals of age 60 years or older with a Diagnostic and Statistical Manual - IV (DSM-IV) diagnosis of major depressive disorder were enrolled in the neurocognitive outcomes of depression in the elderly study. Participants received manualized antidepressant treatment and were followed longitudinally for an average of 5 years. Study analyses included participants who remitted. Measures included demographic and clinical measures, medical comorbidity, disability, life stress, social support, and neuropsychological testing. A subset underwent structural magnetic resonance imaging (MRI). RESULTS Of 241 remitted elders, approximately over 4 years, 137 (56.8%) experienced recurrence and 104 (43.2%) maintained remission. In the final model, greater recurrence risk was associated with female sex (hazard ratio [HR] = 1.536; confidence interval [CI] = 1.027-2.297), younger age of onset (HR = 0.990; CI = 0.981-0.999), higher perceived stress (HR = 1.121; CI = 1.022-1.229), disability (HR = 1.060; CI = 1.005-1.119), and less support with activities (HR = 0.885; CI = 0.812-0.963). Recurrence risk was also associated with higher Montgomery-Asberg Depression Rating Scale (MADRS) scores prior to censoring (HR = 1.081; CI = 1.033-1.131) and baseline symptoms of suicidal thoughts by MADRS (HR = 1.175; CI = 1.002-1.377) and sadness by Center for Epidemiologic Studies-Depression (HR = 1.302; CI, 1.080-1.569). Sex, age of onset, and suicidal thoughts were no longer associated with recurrence in a model incorporating report of multiple prior episodes (HR = 2.107; CI = 1.252-3.548). Neither neuropsychological test performance nor MRI measures of aging pathology were associated with recurrence. CONCLUSIONS Over half of the depressed elders who remitted experienced recurrence, mostly within 2 years. Multiple clinical and environmental measures predict recurrence risk. Work is needed to develop instruments that stratify risk.
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Affiliation(s)
- Yi Deng
- The Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Douglas R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - Guy G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Kimberly Albert
- The Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Meghan Riddle
- The Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - John L. Beyer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - Warren D. Taylor
- The Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA,Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37212, USA
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6
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Sachs-Ericsson NJ, Hajcak G, Sheffler JL, Stanley IH, Selby EA, Potter GG, Steffens DC. Putamen Volume Differences Among Older Adults: Depression Status, Melancholia, and Age. J Geriatr Psychiatry Neurol 2018; 31:39-49. [PMID: 29251178 DOI: 10.1177/0891988717747049] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Individuals with major depressive disorder (MDD) may exhibit smaller striatal volumes reflecting deficits in the reward circuit. Deficits may change with age and be more pronounced among the melancholic subtype. Limited research has investigated striatal volume differences in older adults and by depression subtypes. METHOD We used baseline data from the Neurocognitive Outcomes of Depression in the Elderly study. We examined volumetric differences in the putamen and caudate nucleus among older adults (60 years and older), comparing healthy control participants (n = 134) to depressed participants (n = 226), and comparing nonmelancholic depressed participants (n = 93) to melancholic depressed participants (n = 133). Group-by-age interactions were examined. RESULTS There were no significant group differences for the caudate nucleus. For the left putamen, investigation of the significant group-by-age interaction revealed that volume size was greater for the healthy controls compared to the depressed participants but only at younger ages (60-65 years); group differences diminished with increasing age. Examining volume by depression subtype revealed that the melancholic depressed participants had a smaller left putamen compared to the nonmelancholic depressed participants. Anhedonia symptoms were related to both smaller left and right putamen. CONCLUSION Structural abnormalities in reward regions may underlie the anhedonic phenotype. Volume loss associated with MDD may attenuate in older age.
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Affiliation(s)
| | - Greg Hajcak
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Julia L Sheffler
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Ian H Stanley
- 1 Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Edward A Selby
- 2 Department of Psychology, Rutgers University, Piscataway, NJ, USA
| | - Guy G Potter
- 3 Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - David C Steffens
- 4 Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Johnson AD, McQuoid DR, Steffens DC, Payne ME, Beyer JL, Taylor WD. Effects of stressful life events on cerebral white matter hyperintensity progression. Int J Geriatr Psychiatry 2017; 32:e10-e17. [PMID: 28029184 PMCID: PMC5489375 DOI: 10.1002/gps.4644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Exposure to stressful events is associated with both occurrence of depression and also vascular disease. The objective of this study was to determine whether higher levels of stress exposure was related to measures of pathological brain aging, specifically white matter hyperintensity volumes, in older adults with and without depression. METHODS The sample included 130 depressed and 110 never-depressed older adults aged 60 years or older enrolled in a longitudinal study at an academic medical center. Participants completed clinical assessments, assessment of stressful event exposure and perceived stress, and magnetic resonance imaging at baseline and after 2 years. Analyses examined both cross-sectional and longitudinal relationships between stress measures and white matter hyperintensity volumes. RESULTS There were no statistically significant relationships observed between cross-sectional baseline stress measures and either baseline hyperintensity volume or 2-year change in hyperintensity volume. However, after controlling for demographic variables and baseline measures, change in stressor exposure was associated with change in hyperintensity volumes. In this analysis, increased stressor exposure was associated with greater increases in white matter hyperintensity volume, while reductions in stressor exposure were associated with less increase in hyperintensity volume. This relationship did not significantly differ based on the presence of either depression or medical comorbidities. CONCLUSIONS This work adds to a growing literature associating exposure to stressful events in later life with more rapid pathological brain aging. Work is needed to understand the physiological mechanisms by which stress exposure has this effect and examine whether stress reduction techniques may modify these observed outcomes. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne D. Johnson
- The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Douglas R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Martha E. Payne
- Office of Research Development, Duke University School of Medicine, Durham, NC, 27710, USA
| | - John L. Beyer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA
| | - Warren D. Taylor
- The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, 37212, USA,Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, 37212, USA
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Metric to quantify white matter damage on brain magnetic resonance images. Neuroradiology 2017; 59:951-962. [PMID: 28815362 PMCID: PMC5596039 DOI: 10.1007/s00234-017-1892-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 07/21/2017] [Indexed: 11/27/2022]
Abstract
Purpose Quantitative assessment of white matter hyperintensities (WMH) on structural Magnetic Resonance Imaging (MRI) is challenging. It is important to harmonise results from different software tools considering not only the volume but also the signal intensity. Here we propose and evaluate a metric of white matter (WM) damage that addresses this need. Methods We obtained WMH and normal-appearing white matter (NAWM) volumes from brain structural MRI from community dwelling older individuals and stroke patients enrolled in three different studies, using two automatic methods followed by manual editing by two to four observers blind to each other. We calculated the average intensity values on brain structural fluid-attenuation inversion recovery (FLAIR) MRI for the NAWM and WMH. The white matter damage metric is calculated as the proportion of WMH in brain tissue weighted by the relative image contrast of the WMH-to-NAWM. The new metric was evaluated using tissue microstructure parameters and visual ratings of small vessel disease burden and WMH: Fazekas score for WMH burden and Prins scale for WMH change. Results The correlation between the WM damage metric and the visual rating scores (Spearman ρ > =0.74, p < 0.0001) was slightly stronger than between the latter and WMH volumes (Spearman ρ > =0.72, p < 0.0001). The repeatability of the WM damage metric was better than WM volume (average median difference between measurements 3.26% (IQR 2.76%) and 5.88% (IQR 5.32%) respectively). The follow-up WM damage was highly related to total Prins score even when adjusted for baseline WM damage (ANCOVA, p < 0.0001), which was not always the case for WMH volume, as total Prins was highly associated with the change in the intense WMH volume (p = 0.0079, increase of 4.42 ml per unit change in total Prins, 95%CI [1.17 7.67]), but not with the change in less-intense, subtle WMH, which determined the volumetric change. Conclusion The new metric is practical and simple to calculate. It is robust to variations in image processing methods and scanning protocols, and sensitive to subtle and severe white matter damage. Electronic supplementary material The online version of this article (doi:10.1007/s00234-017-1892-1) contains supplementary material, which is available to authorized users.
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Automatic Detection of White Matter Hyperintensities in Healthy Aging and Pathology Using Magnetic Resonance Imaging: A Review. Neuroinformatics 2016; 13:261-76. [PMID: 25649877 PMCID: PMC4468799 DOI: 10.1007/s12021-015-9260-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
White matter hyperintensities (WMH) are commonly seen in the brain of healthy elderly subjects and patients with several neurological and vascular disorders. A truly reliable and fully automated method for quantitative assessment of WMH on magnetic resonance imaging (MRI) has not yet been identified. In this paper, we review and compare the large number of automated approaches proposed for segmentation of WMH in the elderly and in patients with vascular risk factors. We conclude that, in order to avoid artifacts and exclude the several sources of bias that may influence the analysis, an optimal method should comprise a careful preprocessing of the images, be based on multimodal, complementary data, take into account spatial information about the lesions and correct for false positives. All these features should not exclude computational leanness and adaptability to available data.
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Valdés Hernández MDC, González-Castro V, Ghandour DT, Wang X, Doubal F, Muñoz Maniega S, Armitage PA, Wardlaw JM. On the computational assessment of white matter hyperintensity progression: difficulties in method selection and bias field correction performance on images with significant white matter pathology. Neuroradiology 2016; 58:475-85. [PMID: 26833053 PMCID: PMC4846712 DOI: 10.1007/s00234-016-1648-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Subtle inhomogeneities in the scanner's magnetic fields (B0 and B1) alter the intensity levels of the structural magnetic resonance imaging (MRI) affecting the volumetric assessment of WMH changes. Here, we investigate the influence that (1) correcting the images for the B1 inhomogeneities (i.e. bias field correction (BFC)) and (2) selection of the WMH change assessment method can have on longitudinal analyses of WMH progression and discuss possible solutions. METHODS We used brain structural MRI from 46 mild stroke patients scanned at stroke onset and 3 years later. We tested three BFC approaches: FSL-FAST, N4 and exponentially entropy-driven homomorphic unsharp masking (E(2)D-HUM) and analysed their effect on the measured WMH change. Separately, we tested two methods to assess WMH changes: measuring WMH volumes independently at both time points semi-automatically (MCMxxxVI) and subtracting intensity-normalised FLAIR images at both time points following image gamma correction. We then combined the BFC with the computational method that performed best across the whole sample to assess WMH changes. RESULTS Analysis of the difference in the variance-to-mean intensity ratio in normal tissue between BFC and uncorrected images and visual inspection showed that all BFC methods altered the WMH appearance and distribution, but FSL-FAST in general performed more consistently across the sample and MRI modalities. The WMH volume change over 3 years obtained with MCMxxxVI with vs. without FSL-FAST BFC did not significantly differ (medians(IQR)(with BFC) = 3.2(6.3) vs. 2.9(7.4)ml (without BFC), p = 0.5), but both differed significantly from the WMH volume change obtained from subtracting post-processed FLAIR images (without BFC)(7.6(8.2)ml, p < 0.001). This latter method considerably inflated the WMH volume change as subtle WMH at baseline that became more intense at follow-up were counted as increase in the volumetric change. CONCLUSIONS Measurement of WMH volume change remains challenging. Although the overall volumetric change was not significantly affected by the application of BFC, these methods distorted the image intensity distribution affecting subtle WMH. Subtracting the FLAIR images at both time points following gamma correction seems a promising technique but is adversely affected by subtle WMH. It is important to take into account not only the changes in volume but also in the signal intensity.
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Affiliation(s)
- Maria Del C Valdés Hernández
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Victor González-Castro
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Dina T Ghandour
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Xin Wang
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Fergus Doubal
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Susana Muñoz Maniega
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Paul A Armitage
- Department of Cardiovascular Sciences, University of Sheffield, Sheffield, UK
| | - Joanna M Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brian Sciences, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
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11
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Hybels CF, Pieper CF, Payne ME, Steffens DC. Late-life Depression Modifies the Association Between Cerebral White Matter Hyperintensities and Functional Decline Among Older Adults. Am J Geriatr Psychiatry 2016; 24:42-49. [PMID: 25863558 PMCID: PMC4567962 DOI: 10.1016/j.jagp.2015.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/21/2015] [Accepted: 03/09/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Vascular lesions seen through brain imaging as hyperintensities are associated with both depression and functional impairment in older adults. Our objective was to determine if the relationship between the volume of cerebral white matter hyperintensities (WMHs) and functional decline differed in the presence of late life depression. DESIGN Secondary analysis of data collected through the Neurocognitive Outcomes of Depression Study. Analysis techniques included general linear mixed models examining trajectories of functional change predicted by lesion volume at baseline. PARTICIPANTS 381 participants (244 patients diagnosed with major depression and 137 never depressed comparison participants) ages 60 years and older followed for up to 16 years. MEASUREMENTS WMH volume was measured through analysis of brain magnetic resonance imaging data. Functional limitations included difficulties with basic activities of daily living tasks, instrumental activities of daily living tasks, and mobility. RESULTS Those participants who were both depressed and had a higher volume of WMHs at baseline were most at risk for functional decline across all measures of function. Among the never depressed, those with a higher WMH volume at baseline had a more accelerated rate of functional decline than those with lower WMH volume, and those who were depressed with lower volume of WMH started with more limitations than the never depressed but appeared to progress at a rate similar to those who were never depressed with lower WMH. CONCLUSION Older patients with both cerebrovascular risk factors and depression are at an increased risk for functional decline, and may benefit from the treatment of both conditions.
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Affiliation(s)
- Celia F. Hybels
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham NC 27710, Phone: (919) 660-7546, FAX: (919) 668-0453
| | - Carl F. Pieper
- Department of Biostatistics and Bioinformatics, Center for the Study of Aging and Human Development, Duke University Medical Center
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Neuropsychiatric Imaging Research Laboratory, Center for the Study of Aging and Human Development, Duke University Medical Center
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Sudre CH, Cardoso MJ, Bouvy WH, Biessels GJ, Barnes J, Ourselin S. Bayesian model selection for pathological neuroimaging data applied to white matter lesion segmentation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:2079-2102. [PMID: 25850086 DOI: 10.1109/tmi.2015.2419072] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In neuroimaging studies, pathologies can present themselves as abnormal intensity patterns. Thus, solutions for detecting abnormal intensities are currently under investigation. As each patient is unique, an unbiased and biologically plausible model of pathological data would have to be able to adapt to the subject's individual presentation. Such a model would provide the means for a better understanding of the underlying biological processes and improve one's ability to define pathologically meaningful imaging biomarkers. With this aim in mind, this work proposes a hierarchical fully unsupervised model selection framework for neuroimaging data which enables the distinction between different types of abnormal image patterns without pathological a priori knowledge. Its application on simulated and clinical data demonstrated the ability to detect abnormal intensity clusters, resulting in a competitive to improved behavior in white matter lesion segmentation when compared to three other freely-available automated methods.
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Wardlaw JM, Valdés Hernández MC, Muñoz-Maniega S. What are white matter hyperintensities made of? Relevance to vascular cognitive impairment. J Am Heart Assoc 2015; 4:001140. [PMID: 26104658 PMCID: PMC4599520 DOI: 10.1161/jaha.114.001140] [Citation(s) in RCA: 521] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Joanna M Wardlaw
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Maria C Valdés Hernández
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
| | - Susana Muñoz-Maniega
- Division of Neuroimaging Sciences and Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (J.M.W., M.C.V.H., S.M.M.)
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Taylor WD, McQuoid DR, Payne ME, Zannas AS, MacFall JR, Steffens DC. Hippocampus atrophy and the longitudinal course of late-life depression. Am J Geriatr Psychiatry 2014; 22:1504-12. [PMID: 24378256 PMCID: PMC4031313 DOI: 10.1016/j.jagp.2013.11.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Smaller hippocampal volumes are observed in depression but it remains unclear how antidepressant response and persistent depression relate to changes in hippocampal volume. We examined the longitudinal relationship between hippocampal atrophy and course of late-life depression. SETTING Academic medical center. PARTICIPANTS Depressed and never-depressed cognitively intact subjects age 60 years or older. MEASUREMENTS Depression severity was measured every three months with the Montgomery-Asberg Depression Rating Scale (MADRS). Participants also completed cranial 1.5-T magnetic resonance imaging every 2 years. We compared 2-year change in hippocampal volume based on remission status, then in expanded analyses examined how hippocampal volumes predicted MADRS score. RESULTS In analyses of 92 depressed and 70 never-depressed subjects, over 2 years the cohort whose depression never remitted exhibited greater hippocampal atrophy than the never-depressed cohort. In expanded analyses of a broader sample of 152 depressed elders, depression severity was significantly predicted by a hippocampus × time interaction where smaller hippocampus volumes over time were associated with greater depression severity. CONCLUSIONS Hippocampal atrophy is associated with greater and persistent depression severity. Neuropathological studies are needed to determine if this atrophy is related to the toxic effects of persistent depression or related to underlying Alzheimer disease.
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Affiliation(s)
- Warren D. Taylor
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, 37212
| | - Douglas R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710
| | - Anthony S. Zannas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710
| | - James R. MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, 06030
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Degree of contribution (DoC) feature selection algorithm for structural brain MRI volumetric features in depression detection. Int J Comput Assist Radiol Surg 2014; 10:1003-16. [DOI: 10.1007/s11548-014-1130-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Zannas AS, McQuoid DR, Payne ME, MacFall JR, Ashley-Koch A, Steffens DC, Potter GG, Taylor WD. Association of gene variants of the renin-angiotensin system with accelerated hippocampal volume loss and cognitive decline in old age. Am J Psychiatry 2014; 171:1214-21. [PMID: 25124854 PMCID: PMC4329281 DOI: 10.1176/appi.ajp.2014.13111543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Genetic factors confer risk for neuropsychiatric phenotypes, but the polygenic etiology of these phenotypes makes identification of genetic culprits challenging. An approach to this challenge is to examine the effects of genetic variation on relevant endophenotypes, such as hippocampal volume loss. A smaller hippocampus is associated with gene variants of the renin-angiotensin system (RAS), a system implicated in vascular disease. However, no studies to date have investigated longitudinally the effects of genetic variation of RAS on the hippocampus. METHOD The authors examined the effects of polymorphisms of AGTR1, the gene encoding angiotensin-II type 1 receptor of RAS, on longitudinal hippocampal volumes of older adults. In all, 138 older adults (age ≥60 years) were followed for an average of about 4 years. The participants underwent repeated structural MRI and comprehensive neurocognitive testing, and they were genotyped for four AGTR1 single-nucleotide polymorphisms (SNPs) with low pairwise linkage disequilibrium values and apolipoprotein E (APOE) genotype. RESULTS Genetic variants at three AGTR1 SNPs (rs2638363, rs1492103, and rs2675511) were independently associated with accelerated hippocampal volume loss over the 4-year follow-up period in the right but not left hemisphere. Intriguingly, these AGTR1 risk alleles also predicted worse episodic memory performance but were not related to other cognitive measures. Two risk variants (rs2638363 and rs12721331) interacted with the APOE4 allele to accelerate right hippocampal volume loss. CONCLUSIONS Risk genetic variants of the RAS may accelerate memory decline in older adults, an effect that may be conferred by accelerated hippocampal volume loss. Molecules involved in this system may hold promise as early therapeutic targets for late-life neuropsychiatric disorders.
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Affiliation(s)
- Anthony S. Zannas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710,Max Planck Institute of Psychiatry, Munich, 80804, Germany,Correspondence: Anthony S. Zannas, MD, MSc, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany, , Telephone: 00498930622323
| | - Douglas R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710
| | - Martha E Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710,Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC 27705
| | - James R. MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Allison Ashley-Koch
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Sciences Center, Farmington, CT, 06030
| | - Guy G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710
| | - Warren D. Taylor
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, 37212
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McAusland J, Tam RC, Wong E, Riddehough A, Li DKB. Optimizing the use of radiologist seed points for improved multiple sclerosis lesion segmentation. IEEE Trans Biomed Eng 2014; 57. [PMID: 20601307 DOI: 10.1109/tbme.2010.2055865] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many current methods for multiple sclerosis (MS) lesion segmentation require radiologist seed points as input, but do not necessarily allow the expert to work in an intuitive or efficient way. Ironically, most methods also assume that the points are placed optimally. This paper examines how seed points can be processed with intuitive heuristics, which provide improved segmentation accuracy while facilitating quick and natural point placement. Using a large set of MRIs from an MS clinical trial, two radiologists are asked to seed the lesions while unaware that the points would be fed into a classifier, based on Parzen windows, that automatically delineates each marked lesion. To evaluate the impact of the new heuristics, an interactive region-growing method is used to provide ground truth and the Dice coefficient (DC) and Spearman’s rank correlation are used as the primary measures of agreement. A stratified analysis is performed to determine the effect on scans with low-, medium-, and high lesion loads. Compared to the unenhanced classifier, the heuristics dramatically improve the DC (+32.91 pt.) and correlation (+0.50) for the scans with low lesion loads, and also improve the DC (+14.55 pt.) and correlation (+0.15) for the scans with medium lesion loads, while having aminimal effect for the scans with high lesion loads, which are already segmented accurately by Parzen windows.With the heuristics, the DC is close to 80% and the correlation is above 0.9 for all three load categories.
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Hybels CF, Pieper CF, Landerman LR, Payne ME, Steffens DC. Vascular lesions and functional limitations among older adults: does depression make a difference? Int Psychogeriatr 2014; 26:1-9. [PMID: 24811010 PMCID: PMC4225185 DOI: 10.1017/s1041610214000829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Background: The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment. Methods: The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging. Results: In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression. Conclusions: These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.
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Affiliation(s)
- Celia F. Hybels
- Associate Professor, Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham NC 27710, Phone: (919) 660-7546, FAX: (919) 668-0453
| | - Carl F. Pieper
- Assistant Professor, Department of Biostatistics and Bioinformatics, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham NC 27710
| | - Lawrence R. Landerman
- Associate Professor, Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham NC 27710
| | - Martha E. Payne
- Associate Professor, Department of Psychiatry and Behavioral Sciences, Neuropsychiatric Imaging Research Laboratory, Center for the Study of Aging and Human Development, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham NC 27705
| | - David C. Steffens
- Professor and Chair, Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington CT 06030-1410
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Elevated brain lesion volumes in older adults who use calcium supplements: a cross-sectional clinical observational study. Br J Nutr 2014; 112:220-7. [PMID: 24787048 DOI: 10.1017/s0007114514000828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Recent studies have implicated Ca supplements in vascular risk elevation, and therefore these supplements may also be associated with the occurrence of brain lesions (or hyperintensities) in older adults. These lesions represent damage to brain tissue that is caused by ischaemia. In the present cross-sectional clinical observational study, the association between Ca-containing dietary supplement use and lesion volumes was investigated in a sample of 227 older adults (60 years and above). Food and supplemental Ca intakes were assessed with the Block 1998 FFQ; participants with supplemental Ca intake above zero were categorised as supplement users. Lesion volumes were determined from cranial MRI (1.5 tesla) scans using a semi-automated technique; volumes were log-transformed because they were non-normal. ANCOVA models revealed that supplement users had greater lesion volumes than non-users, even after controlling for food Ca intake, age, sex, race, years of education, energy intake, depression and hypertension (Ca supplement use: β = 0.34, SE 0.10, F(1,217)= 10.98, P= 0.0011). The influence of supplemental Ca use on lesion volume was of a magnitude similar to that of the influence of hypertension, a well-established risk factor for lesions. Among the supplement users, the amount of supplemental Ca was not associated with lesion volume (β = - 0.000035, SE 0.00 015, F(1,139)= 0.06, P= 0.81). The present study demonstrates that the use of Ca-containing dietary supplements, even low-dose supplements, by older adults may be associated with greater lesion volumes. Evaluation of randomised controlled trials is warranted to determine whether this relationship is a causal one.
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Application of variable threshold intensity to segmentation for white matter hyperintensities in fluid attenuated inversion recovery magnetic resonance images. Neuroradiology 2014; 56:265-81. [DOI: 10.1007/s00234-014-1322-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
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Fazekas F. Incidental periventricular white matter hyperintensities revisited: what detailed morphologic image analyses can tell us. AJNR Am J Neuroradiol 2014; 35:63-4. [PMID: 23886746 DOI: 10.3174/ajnr.a3714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- F Fazekas
- Department of NeurologyMedical University GrazGraz, Austria
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Iorio M, Spalletta G, Chiapponi C, Luccichenti G, Cacciari C, Orfei MD, Caltagirone C, Piras F. White matter hyperintensities segmentation: a new semi-automated method. Front Aging Neurosci 2013; 5:76. [PMID: 24339815 PMCID: PMC3857525 DOI: 10.3389/fnagi.2013.00076] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 11/13/2022] Open
Abstract
White matter hyperintensities (WMH) are brain areas of increased signal on T2-weighted or fluid-attenuated inverse recovery magnetic resonance imaging (MRI) scans. In this study we present a new semi-automated method to measure WMH load that is based on the segmentation of the intensity histogram of fluid-attenuated inversion recovery images. Thirty patients with mild cognitive impairment with variable WMH load were enrolled. The semi-automated WMH segmentation included removal of non-brain tissue, spatial normalization, removal of cerebellum and brain stem, spatial filtering, thresholding to segment probable WMH, manual editing for correction of false positives and negatives, generation of WMH map, and volumetric estimation of the WMH load. Accuracy was quantitatively evaluated by comparing semi-automated and manual WMH segmentations performed by two independent raters. Differences between the two procedures were assessed using Student’s t-tests and similarity was evaluated using linear regression model and Dice similarity coefficient (DSC). The volumes of the manual and semi-automated segmentations did not statistically differ (t-value = -1.79, DF = 29, p = 0.839 for rater 1; t-value = 1.113, DF = 29, p = 0.2749 for rater 2), were highly correlated [R2 = 0.921, F(1,29) = 155.54, p < 0.0001 for rater 1; R2 = 0.935, F(1,29) = 402.709, p < 0.0001 for rater 2] and showed a very strong spatial similarity (mean DSC = 0.78, for rater 1 and 0.77 for rater 2). In conclusion, our semi-automated method to measure the load of WMH is highly reliable and could represent a good tool that could be easily implemented in routinely neuroimaging analyses to map clinical consequences of WMH.
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Affiliation(s)
- Mariangela Iorio
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation Rome, Italy
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Valdés Hernández MC, Piper RJ, Bastin ME, Royle NA, Maniega SM, Aribisala BS, Murray C, Deary IJ, Wardlaw JM. Morphologic, distributional, volumetric, and intensity characterization of periventricular hyperintensities. AJNR Am J Neuroradiol 2013; 35:55-62. [PMID: 23811980 DOI: 10.3174/ajnr.a3612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities are characteristic of old age and identifiable on FLAIR and T2-weighted MR imaging. They are typically separated into periventricular or deep categories. It is unclear whether the innermost segment of periventricular white matter hyperintensities is truly abnormal or is imaging artifacts. MATERIALS AND METHODS We used FLAIR MR imaging from 665 community-dwelling subjects 72-73 years of age without dementia. Periventricular white matter hyperintensities were visually allocated into 4 categories: 1) thin white line; 2) thick rim; 3) penetrating toward or confluent with deep white matter hyperintensities; and 4) diffuse ill-defined, labeled as "subtle extended periventricular white matter hyperintensities." We measured the maximum intensity and width of the periventricular white matter hyperintensities, mapped all white matter hyperintensities in 3D, and investigated associations between each category and hypertension, stroke, diabetes, hypercholesterolemia, cardiovascular disease, and total white matter hyperintensity volume. RESULTS The intensity patterns and morphologic features were different for each periventricular white matter hyperintensity category. Both the widths (r = 0.61, P < .001) and intensities (r = 0.51, P < .001) correlated with total white matter hyperintensity volume and with each other (r = 0.55, P < .001) for all categories with the exception of subtle extended periventricular white matter hyperintensities, largely characterized by evidence of erratic, ill-defined, and fragmented pale white matter hyperintensities (width: r = 0.02, P = .11; intensity: r = 0.02, P = .84). The prevalence of hypertension, hypercholesterolemia, and neuroradiologic evidence of stroke increased from periventricular white matter hyperintensity categories 1 to 3. The mean periventricular white matter hyperintensity width was significantly larger in subjects with hypertension (mean difference = 0.5 mm, P = .029) or evidence of stroke (mean difference = 1 mm, P < .001). 3D mapping revealed that periventricular white matter hyperintensities were discontinuous with deep white matter hyperintensities in all categories, except only in particular regions in brains with category 3. CONCLUSIONS Periventricular white matter hyperintensity intensity levels, distribution, and association with risk factors and disease suggest that in old age, these are true tissue abnormalities and therefore should not be dismissed as artifacts. Dichotomizing periventricular and deep white matter hyperintensities by continuity from the ventricle edge toward the deep white matter is possible.
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Zannas AS, McQuoid DR, Payne ME, Steffens DC, MacFall JR, Ashley-Koch A, Taylor WD. Negative life stress and longitudinal hippocampal volume changes in older adults with and without depression. J Psychiatr Res 2013; 47:829-34. [PMID: 23478048 PMCID: PMC3622849 DOI: 10.1016/j.jpsychires.2013.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
Abstract
Major depressive disorder is associated with smaller hippocampal volumes but the mechanisms underlying this relationship are unclear. To examine the effect of environmental influences, we examined the relationship between self-reported stressors and two-year change in hippocampal volume. Seventy elderly nondepressed subjects and eighty-nine elderly depressed subjects were followed for two years. The number of negative stressful life events (nSLE), perceived stress levels, and cranial MRI were obtained at baseline and at the two-year assessment. For secondary analyses, subjects provided blood for 5-HTTLPR polymorphism genotyping. After controlling for covariates including presence or absence of depression, greater numbers of baseline nSLEs were significantly associated with greater baseline hippocampal volumes bilaterally. Greater numbers of baseline nSLEs were also associated with reduction in hippocampal volume over two years in the right but not the left hemisphere. Neither perceived stress levels nor changes in stress measures were significantly associated with hippocampal volume measures. However, in secondary analyses, we found that increases in perceived stress over time was associated with volume reduction of the left hippocampus, but only in 5-HTTLPR L/L homozygotes. Our findings suggest different short- and long-term effects of negative life stressors on hippocampal volumes in older adults. These effects appear independent on the presence or absence of depression. Furthermore, these effects may be moderated by genetic polymorphisms in key neurotransmitter systems. These novel findings have important implications for understanding environmental influences on brain aging.
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Affiliation(s)
- Anthony S. Zannas
- Department of Psychiatry, Duke University Medical Center, Durham, NC, 27710
| | - Douglas R. McQuoid
- Department of Psychiatry, Duke University Medical Center, Durham, NC, 27710
| | - Martha E. Payne
- Department of Psychiatry, Duke University Medical Center, Durham, NC, 27710
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut Health Sciences Center, Farmington, CT, 06030
| | - James R. MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC, 27710
| | | | - Warren D. Taylor
- Department of Psychiatry, Vanderbilt University, Nashville, TN, 37212,Correspondence: Warren D. Taylor, MD, MHSc, Vanderbilt University, 1601 23rd Avenue South, Nashville, TN 37212, , Telephone: (615) 322-1073, Fax: (615) 875-0686
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Towards automated detection of depression from brain structural magnetic resonance images. Neuroradiology 2013; 55:567-84. [PMID: 23338839 DOI: 10.1007/s00234-013-1139-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/07/2013] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Depression is a major issue worldwide and is seen as a significant health problem. Stigma and patient denial, clinical experience, time limitations, and reliability of psychometrics are barriers to the clinical diagnoses of depression. Thus, the establishment of an automated system that could detect such abnormalities would assist medical experts in their decision-making process. This paper reviews existing methods for the automated detection of depression from brain structural magnetic resonance images (sMRI). METHODS Relevant sources were identified from various databases and online sites using a combination of keywords and terms including depression, major depressive disorder, detection, classification, and MRI databases. Reference lists of chosen articles were further reviewed for associated publications. RESULTS The paper introduces a generic structure for representing and describing the methods developed for the detection of depression from sMRI of the brain. It consists of a number of components including acquisition and preprocessing, feature extraction, feature selection, and classification. CONCLUSION Automated sMRI-based detection methods have the potential to provide an objective measure of depression, hence improving the confidence level in the diagnosis and prognosis of depression.
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Ong KH, Ramachandram D, Mandava R, Shuaib IL. Automatic white matter lesion segmentation using an adaptive outlier detection method. Magn Reson Imaging 2012; 30:807-23. [DOI: 10.1016/j.mri.2012.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/29/2011] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
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Taylor WD, Benjamin S, McQuoid DR, Payne ME, Krishnan RR, MacFall JR, Ashley-Koch A. AGTR1 gene variation: association with depression and frontotemporal morphology. Psychiatry Res 2012; 202:104-9. [PMID: 22703619 PMCID: PMC3398195 DOI: 10.1016/j.pscychresns.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/29/2012] [Accepted: 03/26/2012] [Indexed: 11/27/2022]
Abstract
The renin-angiotensin system (RAS) is implicated in the response to physiological and psychosocial stressors, but its role in stress-related psychiatric disorders is poorly understood. We examined if variation in AGTR1, the gene coding for the type 1 angiotensin II receptor (AT(1)R), is associated with a diagnosis of depression and differences in white matter hyperintensities and frontotemporal brain volumes. Participants comprised 257 depressed and 116 nondepressed elderly Caucasian subjects who completed clinical assessments and provided blood samples for genotyping. We used a haplotype-tagging single nucleotide polymorphism (htSNP) analysis to test for variation in AGTR1. For measurement of hyperintense lesions, 1.5 Tesla magnetic resonance imaging (MRI) data were available on 33 subjects. For measurements of the hippocampus and dorsolateral prefrontal cortex (dlPFC), 3 Tesla MRI data were available on 70 subjects. Two htSNPs exhibited statistically significant frequency differences between diagnostic cohorts: rs10935724 and rs12721331. Although hyperintense lesion volume did not significantly differ by any htSNP, dlPFC and hippocampus volume differed significantly for several htSNPs. Intriguingly, for those htSNPs differing significantly for both dlPFC and hippocampus volume, the variant associated with smaller dlPFC volume was associated with larger hippocampal volume. This supports the idea that genetic variation in AGTR1 is associated with depression and differences in frontotemporal morphology.
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Affiliation(s)
- Warren D Taylor
- Department of Psychiatry, Duke University Medical Center, Durham, NC 27710, USA.
| | - Sophiya Benjamin
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Douglas R McQuoid
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Martha E Payne
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA,Duke Neuropsychiatric Imaging Research Laboratory, Durham, NC, USA
| | - Ranga R Krishnan
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA,Duke-NUS Graduate Medical School, Singapore, Singapore
| | - James R MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC, USA,Duke Neuropsychiatric Imaging Research Laboratory, Durham, NC, USA
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Wardlaw JM, Bastin ME, Valdés Hernández MC, Maniega SM, Royle NA, Morris Z, Clayden JD, Sandeman EM, Eadie E, Murray C, Starr JM, Deary IJ. Brain aging, cognition in youth and old age and vascular disease in the Lothian Birth Cohort 1936: rationale, design and methodology of the imaging protocol. Int J Stroke 2012; 6:547-59. [PMID: 22111801 DOI: 10.1111/j.1747-4949.2011.00683.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE As the population of the world ages, age-related cognitive decline is becoming an ever-increasing problem. However, the changes in brain structure that accompany normal aging, and the role they play in cognitive decline, remain to be fully elucidated. AIMS This study aims to characterize changes in brain structure in old age, and to investigate relationships between brain aging and cognitive decline using the Lothian Birth Cohort 1936. Here, we report the rationale, design and methodology of the brain and neurovascular imaging protocol developed to study this cohort. DESIGN An observational, longitudinal study of the Lothian Birth Cohort 1936, which comprises 1091 relatively healthy individuals now in their 70s and living in the Edinburgh area. They are surviving participants of the Scottish Mental Survey 1947, which involved a test of general intelligence taken at age 11 years. At age 70 years, the Lothian Birth Cohort 1936 undertook detailed cognitive, medical and genetic testing, and provided social, family, nutritional, quality of life and physical activity information. At mean age 73 years they underwent detailed brain MRI and neurovascular ultrasound imaging, repeat cognitive and other testing. The MRI protocol is designed to provide qualitative and quantitative measures of gray and white matter atrophy, severity and location of white matter lesions, enlarged perivascular spaces, brain mineral deposits, microbleeds and integrity of major white matter tracts. The neurovascular ultrasound imaging provides velocity, stenosis and intima-media thickness measurements of the carotid and vertebral arteries. STUDY This valuable imaging dataset will be used to determine which changes in brain structural parameters have the largest effects on cognitive aging. Analysis will include multimodal image analysis and multivariate techniques, such as factor analysis and structural equation modelling. Especially valuable is the ability within this sample to examine the influence that early life intelligence has on brain structural parameters in old age, and the role of genetic, vascular, educational and lifestyle factors. OUTCOMES Final outcomes include associations between early and late life cognition and integrity of key white matter tracts, volume of gray and white matter, myelination, brain water content, and visible abnormalities such as white matter lesions and mineral deposits; and influences of vascular risk factors, diet, environment, social metrics, education and genetics on healthy brain aging. It is intended that this information will help to inform and develop strategies for successful cognitive aging.
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Affiliation(s)
- Joanna M Wardlaw
- Brain Research Imaging Centre, Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
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Hayward RD, Owen AD, Koenig HG, Steffens DC, Payne ME. Associations of religious behavior and experiences with extent of regional atrophy in the orbitofrontal cortex during older adulthood. RELIGION, BRAIN & BEHAVIOR 2011; 1:103-118. [PMID: 22611519 PMCID: PMC3352675 DOI: 10.1080/2153599x.2011.598328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The orbitofrontal cortex (OFC) is a region of the brain that has been empirically linked with religious or spiritual activity, and atrophy in this region has been shown to contribute to serious mental illness in late life. This study used structural magnetic resonance imaging to examine the association between religious or spiritual factors and volume of the orbitalfrontal cortex (OFC). Change in the volume of participants' left and right OFC was measured longitudinally over a period of two to eight years. Multiple linear regression analyses showed that religious or spiritual factors were related to extent of atrophy in the left OFC. Significantly less atrophy of the left OFC was observed in participants who reported a life-changing religious or spiritual experience during the course of the study, and in members of Protestant religious groups who reported being born-again when entering the study. Significantly greater atrophy of the left OFC was also associated with more frequent participation in public religious worship. No significant relationship was observed between religious or spiritual factors and extent of atrophy in the right OFC. These results support the presence of a long-term relationship between religious or spiritual experience and brain structure, which may have clinical implications.
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Affiliation(s)
- R. David Hayward
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Neuropsychiatric Research Imaging Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Amy D. Owen
- Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC, USA
| | - Harold G. Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC, USA
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Neuropsychiatric Research Imaging Laboratory, Duke University Medical Center, Durham, NC, USA
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Owen AD, Hayward RD, Koenig HG, Steffens DC, Payne ME. Religious factors and hippocampal atrophy in late life. PLoS One 2011; 6:e17006. [PMID: 21479219 PMCID: PMC3068149 DOI: 10.1371/journal.pone.0017006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/06/2011] [Indexed: 02/05/2023] Open
Abstract
Despite a growing interest in the ways spiritual beliefs and practices are reflected in brain activity, there have been relatively few studies using neuroimaging data to assess potential relationships between religious factors and structural neuroanatomy. This study examined prospective relationships between religious factors and hippocampal volume change using high-resolution MRI data of a sample of 268 older adults. Religious factors assessed included life-changing religious experiences, spiritual practices, and religious group membership. Hippocampal volumes were analyzed using the GRID program, which is based on a manual point-counting method and allows for semi-automated determination of region of interest volumes. Significantly greater hippocampal atrophy was observed for participants reporting a life-changing religious experience. Significantly greater hippocampal atrophy was also observed from baseline to final assessment among born-again Protestants, Catholics, and those with no religious affiliation, compared with Protestants not identifying as born-again. These associations were not explained by psychosocial or demographic factors, or baseline cerebral volume. Hippocampal volume has been linked to clinical outcomes, such as depression, dementia, and Alzheimer's Disease. The findings of this study indicate that hippocampal atrophy in late life may be uniquely influenced by certain types of religious factors.
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Affiliation(s)
- Amy D. Owen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America
| | - R. David Hayward
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
| | - Harold G. Koenig
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, North Carolina, United States of America
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Steffens DC, McQuoid DR, Payne ME, Potter GG. Change in hippocampal volume on magnetic resonance imaging and cognitive decline among older depressed and nondepressed subjects in the neurocognitive outcomes of depression in the elderly study. Am J Geriatr Psychiatry 2011; 19:4-12. [PMID: 20808107 PMCID: PMC3010251 DOI: 10.1097/jgp.0b013e3181d6c245] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION previous studies have linked hippocampal volume change and cognitive decline in older adults with dementia. The authors examined hippocampal volume change and cognitive change in older nondemented adults with and without major depression. METHODS the sample consisted of 90 depressed individuals and 72 healthy, nondepressed individuals aged 60 years and older who completed at least 2 years of follow-up data. All patients underwent periodic clinical evaluation by a geriatric psychiatrist as well as baseline and 2-year magnetic resonance imaging. RESULTS over 2 years, the depressed group showed a greater reduction in left hippocampal volume (normalized for total cerebral volume) compared with the nondepressed group (mean difference = 0.013 ± 0.0059, t = 2.18, df = 160, p <0.0305). The difference remained significant after controlling for age, sex, and baseline normalized left hippocampal volume. The authors also found that hippocampal change from baseline to 2 years was associated with subsequent change in Mini-Mental State Examination score from 2 years to 2½ years (left t = 2.81, df = 66, p = 0.0066; right t = 2.40, df = 66, p = 0.0193) among the depressed group. CONCLUSIONS these findings add to the literature linking hippocampal volume loss and late-life depression. Depressed patients with hippocampal volume loss are at greater risk of cognitive decline.
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Affiliation(s)
- David C Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Variability in frontotemporal brain structure: the importance of recruitment of African Americans in neuroscience research. PLoS One 2010; 5:e13642. [PMID: 21049028 PMCID: PMC2964318 DOI: 10.1371/journal.pone.0013642] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/04/2010] [Indexed: 11/19/2022] Open
Abstract
Background Variation in brain structure is both genetically and environmentally influenced. The question about potential differences in brain anatomy across populations of differing race and ethnicity remains a controversial issue. There are few studies specifically examining racial or ethnic differences and also few studies that test for race-related differences in context of other neuropsychiatric research, possibly due to the underrepresentation of ethnic minorities in clinical research. It is within this context that we conducted a secondary data analysis examining volumetric MRI data from healthy participants and compared the volumes of the amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebral volume between Caucasian and African-American participants. We discuss the importance of this finding in context of neuroimaging methodology, but also the need for improved recruitment of African Americans in clinical research and its broader implications for a better understanding of the neural basis of neuropsychiatric disorders. Methodology/Principal Findings This was a case control study in the setting of an academic medical center outpatient service. Participants consisted of 44 Caucasians and 33 ethnic minorities. The following volumetric data were obtained: amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebrum. Each participant completed a 1.5 T magnetic resonance imaging (MRI). Our primary finding in analyses of brain subregions was that when compared to Caucasians, African Americans exhibited larger left OFC volumes (F 1,68 = 7.50, p = 0.008). Conclusions The biological implications of our findings are unclear as we do not know what factors may be contributing to these observed differences. However, this study raises several questions that have important implications for the future of neuropsychiatric research.
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Taylor WD, Steffens DC, Ashley-Koch A, Payne ME, MacFall JR, Potocky CF, Krishnan KRR. Angiotensin receptor gene polymorphisms and 2-year change in hyperintense lesion volume in men. Mol Psychiatry 2010; 15:816-22. [PMID: 19274051 PMCID: PMC2891956 DOI: 10.1038/mp.2009.26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This longitudinal study examined the relationship between 2-year change in white matter hyperintense lesion (WML) volume and polymorphisms in genes coding for the angiotensin-II type 1 and type 2 receptors, AGTR1 A1166C and AGTR2 C3123A, respectively. 137 depressed and 94 non-depressed participants aged >or=60 years were enrolled. Standard clinical evaluations were performed on all participants and blood samples obtained for genotyping. 1.5-T MRI (magnetic resonance imaging) data were obtained at baseline and approximately 2 years later. These scans were processed using a semi-automated segmentation process, which allowed for the calculation of WML volume at each time point. Statistical models were tested for the relationship between change in WML volume and genotype, while also controlling for age, sex, diagnostic strata, baseline WML volume and comorbid cerebrovascular risk factors. In men, AGTR1 1166A allele homozygotes exhibited significantly less change in WML volume than 1166C carriers. We also found that men reporting hypertension (HTN) with the AGTR2 3123C allele exhibit less change in WML volume than hypertensive men with the 3123A allele, or men without HTN. There were no significant relationships between these polymorphisms and change in WML volume in women. No significant gene-gene or gene-depression interactions were observed. Our results parallel earlier observed gender differences of the relationship between other renin-angiotensin system polymorphisms and HTN. Further work is needed to determine whether these observed relationships are secondary to polymorphisms affecting response to antihypertensive medication, and whether antihypertensive medications can slow WML progression and lower the risk of morbidity associated with WMLs.
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Affiliation(s)
- Warren D. Taylor
- The Department of Psychiatry, Duke University Medical Center, Durham, NC,The Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC
| | - David C. Steffens
- The Department of Psychiatry, Duke University Medical Center, Durham, NC,The Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC
| | - Allison Ashley-Koch
- The Department of Medicine, Duke University Medical Center, Durham, NC,The Duke Center for Human Genetics, Duke University Medical Center, Durham, NC
| | - Martha E. Payne
- The Department of Psychiatry, Duke University Medical Center, Durham, NC,The Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC
| | - James R. MacFall
- The Department of Radiology, Duke University Medical Center, Durham, NC,The Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC
| | - Christopher F. Potocky
- The Department of Medicine, Duke University Medical Center, Durham, NC,The Duke Center for Human Genetics, Duke University Medical Center, Durham, NC
| | - K. Ranga R. Krishnan
- The Department of Psychiatry, Duke University Medical Center, Durham, NC,The Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC,The Duke-NUS Graduate Medical School Singapore
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Marquine MJ, Attix DK, Goldstein LB, Samsa GP, Payne ME, Chelune GJ, Steffens DC. Differential patterns of cognitive decline in anterior and posterior white matter hyperintensity progression. Stroke 2010; 41:1946-50. [PMID: 20651266 DOI: 10.1161/strokeaha.110.587717] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMHs) found on brain MRI in elderly individuals are largely thought to be due to microvascular disease, and its progression has been associated with cognitive decline. The present study sought to determine patterns of cognitive decline associated with anterior and posterior WMH progression. METHODS Subjects included 110 normal controls, aged >or=60 years, who were participants in the Duke Neurocognitive Outcomes of Depression in the Elderly study. All subjects had comprehensive cognitive evaluations and MRI scans at baseline and after 2 years. Cognitive composites were created in 5 domains: complex processing speed, working memory, general memory, visual-constructional skills, and language. Change in cognition was calculated using standard regression-based models accounting for variables known to impact serial testing. A semiautomated segmentation method was used to measure WMH extent in anterior and posterior brain regions. Hierarchical multiple linear regression models were used to evaluate which of the 5 measured cognitive domains was most strongly associated with regional (anterior and posterior) and total WMH progression after adjusting for demographics (age, sex, and education). RESULTS Decline in complex processing speed was independently associated with both anterior (r(2)=0.06, P=0.02) and total WMH progression (r(2)=0.05, P=0.04). In contrast, decline in visual-constructional skills was uniquely associated with posterior progression (r(2)=0.05, P<0.05). CONCLUSIONS Distinct cognitive profiles are associated with anterior and posterior WMH progression among normal elders. These differing profiles need to be considered when evaluating the cognitive correlates of WMHs.
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Affiliation(s)
- María J Marquine
- Departments of Neurology, the American Stroke Association/Bugher Foundation Center for Stroke Prevention Research, Duke University Medical Center, Durham, NC 27705, USA.
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The brain-derived neurotrophic factor Val66Met polymorphism, hippocampal volume, and cognitive function in geriatric depression. Am J Geriatr Psychiatry 2010; 18:323-31. [PMID: 20220593 PMCID: PMC2928477 DOI: 10.1097/jgp.0b013e3181cabd2b] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is associated with geriatric depression. In studies of younger adults without depression, met allele carriers exhibit smaller hippocampal volumes and have poorer performance on neuropsychological tests. The authors examined the relationship between the BDNF gene and hippocampal volumes in depressed and nondepressed older individuals and its relationship with memory functions mediated by the hippocampus. DESIGN One hundred seventy-six elderly depressed white participants and 88 nondepressed participants completed clinical assessments, neuropsychological testing, and provided blood samples for genotyping. One hundred seventy-three participants also underwent brain magnetic resonance imaging. Statistical modeling tested the relationship between genotype and hippocampal volume and function while controlling for diagnosis and other covariates. RESULTS BDNF genotype was not associated with a difference in performance on tests mediated by the hippocampus, including word list learning, prose recall, nonverbal memory, or digit span. After controlling for covariates, BDNF genotype was not significantly associated with hippocampal volume (F[1, 171] = 1.10, p = 0.30). CONCLUSION Despite different findings in younger populations, the BDNF Val66Met polymorphism is not significantly associated with hippocampal volume or function in a geriatric population. The authors hypothesize that other factors may have a stronger effect on hippocampal structure in older individuals and that the association between the Val66Met polymorphism and geriatric depression is mediated through other mechanisms.
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BDNF Val66Met genotype and 6-month remission rates in late-life depression. THE PHARMACOGENOMICS JOURNAL 2010; 11:146-54. [PMID: 20195291 DOI: 10.1038/tpj.2010.12] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although not observed in younger adult cohorts, in older individuals the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with major depressive disorder (MDD) risk. It is further associated with subjective social support and magnetic resonance imaging (MRI) hyperintense lesions, clinical features independently related to MDD. We examined the relationship between this polymorphism and antidepressant remission rates in an elderly sample with MDD, while also testing for mediation effects of social support and hyperintensities. A total of 229 elderly Caucasian subjects with MDD completed baseline assessments, 1.5 T MRI, and BDNF genotyping. They received antidepressant medication under a structured treatment algorithm and were evaluated for remission at 3 and 6 months. At the 3-month evaluation, BDNF Val66Met genotype was not associated with remission (Wald's χ²=2.51, P=0.1131). When not controlling for multiple comparisons, Met66 allele carriers were more likely to be remitted at 6 months (χ²=4.32, P=0.0377) with an odds ratio of 1.82 (95% CI: 1.04, 3.22). This effect persisted after controlling for lesion volume and social support, neither of which mediated this relationship. Thus in this exploratory analysis, the Met66 allele may be associated with increased odds of remission in older subjects, but also with increased time to remission as there was no 3-month effect.
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Hernández MDCV, Ferguson KJ, Chappell FM, Wardlaw JM. New multispectral MRI data fusion technique for white matter lesion segmentation: method and comparison with thresholding in FLAIR images. Eur Radiol 2010; 20:1684-91. [PMID: 20157814 PMCID: PMC2882045 DOI: 10.1007/s00330-010-1718-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 12/06/2009] [Indexed: 11/25/2022]
Abstract
Objective Brain tissue segmentation by conventional threshold-based techniques may have limited accuracy and repeatability in older subjects. We present a new multispectral magnetic resonance (MR) image analysis approach for segmenting normal and abnormal brain tissue, including white matter lesions (WMLs). Methods We modulated two 1.5T MR sequences in the red/green colour space and calculated the tissue volumes using minimum variance quantisation. We tested it on 14 subjects, mean age 73.3 ± 10 years, representing the full range of WMLs and atrophy. We compared the results of WML segmentation with those using FLAIR-derived thresholds, examined the effect of sampling location, WML amount and field inhomogeneities, and tested observer reliability and accuracy. Results FLAIR-derived thresholds were significantly affected by the location used to derive the threshold (P = 0.0004) and by WML volume (P = 0.0003), and had higher intra-rater variability than the multispectral technique (mean difference ± SD: 759 ± 733 versus 69 ± 326 voxels respectively). The multispectral technique misclassified 16 times fewer WMLs. Conclusion Initial testing suggests that the multispectral technique is highly reproducible and accurate with the potential to be applied to routinely collected clinical MRI data. Electronic supplementary material The online version of this article (doi:10.1007/s00330-010-1718-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria del C Valdés Hernández
- SFC Brain Imaging Research Centre, SINAPSE Collaboration, Division of Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK.
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Beyer JL, Kuchibhatla M, Payne ME, MacFall J, Cassidy F, Krishnan KRR. Gray and white matter brain volumes in older adults with bipolar disorder. Int J Geriatr Psychiatry 2009; 24:1445-52. [PMID: 19452498 PMCID: PMC4441218 DOI: 10.1002/gps.2285] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Structural magnetic resonance imaging (MRI) studies have been inconsistent in demonstrating volumetric differences in subjects with bipolar disorder. Most studies have not found difference in total gray or white matter in bipolar patients compared with controls, but there have been several studies suggesting that regional abnormalities are present. These have predominately been located in the frontal and temporal lobes. Since age has been inversely correlated with total gray matter in patients, analyses of gray matter changes in older adults or in studies that have included older subjects have been difficult. This study assessed the presence of gray matter volume, and the potential for regional volumetric differences in older adults with bipolar disorder. METHODS Fifty-six older adults with DSM-IV bipolar disorder (mean age 60.5) and 43 non-psychiatrically ill controls (mean age 58.1) had structured interviews and MRI scanning on a 1.5T GE Scanner. Image parcellation divided the cerebrum into 16 units. Volumetric differences were examined using the multivariate linear regression models with alpha = 0.05. RESULTS Relative to controls, the older adults with bipolar disorder had significantly smaller gray matter volumes bilaterally in the inferior frontal areas. White matter volume was also reduced in these same areas but did not reach statistical significance when controlled for gender and age. No significant difference was noted in total gray or white matter volumes. CONCLUSIONS Older adults with bipolar disorder showed gray matter volumetric deficits in inferior frontal lobe regions which include structures identified as contributing to the anterior limbic network.
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Affiliation(s)
- John L. Beyer
- Correspondence to: J. L. Beyer, Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, P.O. Box 3519, DUMC, Durham, NC 27710, USA.,
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Influence of the MTHFR C677T polymorphism on magnetic resonance imaging hyperintensity volume and cognition in geriatric depression. Am J Geriatr Psychiatry 2009; 17:847-55. [PMID: 19910873 PMCID: PMC2805265 DOI: 10.1097/jgp.0b013e3181aad5b2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The 5,10-methylenetetrahydrofolate reductase gene (MTHFR) has been linked to unipolar major depressive disorder (MDD) and magnetic resonance imaging (MRI) hyperintensities. The authors examined the relationship between the MTHFR C677T polymorphism (C677T) and a) geriatric depression, b) MRI hyperintense lesion volume, and c) neurocognitive test performance. DESIGN Cross-sectional. SETTING Duke University Medical Center. PARTICIPANTS Depressed (N = 178) and comparison (N = 85) elderly subjects. MEASUREMENTS Subjects had blood drawn to assess MTHFR genotype, were imaged by MRI to determine their white matter hyperintense lesion (WML) and gray matter hyperintense lesion (GML) volume, and assessed using a comprehensive neurocognitive battery evaluating multiple domains of function. Linear regression models were fit to test the effect of genotype, a depression by genotype interaction, and an age by genotype interaction on both hyperintense lesion volume measures and neurocognitive task performance. RESULTS The MTHFR C677T genotype by age interaction term was significantly associated with MRI WML volume (p = 0.0175); however, this relationship was no longer statistically significant when WML volumes underwent a log transformation to produce a more normal distribution. The 677T allele was neither more frequent in depressed subjects nor associated with either gray matter hyperintensity volume or neurocognitive test performance. CONCLUSIONS MTHFR genotype affects the relationship between age and WML volume where individuals who carry the 677T allele exhibit greater WML volume by age, although this relationship should be verified given the failure to replicate the finding using transformed WML volumes. Genotype was not related to GML volume, cognitive function, or presence of depression, although demographic differences could account for this negative finding.
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Pan CC, McQuoid DR, Taylor WD, Payne ME, Ashley-Koch A, Steffens DC. Association analysis of the COMT/MTHFR genes and geriatric depression: an MRI study of the putamen. Int J Geriatr Psychiatry 2009; 24:847-55. [PMID: 19235787 PMCID: PMC2711996 DOI: 10.1002/gps.2206] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Catechol-O-Methyltransferase (COMT) and Methylenetetrahydrofolate reductase (MTHFR) had been reported to relate to depression but with inconsistent results. The basal ganglia are also important in the pathophysiology of affective disorder via connections with limbic system and prefrontal cortex. The authors examined the relationship between an interaction of COMT/MTHFR polymorphisms and volumes of putamen in depressed and nondepressed elders. METHODS Participants included 170 depressed and 83 nondepressed subjects aged 60 years or older. Subjects completed cross-sectional assessments, including clinical evaluation, brain magnetic resonance imaging (MRI) scan, and COMT Val158Met and MTHFR C677T genotyping. Putamen volumes were measured using 1.5-Tesla whole-body MRI system. Statistical models examined the relationship between COMT/MTHFR genotype, proportional volumes of putamen and depression while controlling for age and sex. RESULTS After controlling for covariates, among depressed subjects with MTHFR C/C, both the right and left putamen had smaller volumes as the number of COMT 158Val increased. The left putamen volumes of depressed subjects with COMT Met/Met were smaller as the number of MTHFR 677T increased compared to nondepressed subjects. CONCLUSIONS Our findings do not support a major role for COMT or MTHFR alone. However, an epigenetic interaction of COMT Val158Met and MTHFR C677T polymorphisms may contribute to putamen volumes differences between depressed and nondepressed subjects. Further studies with a larger sample size are necessary to support a genetically based role for basal ganglia structures in the etiopathogenesis of depression.
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Affiliation(s)
- Chih-Chuan Pan
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Taiwan
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Jones LD, Payne ME, Messer DF, Beyer JL, MacFall JR, Krishnan KRR, Taylor WD. Temporal lobe volume in bipolar disorder: relationship with diagnosis and antipsychotic medication use. J Affect Disord 2009; 114:50-7. [PMID: 18691766 PMCID: PMC2643314 DOI: 10.1016/j.jad.2008.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 06/30/2008] [Accepted: 07/01/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND We tested for differences in temporal lobe volume in bipolar disorder and the relationship between these volumes and psychotropic medication use. METHODS 125 subjects with bipolar disorder and 87 comparison subjects with no psychiatric illness completed clinical interviews and 1.5T MRI brain scans. Temporal lobe volumes were manually traced and segmented into gray matter and white matter volumes using an automated process. General linear models examined the relationship between these volumes and diagnosis as the primary predictor with age, sex, education, and race as copredictors. Secondary analyses incorporated the use of psychotropic medication into the linear models, and parsimonious models developed through backwards regression. RESULTS In initial models, subjects with bipolar disorder exhibited larger temporal lobe white matter bilaterally (left: F(1,211)=2.86, p=0.0047; right: F(1,211)=3.25, p=0.0014). Current antipsychotic use was significantly associated with larger bilateral temporal lobe white matter volumes (left: F(2,211)=9.45, p=0.0001; right: F(2,211)=10.79, p<0.0001), wherein bipolar subjects taking antipsychotics had larger volumes than bipolar subjects not taking antipsychotics or healthy comparison subjects. Temporal lobe gray matter volume was not significantly associated with diagnosis or medication use. LIMITATIONS Excluding subjects with substance use disorders may limit the study's generalizability. CONCLUSIONS These findings indicate that differences in temporal lobe white matter are associated with bipolar disorder and use of antipsychotic medications.
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Affiliation(s)
- Lindsay D. Jones
- The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States, The School of Medicine, Duke University, Durham, North Carolina, United States
| | - Martha E. Payne
- The Department of Psychiatry, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States
| | - Denise F. Messer
- The Department of Psychiatry, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States
| | - John L. Beyer
- The Department of Psychiatry, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States
| | - James R. MacFall
- The Department of Radiology, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States
| | - K. Ranga R Krishnan
- The Department of Psychiatry, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States, The Duke-NUS Graduate Medical School, Singapore
| | - Warren D. Taylor
- The Department of Psychiatry, Duke University, Durham, North Carolina, United States, The Neuropsychiatric Imaging Research Laboratory, Duke University, Durham, North Carolina, United States,Corresponding author: Warren D. Taylor, MD, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3903, Durham, NC 27710, P: (919) 668-7887, F: (919) 681-7668,
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Potter G, McQuoid D, Steffens D, Welsh-Bohmer K, Krishnan K. Neuropsychological correlates of magnetic resonance imaging-defined subcortical ischemic depression. Int J Geriatr Psychiatry 2009; 24:219-25. [PMID: 18655212 PMCID: PMC2645482 DOI: 10.1002/gps.2093] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The goal of the current study was to examine the neuropsychological profile of magnetic resonance imaging (MRI)-defined subcortical ischemic depression (SID). METHODS Clinically depressed older adults with MRI-defined SID (n = 70) and depressed elders without SID (n = 75) were compared on neuropsychological performance, depression symptoms, and medical burden. RESULTS Group comparisons revealed that the SID was associated with worse performance on all neuropsychological measures, but also with greater age, higher cardiac illness burden, and greater deficits in the depression symptoms of self-initiation and concentration. In multivariate regression models, auditory working memory and nonverbal memory remained worse among the SID group after controlling for contributions of age, cardiovascular risk, and depression symptoms. CONCLUSIONS Although auditory working memory span and nonverbal memory appear to be specifically associated with the ischemic pathology that defines SID, the typical individual with SID is also likely to have a broader profile of neuropsychological deficits than those without SID because they are typically older and have specific depression symptoms that predispose them to compromised neurocognitive performance.
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Affiliation(s)
- G.G. Potter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - D.R. McQuoid
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - D.C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - K.A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina,Department of Medicine (Neurology), Duke University Medical Center, Durham, North Carolina and Joseph and Kathleen Bryan Alzheimer’s Disease Research Center
| | - K.R.R. Krishnan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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Trone RJ, Weaver KG, Steffens DC, Payne ME. Glycemic index and glycemic load are not associated with brain lesions in the elderly. J Nutr Health Aging 2009; 13:117-20. [PMID: 19214339 PMCID: PMC2850063 DOI: 10.1007/s12603-009-0017-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The goal of this study was to determine if brain lesion volume was correlated with dietary glycemic index and glycemic load in elderly individuals. DESIGN AND SETTING This cross-sectional study was performed at an academic medical center as part of a clinical study of late-life depression. PARTICIPANTS Subjects (n=137) were age 60 or over, and were participating as non-depressed comparison subjects. MEASUREMENTS Food intake was assessed using the Block 1998 food frequency questionnaire. Glycemic index and glycemic load measures were derived from reported food intake. Brain lesion volumes were calculated from magnetic resonance imaging (MRI). RESULTS No significant associations were found between glycemic index or glycemic load, and brain lesion volume. CONCLUSION Dietary glycemic measures may be unrelated to brain lesions or may be related to brain lesions only in individuals with impaired glycemic control or other vascular risk factors. Further studies are needed to confirm this finding and to determine if glycemic control moderates this association.
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Affiliation(s)
- Ronald J. Trone
- Department of Clinical Research, Campbell University, Morrisville, NC 27560 USA (work was completed as part of the Master of Science in Clinical Research program)
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Keri G. Weaver
- Department of Clinical Research, Campbell University, Morrisville, NC 27560 USA (work was completed as part of the Master of Science in Clinical Research program)
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA
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Kim KW, MacFall JR, Payne ME. Classification of white matter lesions on magnetic resonance imaging in elderly persons. Biol Psychiatry 2008; 64:273-80. [PMID: 18471801 PMCID: PMC2593803 DOI: 10.1016/j.biopsych.2008.03.024] [Citation(s) in RCA: 334] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 03/06/2008] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
White matter lesions, commonly seen on MRIs of elderly people, are related to various geriatric disorders, including cerebrovascular diseases, cardiovascular diseases, dementia, and psychiatric disorders. Currently, white matter lesions are divided into periventricular white matter lesions and deep white matter lesions. Although the meaning of these terms varies by study and this dichotomization itself is still in debate, a possible dissimilarity in pathogenic mechanisms between periventricular white matter lesions and deep white matter lesions are providing some clues for understanding pathophysiology of many geriatric syndromes associated with white matter lesions. We have reviewed the distinctions between periventricular white matter lesions and deep white matter lesions in terms of etiology, histopathology, functional correlates, and imaging methodologies. We suggest a new subclassification of white matter lesions that might have better etiological and functional relevance than the current simple dichotomization. The new categories are juxtaventricular, periventricular, deep white, and juxtacortical. This new classification scheme might contribute to reducing the heterogeneity of white matter lesion findings in future research.
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Affiliation(s)
- Ki Woong Kim
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA,Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,Department of Neuropsychiatry, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Gyeonggido, Korea
| | - James R. MacFall
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA,Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA,Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705 USA,CORRESPONDENCE: Martha E. Payne, PhD, RD, MPH, Duke University Medical Center, 2200 West Main Street, Suite B210, Durham, NC 27705, USA, Tel.: (919) 416-7543 Fax: (919) 416-7547
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Greenberg DL, Payne ME, MacFall JR, Steffens DC, Krishnan RR. Hippocampal volumes and depression subtypes. Psychiatry Res 2008; 163:126-32. [PMID: 18508244 PMCID: PMC2486434 DOI: 10.1016/j.pscychresns.2007.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Revised: 09/25/2007] [Accepted: 12/22/2007] [Indexed: 11/29/2022]
Abstract
Studies of depression and hippocampal volume have yielded inconsistent results. This inconsistency could stem from the heterogeneity of depressive disorders. We conducted cross-sectional and longitudinal analyses of hippocampal volumes in atypical depressive, melancholic depressive, and control subjects. We found no effect of depression subtype on hippocampal volume or memory performance.
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Affiliation(s)
- Daniel L. Greenberg
- VA Boston Healthcare System, Boston, MA, USA,Correspondence to: Daniel L. Greenberg, PhD, Psychology Research (151-A), 150 South Huntington Avenue, Boston, MA 02130, , Ph: 818-926-0421
| | - Martha E. Payne
- Psychiatry Department, Duke University Medical Center, Durham, NC, USA, Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC, USA
| | - James R. MacFall
- Radiology Department, Duke University Medical Center, Durham, NC, USA, Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, NC, USA
| | - David C. Steffens
- Psychiatry Department, Duke University Medical Center, Durham, NC, USA
| | - Ranga R. Krishnan
- Psychiatry Department, Duke University Medical Center, Durham, NC, USA
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Doty TJ, Payne ME, Steffens DC, Beyer JL, Krishnan KRR, LaBar KS. Age-dependent reduction of amygdala volume in bipolar disorder. Psychiatry Res 2008; 163:84-94. [PMID: 18407469 PMCID: PMC2483539 DOI: 10.1016/j.pscychresns.2007.08.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 05/17/2007] [Accepted: 08/09/2007] [Indexed: 12/31/2022]
Abstract
The amygdala is hypothesized to play a critical role in mood regulation, yet its involvement in bipolar disorder remains unclear. The aim of the present study was to compare measurements of amygdala volumes in a relatively large sample of bipolar disorder patients and healthy controls ranging in age from 18 to 49 years. Subjects comprised 54 adult patients meeting DSM-IV criteria for bipolar disorder and 41 healthy controls matched for age, sex, and education. Magnetic resonance imaging (1.5 T) was performed to obtain volumetric measurements of the amygdala using a manual region-of-interest tracing method with software that allowed simultaneous visualization of the amygdala in three orthogonal planes. The anterior head of the hippocampus was removed in the sagittal plane prior to amygdala volumetry measurement. Multiple regression analysis was computed on amygdala volume measurements as a function of diagnosis, age, sex, and cerebral volume. Bipolar patients showed an age-related reduction of amygdala volume, but controls did not. Among bipolar subjects, amygdala volume was unrelated to medication history. There were no significant hemispheric or sex interactions with the main effects. Results support a role for amygdala dysfunction in bipolar disorder which appears most robustly in older relative to younger adult patients. Differential aging effects in bipolar disorder may compromise amygdala integrity and contribute to mood dysregulation.
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Affiliation(s)
- Tracy J. Doty
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710,Center for Cognitive Neuroscience, Duke University Medical Center, Durham, NC, USA 27710
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710
| | - John L. Beyer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710
| | - K. Ranga R. Krishnan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710
| | - Kevin S. LaBar
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27710,Center for Cognitive Neuroscience, Duke University Medical Center, Durham, NC, USA 27710,Address for Correspondence: Kevin S. LaBar, Ph.D., Center for Cognitive Neuroscience, Duke University Box 90999, Durham, NC 27708-0999, tel: (919) 681-0664, fax: (919) 681-0815, e-mail:
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Payne ME, Anderson JJB, Steffens DC. Calcium and vitamin D intakes may be positively associated with brain lesions in depressed and nondepressed elders. Nutr Res 2008; 28:285-92. [PMID: 19083421 PMCID: PMC2516961 DOI: 10.1016/j.nutres.2008.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 02/20/2008] [Accepted: 02/21/2008] [Indexed: 10/22/2022]
Abstract
Studies indicate that diet and vascular calcification may be related to the occurrence of brain lesions, although the importance of dietary calcium and vitamin D has not been investigated. The objective of this study was to test the hypothesis that calcium and vitamin D intakes would be positively associated with brain lesion volumes in elderly individuals with and without late-life depression. A cross-sectional study was performed as part of a longitudinal clinical study of late-life depression. Calcium and vitamin D intakes were assessed in 232 elderly subjects (95 with current or prior depression, 137 without depression) using a Block 1998 food frequency questionnaire. Calcium, vitamin D, and kilojoule intake were determined. Brain lesion volumes were calculated from magnetic resonance imaging scan. Subjects were 60 years or older. Calcium and vitamin D intakes were significantly and positively correlated with brain lesion volume (P < .05 and P < .001, respectively). In 2 separate multivariable models, controlling for age, hypertension, diabetes, heart disease, group (depression/comparison), lesion load (high/low), and total kilocalories, these positive associations remained significant (P < .05 for calcium; P < .001 for vitamin D). In conclusion, calcium and vitamin D consumption were associated with brain lesions in elderly subjects even after controlling for potentially explanatory variables. These associations may be due to vascular calcification or other mechanism. The possibility of adverse effects of high intakes of calcium and vitamin D needs to be further explored in longitudinal studies of elderly subjects.
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Affiliation(s)
- Martha E Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Jongen C, Biessels GJ. Structural brain imaging in diabetes: A methodological perspective. Eur J Pharmacol 2008; 585:208-18. [DOI: 10.1016/j.ejphar.2007.11.085] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 09/20/2007] [Accepted: 11/14/2007] [Indexed: 11/17/2022]
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Sheline YI, Price JL, Vaishnavi SN, Mintun MA, Barch DM, Epstein AA, Wilkins CH, Snyder AZ, Couture L, Schechtman K, McKinstry RC. Regional white matter hyperintensity burden in automated segmentation distinguishes late-life depressed subjects from comparison subjects matched for vascular risk factors. Am J Psychiatry 2008; 165:524-32. [PMID: 18281408 PMCID: PMC4118770 DOI: 10.1176/appi.ajp.2007.07010175] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Segmented brain white matter hyperintensities were compared between subjects with late-life depression and age-matched subjects with similar vascular risk factor scores. Correlations between neuropsychological performance and whole brain-segmented white matter hyperintensities and white and gray matter volumes were also examined. METHOD Eighty-three subjects with late-life depression and 32 comparison subjects underwent physical examination, psychiatric evaluation, neuropsychological testing, vascular risk factor assessment, and brain magnetic resonance imaging (MRI). Automated segmentation methods were used to compare the total brain and regional white matter hyperintensity burden between depressed patients and comparison subjects. RESULTS Depressed patients and comparison subjects did not differ in demographic variables, including vascular risk factor, or whole brain-segmented volumes. However, depressed subjects had seven regions of greater white matter hyperintensities located in the following white matter tracts: the superior longitudinal fasciculus, fronto-occipital fasciculus, uncinate fasciculus, extreme capsule, and inferior longitudinal fasciculus. These white matter tracts underlie brain regions associated with cognitive and emotional function. In depressed patients but not comparison subjects, volumes of three of these regions correlated with executive function; whole brain white matter hyperintensities correlated with executive function; whole brain white matter correlated with episodic memory, processing speed, and executive function; and whole brain gray matter correlated with processing speed. CONCLUSIONS These findings support the hypothesis that the strategic location of white matter hyperintensities may be critical in late-life depression. Further, the correlation of neuropsychological deficits with the volumes of whole brain white matter hyperintensities and gray and white matter in depressed subjects but not comparison subjects supports the hypothesis of an interaction between these structural brain components and depressed status.
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