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Janssen E, van Dalen JW, Cai M, Jacob MA, Marques J, Duering M, Richard E, Tuladhar AM, de Leeuw FE, Hilkens N. Visit-to-visit blood pressure variability and progression of white matter hyperintensities over 14 years. Blood Press 2024; 33:2314498. [PMID: 38477113 DOI: 10.1080/08037051.2024.2314498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years. Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants. Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 - 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01-1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years. Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.
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Affiliation(s)
- Esther Janssen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Willem van Dalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mengfei Cai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | - Mina A Jacob
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Marques
- Center for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marco Duering
- Department of Biomedical Engineering, Medical Image Analysis Center (MIAC AG) and qbig, University of Basel, Basel, Switzerland
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Public and Occupational Health, AMC, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina Hilkens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Melgarejo JD, Vatcheva KP, Mejia-Arango S, Charisis S, Patil D, Mena LJ, Garcia A, Alliey-Rodriguez N, Satizabal CL, Chavez CA, Gaona C, Silva E, Mavarez RP, Lee JH, Terwilliger JD, Blangero J, Seshadri S, Maestre GE. Association of longitudinal changes in 24-h blood pressure level and variability with cognitive decline. J Hypertens 2024; 42:1985-1993. [PMID: 39146553 PMCID: PMC11449671 DOI: 10.1097/hjh.0000000000003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/12/2024] [Accepted: 06/29/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE A high office blood pressure (BP) is associated with cognitive decline. However, evidence of 24-h ambulatory BP monitoring is limited, and no studies have investigated whether longitudinal changes in 24-h BP are associated with cognitive decline. We aimed to test whether higher longitudinal changes in 24-h ambulatory BP measurements are associated with cognitive decline. METHODS We included 437 dementia-free participants from the Maracaibo Aging Study with prospective data on 24-h ambulatory BP monitoring and cognitive function, which was assessed using the selective reminding test (SRT) and the Mini-Mental State Examination (MMSE). Using multivariate linear mixed regression models, we analyzed the association between longitudinal changes in measures of 24-h ambulatory BP levels and variability with cognitive decline. RESULTS Over a median follow-up of 4 years (interquartile range, 2-5 years), longitudinal changes in 24-h BP level were not associated with cognitive function ( P ≥ 0.09). Higher longitudinal changes in 24-h and daytime BP variability were related to a decline in SRT-delayed recall score; the adjusted scores lowered from -0.10 points [95% confidence interval (CI), -0.16 to -0.04) to -0.07 points (95% CI, -0.13 to -0.02). We observed that a higher nighttime BP variability during follow-up was associated with a decline in the MMSE score (adjusted score lowered from -0.08 to -0.06 points). CONCLUSION Higher 24-h BP variability, but not BP level, was associated with cognitive decline. Prior to or in the early stages of cognitive decline, 24-h ambulatory BP monitoring might guide strategies to reduce the risk of major dementia-related disorders including Alzheimer's disease.
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Affiliation(s)
- Jesus D. Melgarejo
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Kristina P. Vatcheva
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- School of Mathematical and Statistical Science, University of Texas Rio Grande Valley, Brownsville, Texas
| | - Silvia Mejia-Arango
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
| | - Sokratis Charisis
- Neuroimage Analytics Laboratory and the Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases
- Department of Neurology, University of Texas Health Science Center at San Antonio
| | - Dhrumil Patil
- Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis J. Mena
- Polytechnic University of Sinaloa, Mazatlán, Sinaloa, Mexico
| | - Antonio Garcia
- Department of Human Genetics
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville
| | - Ney Alliey-Rodriguez
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Claudia L. Satizabal
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Carlos A. Chavez
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Ciro Gaona
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Egle Silva
- Laboratory of Ambulatory Recordings, Cardiovascular Institute, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Rosa P. Mavarez
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Joseph H. Lee
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain
- Sergievsky Center & Department of Epidemiology and Neurology
- Departments of Psychiatry and Genetics & Development, Columbia University, New York, New York, USA
| | - Joseph D. Terwilliger
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain
- Sergievsky Center & Department of Epidemiology and Neurology
- Departments of Psychiatry and Genetics & Development, Columbia University, New York, New York, USA
- Division of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland
| | - John Blangero
- Department of Human Genetics
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville
| | - Sudha Seshadri
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Neuroimage Analytics Laboratory and the Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases
- Department of Neurology, University of Texas Health Science Center at San Antonio
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Gladys E. Maestre
- Institute of Neuroscience, Neuro and Behavioral Health Integrated Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen
- South Texas Alzheimer's Disease Research Center, San Antonio/Harlingen, Texas
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
- Department of Human Genetics
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3
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Werring DJ, Ozkan H. The Expanding Clinical Impact of Cerebral Small Vessel Diseases: Tiny but Mighty. Neurology 2024; 103:e209975. [PMID: 39321405 DOI: 10.1212/wnl.0000000000209975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Affiliation(s)
- David J Werring
- From the Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Hatice Ozkan
- From the Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom
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4
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Smith EE, Biessels GJ, Gao V, Gottesman RF, Liesz A, Parikh NS, Iadecola C. Systemic determinants of brain health in ageing. Nat Rev Neurol 2024:10.1038/s41582-024-01016-z. [PMID: 39375564 DOI: 10.1038/s41582-024-01016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 10/09/2024]
Abstract
Preservation of brain health is a worldwide priority. The traditional view is that the major threats to the ageing brain lie within the brain itself. Consequently, therapeutic approaches have focused on protecting the brain from these presumably intrinsic pathogenic processes. However, an increasing body of evidence has unveiled a previously under-recognized contribution of peripheral organs to brain dysfunction and damage. Thus, in addition to the well-known impact of diseases of the heart and endocrine glands on the brain, accumulating data suggest that dysfunction of other organs, such as gut, liver, kidney and lung, substantially affects the development and clinical manifestation of age-related brain pathologies. In this Review, a framework is provided to indicate how organ dysfunction can alter brain homeostasis and promote neurodegeneration, with a focus on dementia. We delineate the associations of subclinical dysfunction in specific organs with dementia risk and provide suggestions for public health promotion and clinical management.
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Affiliation(s)
- Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Virginia Gao
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | | | - Arthur Liesz
- Institute for Stroke and Dementia Research, University Medical Center Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Neal S Parikh
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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5
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Shahid S, Wali A, Iftikhar S, Shaukat S, Zikria S, Rasheed J, Asuroglu T. Computational imaging for rapid detection of grade-I cerebral small vessel disease (cSVD). Heliyon 2024; 10:e37743. [PMID: 39309774 PMCID: PMC11416517 DOI: 10.1016/j.heliyon.2024.e37743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024] Open
Abstract
An early identification and subsequent management of cerebral small vessel disease (cSVD) grade 1 can delay progression into grades II and III. Machine learning algorithms have shown considerable promise in medical image interpretation automation. An experimental cross-sectional study aimed to develop an automated computer-aided diagnostic system based on AI (artificial intelligence) tools to detect grade 1-cSVD with improved accuracy. Patients with Fazekas grade 1 cSVD on Non-Contrast Magnetic Resonance Imaging (MRI) Brain of age >40 years of both genders were included. The dataset was pre-processed to be fed into a 3D convolutional neural network (CNN) model. A 3D stack with the shape (120, 128, 128, 1) containing axial slices from the brain magnetic resonance image was created. The model was created from scratch and contained four convolutional and three fully connected (FC) layers. The dataset was preprocessed by making a 3D stack, and normalizing, resizing, and completing the stack was performed. A 3D-CNN model architecture was designed to train and test preprocessed images. We achieved an accuracy of 93.12 % when 2D axial slices were used. When the 2D slices of a patient were stacked to form a 3D image, an accuracy of 85.71 % was achieved on the test set. Overall, the 3D-CNN model performed very well on the test set. The earliest and the most accurate diagnosis from computational imaging methods can help reduce the huge burden of cSVD and its associated morbidity in the form of vascular dementia.
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Affiliation(s)
- Saman Shahid
- Department of Sciences & Humanities, National University of Computer & Emerging Sciences (NUCES)-FAST Lahore Campus, Punjab, Pakistan
| | - Aamir Wali
- Department of Data Sciences, National University of Computer & Emerging Sciences (NUCES)-FAST Lahore Campus, Punjab, Pakistan
| | - Sadaf Iftikhar
- Department of Neurology, King Edward Medical University/Mayo Hospital, Lahore, Punjab, Pakistan
| | - Suneela Shaukat
- Department of Radiology, King Edward Medical University/Mayo Hospital, Lahore, Punjab, Pakistan
| | - Shahid Zikria
- Department of Sciences & Humanities, National University of Computer & Emerging Sciences (NUCES)-FAST Lahore Campus, Punjab, Pakistan
- Department of Computer Science, Information Technology University (ITU), Lahore, Punjab, Pakistan
| | - Jawad Rasheed
- Department of Computer Engineering, Istanbul Sabahattin Zaim University, Istanbul, 34303, Turkey
- Department of Software Engineering, Istanbul Nisantasi University, Istanbul, Turkey
- Deep Learning and Medical Image Analysis Laboratory, Bogazici University, Istanbul, Turkey
| | - Tunc Asuroglu
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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6
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Kruger A, Joffe D, Lloyd-Jones G, Khan MA, Šalamon Š, Laubscher GJ, Putrino D, Kell DB, Pretorius E. Vascular Pathogenesis in Acute and Long COVID: Current Insights and Therapeutic Outlook. Semin Thromb Hemost 2024. [PMID: 39348850 DOI: 10.1055/s-0044-1790603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
Long coronavirus disease 2019 (COVID-19)-a postacute consequence of severe acute respiratory syndrome coronavirus 2 infection-manifests with a broad spectrum of relapsing and remitting or persistent symptoms as well as varied levels of organ damage, which may be asymptomatic or present as acute events such as heart attacks or strokes and recurrent infections, hinting at complex underlying pathogenic mechanisms. Central to these symptoms is vascular dysfunction rooted in thrombotic endothelialitis. We review the scientific evidence that widespread endothelial dysfunction (ED) leads to chronic symptomatology. We briefly examine the molecular pathways contributing to endothelial pathology and provide a detailed analysis of how these cellular processes underpin the clinical picture. Noninvasive diagnostic techniques, such as flow-mediated dilation and peripheral arterial tonometry, are evaluated for their utility in identifying ED. We then explore mechanistic, cellular-targeted therapeutic interventions for their potential in treating ED. Overall, we emphasize the critical role of cellular health in managing Long COVID and highlight the need for early intervention to prevent long-term vascular and cellular dysfunction.
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Affiliation(s)
- Arneaux Kruger
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - David Joffe
- Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- World Health Network, Cambridge, Massachusetts
| | - Graham Lloyd-Jones
- Department of Radiology, Salisbury District Hospital, Salisbury NHS Foundation Trust, United Kingdom
| | - Muhammed Asad Khan
- World Health Network, Cambridge, Massachusetts
- Directorate of Respiratory Medicine, Manchester University Hospitals, Wythenshawe Hospital, Manchester, United Kingdom
| | | | | | - David Putrino
- Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- World Health Network, Cambridge, Massachusetts
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
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7
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Yan Y, Cheng Y, Jiang S, Xu M, Ye C, Kwapong WR, Tao W, Zhang S, Wardlaw JM, Liu M, Wu B. Acute cerebral small vessel disease: Classification, mechanism, and therapeutic implications. Chin Med J (Engl) 2024:00029330-990000000-01257. [PMID: 39329290 DOI: 10.1097/cm9.0000000000003304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Indexed: 09/28/2024] Open
Affiliation(s)
- Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yajun Cheng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Mangmang Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - William Robert Kwapong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wendan Tao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shuting Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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8
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Liu X, Pan Z, Li Y, Huang X, Zhang X, Xiong F. Logistic regression model for predicting risk factors and contribution of cerebral microbleeds using renal function indicators. Front Neurol 2024; 15:1428625. [PMID: 39364422 PMCID: PMC11447291 DOI: 10.3389/fneur.2024.1428625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/27/2024] [Indexed: 10/05/2024] Open
Abstract
Background The brain and kidneys share similar low-resistance microvascular structures, receiving blood at consistently high flow rates and thus, are vulnerable to blood pressure fluctuations. This study investigates the causative factors of cerebral microbleeds (CMBs), aiming to quantify the contribution of each risk factor by constructing a multivariate model via stepwise regression. Methods A total of 164 hospitalized patients were enrolled from January 2022 to March 2023 in this study, employing magnetic susceptibility-weighted imaging (SWI) to assess the presence of CMBs. The presence of CMBs in patients was determined by SWI, and history, renal function related to CMBs were analyzed. Results Out of 164 participants in the safety analysis, 36 (21.96%) exhibited CMBs and 128 (78.04%) did not exhibit CMBs, and the median age of the patients was 66 years (range: 49-86 years). Multivariate logistic regression identified hypertension (OR = 13.95%, 95% CI: 4.52, 50.07%), blood urea nitrogen (BUN) (OR = 1.57, 95% CI: 1.06-2.40), cystatin C (CyC) (OR = 4.90, 95% CI: 1.20-22.16), and urinary β-2 microglobulin, (OR = 2.11, 95% CI: 1.45-3.49) as significant risk factors for CMBs. The marginal R-square (R M 2 ) was 0.25. Among all determinants, hypertension (47.81%) had the highest weight, followed by UN (11.42%). Quasi-curves plotted using the bootstrap method (999 times) showed good agreement between the predictive model and actual observations. Conclusion Hypertension, BUN, urinary β-2 microglobulin, CyC were risk factors for CMBs morbidity, and controlling the above indicators within a reasonable range will help to reduce the incidence of CMBs.
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Affiliation(s)
- Xuhui Liu
- Department of Neurology of the Second Hospital Affiliated to Lanzhou University, Lanzhou, China
| | - Zheng Pan
- Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yilan Li
- Tianjin 4th Center Hospital, Tianjin, China
| | - Xiaoyong Huang
- Department of Cardiology, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xiner Zhang
- Department of Medical Oncology, Affiliated Tumor Hospital of Xinjiang Medical University, Ürümqi, China
| | - Feng Xiong
- Jinshan Branch of Shanghai Sixth People’s Hospital, Shanghai, China
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9
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Anfray A, Schaeffer S, Hattori Y, Santisteban MM, Casey N, Wang G, Strickland M, Zhou P, Holtzman DM, Anrather J, Park L, Iadecola C. A cell-autonomous role for border-associated macrophages in ApoE4 neurovascular dysfunction and susceptibility to white matter injury. Nat Neurosci 2024:10.1038/s41593-024-01757-6. [PMID: 39294490 DOI: 10.1038/s41593-024-01757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/07/2024] [Indexed: 09/20/2024]
Abstract
Apolipoprotein E4 (ApoE4), the strongest genetic risk factor for sporadic Alzheimer's disease, is also a risk factor for microvascular pathologies leading to cognitive impairment, particularly subcortical white matter injury. These effects have been attributed to alterations in the regulation of the brain blood supply, but the cellular source of ApoE4 and the underlying mechanisms remain unclear. In mice expressing human ApoE3 or ApoE4, we report that border-associated macrophages (BAMs), myeloid cells closely apposed to neocortical microvessels, are both sources and effectors of ApoE4 mediating the neurovascular dysfunction through reactive oxygen species. ApoE4 in BAMs is solely responsible for the increased susceptibility to oligemic white matter damage in ApoE4 mice and is sufficient to enhance damage in ApoE3 mice. The data unveil a new aspect of BAM pathobiology and highlight a previously unrecognized cell-autonomous role of BAM in the neurovascular dysfunction of ApoE4 with potential therapeutic implications.
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Affiliation(s)
- Antoine Anfray
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Samantha Schaeffer
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Yorito Hattori
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Monica M Santisteban
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Nicole Casey
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Gang Wang
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Michael Strickland
- Department of Neurology, Hope Center for Neurological Disorders, Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ping Zhou
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - David M Holtzman
- Department of Neurology, Hope Center for Neurological Disorders, Charles F. and Joanne Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Laibaik Park
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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10
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You SH, Kim B, Kim I, Yang KS, Kim KM, Kim BK, Shin JH. Integrative MR Imaging Interpretation in Cognitive Impairment with Alzheimer's Disease, Small Vessel Disease, and Glymphatic Function-Related MR Parameters. Acad Radiol 2024:S1076-6332(24)00597-X. [PMID: 39294052 DOI: 10.1016/j.acra.2024.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/21/2024] [Accepted: 08/16/2024] [Indexed: 09/20/2024]
Abstract
RATIONALE AND OBJECTIVES The role of MR imaging in patients with cognitive impairment is to evaluate each component of Alzheimer's disease (AD), small vessel disease (SVD), and glymphatic function. We want to validate the diagnostic performance of the comprehensive interpretation of these parameters to predict the cognitive impairment stage. MATERIALS AND METHODS: This retrospective single-center study included 359 patients with cognitive impairment who had undergone MRI (FLAIR, T2WI, 3D-T1WI, susceptibility-weighted imaging, and diffusion tensor imaging [DTI]) and a neuropsychological screening battery between January 2020 and July 2022. Each AD and SVD-related MR parameter was visually evaluated, and DTI analysis along the perivascular space (ALPS) index was calculated. Volumetry analysis was performed using Neurophet AQUA AI-based software. Using logistic regression analysis, four types of models were developed and compared by adding the components in the following order: (1) clinical factors and AD, (2) SVD, (3) glymphatic function-related MR parameters, and (4) volumetric data. Chi-square automatic interaction detection algorithm was used to develop diagnostic tree analysis (DTA) model to predict late-stage cognitive impairment. RESULTS APOE4 status, years of education, medial temporal lobe atrophy score, Fazekas scale score, DTI-ALPS index, and white matter hyperintensity were significant predictors of late-stage cognitive impairment. The performance of the prediction model increased from Model 1 to Model 4 (AUC: 0.880, 0.899, 0.914, and 0.945, respectively). The overall accuracy of the DTA model was 87.47%. CONCLUSION Integrative brain MRI assessments in patients with cognitive impairment, AD, SVD, and glymphatic function-related MR parameters, improve the prediction of late-stage cognitive impairment.
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Affiliation(s)
- Sung-Hye You
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Korea (S.-H.Y., B.K., K.M.K., B.K.K., J.H.S.)
| | - Byungjun Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Korea (S.-H.Y., B.K., K.M.K., B.K.K., J.H.S.).
| | | | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (K.-S.Y.)
| | - Kyung Min Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Korea (S.-H.Y., B.K., K.M.K., B.K.K., J.H.S.)
| | - Bo Kyu Kim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Korea (S.-H.Y., B.K., K.M.K., B.K.K., J.H.S.)
| | - Jae Ho Shin
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Korea (S.-H.Y., B.K., K.M.K., B.K.K., J.H.S.)
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11
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Mu R, Qin X, Zheng W, Yang P, Huang B, Zhu X. Progressive brain structural abnormality in cerebral small vessel disease assessed with MR imaging by using causal network analysis. Neuroimage Clin 2024; 44:103672. [PMID: 39278131 PMCID: PMC11419796 DOI: 10.1016/j.nicl.2024.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/19/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
AIMS Cerebral small vessel disease (CSVD) is a complex condition characterized by a combination of microcirculation disorders and neurodegenerative processes, CSVD is associated with structural abnormalities in multiple brain regions. However, the progressive pattern of structural changes remains unknown. METHODS In order to detail the progressive structural changes in CSVD patients according to the degree of cognitive impairment, we recruited 121 CSVD patients and 104 healthy controls (HCs). Voxel-based morphometry was employed to measure the gray matter volume (GMV) of each participant. According to the VICCCS-2 diagnostic criteria, patients were initially divided into three stage groups, then we investigated the GMV changes in each stage and their causal relationships using causal structure covariance network (CaSCN) analysis. RESULTS Overall, patients with CSVD presented stage-specific GMV alterations compared with HCs. With the worsening of cognitive impairment, the decrease in gray matter volume starts from the right hippocampus and gradually spreads to the cortical-subcortical brain regions. Importantly, the right hippocampus in CSVD patients plays a driving role in the directional network and forms both positive and negative causal effect networks with cortical-subcortical brain regions. CONCLUSIONS This study reveals the significance of the right hippocampus as an early pathological area in CSVD patients and its causal impact on brain GMV changes with disease progression, shedding light on structural brain damage hierarchy and compensatory mechanisms.
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Affiliation(s)
- Ronghua Mu
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004 Guilin, China
| | - Xiaoyan Qin
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004 Guilin, China
| | - Wei Zheng
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004 Guilin, China
| | - Peng Yang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004 Guilin, China
| | - Bingqin Huang
- Department of Radiology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004 Guilin, China; Graduate School, Guilin Medical University, 541002 Guilin, China
| | - Xiqi Zhu
- Department of Radiology, Affiliated Hospital of Youjiang Medical University for Nationalities, 533000 Baise, China; Life Science and Clinical Medicine Research Center, Affiliated Hospital of Youjiang Medical university for Nationalities, 533000 Baise, China.
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12
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Kim KY, Kim E, Lee JY. Impact of amyloid and cardiometabolic risk factors on prognostic capacity of plasma neurofilament light chain for neurodegeneration. Alzheimers Res Ther 2024; 16:202. [PMID: 39267169 PMCID: PMC11397040 DOI: 10.1186/s13195-024-01564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/21/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Plasma neurofilament light chain (NfL) is a blood biomarker of neurodegeneration, including Alzheimer's disease. However, its usefulness may be influenced by common conditions in older adults, including amyloid-β (Aβ) deposition and cardiometabolic risk factors like hypertension, diabetes mellitus (DM), impaired kidney function, and obesity. This longitudinal observational study using the Alzheimer's Disease Neuroimaging Initiative cohort investigated how these conditions influence the prognostic capacity of plasma NfL. METHODS Non-demented participants (cognitively unimpaired or mild cognitive impairment) underwent repeated assessments including the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) scores, hippocampal volumes, and white matter hyperintensity (WMH) volumes at 6- or 12-month intervals. Linear mixed-effect models were employed to examine the interaction between plasma NfL and various variables of interest, such as Aβ (evaluated using Florbetapir positron emission tomography), hypertension, DM, impaired kidney function, or obesity. RESULTS Over a mean follow-up period of 62.5 months, participants with a mean age of 72.1 years (n = 720, 48.8% female) at baseline were observed. Higher plasma NfL levels at baseline were associated with steeper increases in ADAS-Cog scores and WMH volumes, and steeper decreases in hippocampal volumes over time (all p-values < 0.001). Notably, Aβ at baseline significantly enhanced the association between plasma NfL and longitudinal changes in ADAS-Cog scores (p-value 0.005) and hippocampal volumes (p-value 0.004). Regarding ADAS-Cog score and WMH volume, the impact of Aβ was more prominent in cognitively unimpaired than in mild cognitive impairment. Hypertension significantly heightened the association between plasma NfL and longitudinal changes in ADAS-Cog scores, hippocampal volumes, and WMH volumes (all p-values < 0.001). DM influenced the association between plasma NfL and changes in ADAS-Cog scores (p-value < 0.001) without affecting hippocampal and WMH volumes. Impaired kidney function did not significantly alter the association between plasma NfL and longitudinal changes in any outcome variables. Obesity heightened the association between plasma NfL and changes in hippocampal volumes only (p-value 0.026). CONCLUSION This study suggests that the prognostic capacity of plasma NfL may be amplified in individuals with Aβ or hypertension. This finding emphasizes the importance of considering these factors in the NfL-based prognostic model for neurodegeneration in non-demented older adults.
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Affiliation(s)
- Keun You Kim
- Department of Psychiatry, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Brain Korea 21 FOUR Project for Medical Science, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul Metropolitan Government - Seoul National University (SMG-SNU) Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea.
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13
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Choi S, Kum J, Hyun SY, Park TY, Kim H, Kim SK, Kim J. Transcranial focused ultrasound stimulation enhances cerebrospinal fluid movement: Real-time in vivo two-photon and widefield imaging evidence. Brain Stimul 2024; 17:1119-1130. [PMID: 39277129 DOI: 10.1016/j.brs.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) flow is crucial for brain homeostasis and its dysfunction is highly associated with neurodegenerative diseases. Restoring CSF circulation is proposed as a key strategy for the treatment of the diseases. Among the methods to improve CSF circulation, focused ultrasound (FUS) stimulation has emerged as a promising non-invasive brain stimulation technique, with effectiveness evidenced by ex vivo studies. However, due to technical disturbances in in vivo imaging combined with FUS, direct evidence of real-time in vivo CSF flow enhancement by FUS remains elusive. OBJECTIVE To investigate whether FUS administered through the skull base can enhance CSF influx in living animals with various real-time imaging techniques. METHODS We demonstrate a novel method of applying FUS through the skull base, facilitating cortical CSF influx, evidenced by diverse in vivo imaging techniques. Acoustic simulation confirmed effective sonication of our approach through the skull base. After injecting fluorescent CSF tracers into cisterna magna, FUS was administered at the midline of the jaw through the skull base for 30 min, during which imaging was performed concurrently. RESULTS Enhanced CSF influx was observed in macroscopic imaging, demonstrated by the influx area and intensity of the fluorescent dyes after FUS. In two-photon imaging, increased fluorescence was observed in the perivascular space (PVS) after stimulation. Moreover, particle tracking of microspheres showed more microspheres entering the imaging field, with increased mean speed after FUS. CONCLUSION Our findings provide direct real-time in vivo imaging evidence that FUS promotes CSF influx and flow in the PVS.
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Affiliation(s)
- Seunghwan Choi
- Department of East-West Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Jeungeun Kum
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Seon Young Hyun
- KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Tae Young Park
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Hyungmin Kim
- Bionics Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea; KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Sun Kwang Kim
- Department of East-West Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea; KHU-KIST Department of Converging Science and Technology, Kyung Hee University, Seoul, 02447, Republic of Korea; Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea.
| | - Jaeho Kim
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
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14
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Clancy U, Arteaga-Reyes C, Jaime Garcia D, Hewins W, Locherty R, Valdés Hernández MDC, Wiseman SJ, Stringer MS, Thrippleton M, Chappell FM, Jochems ACC, Liu X, Cheng Y, Zhang J, Rudilosso S, Kampaite A, Hamilton OKL, Brown R, Bastin ME, Muñoz Maniega S, Hamilton I, Job D, Doubal FN, Wardlaw JM. Incident Infarcts in Patients With Stroke and Cerebral Small Vessel Disease: Frequency and Relation to Clinical Outcomes. Neurology 2024; 103:e209750. [PMID: 39159417 PMCID: PMC11361828 DOI: 10.1212/wnl.0000000000209750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/25/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Factors associated with cerebral small vessel disease (SVD) progression, including incident infarcts, are unclear. We aimed to determine the frequency of incident infarcts over 1 year after minor stroke and their relation to baseline SVD burden, vascular risks, and recurrent stroke and cognitive outcomes. METHODS We recruited patients with lacunar or nondisabling cortical stroke. After diagnostic imaging, we repeated structural MRI at 3-6 monthly intervals for 12 months, visually assessing incident infarcts on diffusion-weighted imaging or FLAIR. We used logistic regression to determine associations of baseline vascular risks, SVD score, and index stroke subtype with subsequent incident infarcts. We assessed cognitive and functional outcomes at 1 year using Montreal Cognitive Assessment (MoCA) and modified Rankin scale (mRS), adjusting for baseline age, mRS, MoCA, premorbid intelligence, and SVD score. RESULTS We recruited 229 participants, mean age 65.9 (SD 11.1). Over half of all participants, 131 of 229 (57.2%) had had an index lacunar stroke. From baseline to 1-year MRI, we detected 117 incident infarcts in n = 57/229 (24.8%) participants. Incident infarcts were mainly of the small subcortical (86/117 [73.5%] in n = 38/57 [66.7%]) vs cortical infarct subtype (n = 19/57 [33.3%]). N = 39/57 participants had incident infarcts at 1 visit; 18 of 57 at 2 or more visits; and 19 of 57 participants had multiple infarcts at a single visit. Only 7 of 117 incident infarcts corresponded temporally to clinical stroke syndromes. The baseline SVD score was the strongest predictor of incident infarcts (adjusted odds ratio [OR] 1.87, 95% CI 1.39-2.58), while mean arterial pressure was not associated. All participants with incident infarcts were prescribed an antiplatelet or anticoagulant. Lower 1-year MoCA was associated with lower baseline MoCA (β 0.47, 95% CI 0.33-0.61), lower premorbid intelligence, and older age. Higher 1-year mRS was associated with higher baseline mRS only (OR 5.57 [3.52-9.10]). Neither outcome was associated with incident infarcts. DISCUSSION In the year after stroke in a population enriched for lacunar stroke, incident infarcts occurred in one-quarter and were associated with worse baseline SVD. Most incident infarcts detected on imaging did not correspond to clinical stroke/transient ischemic attack. Worse 1-year cognition and function were not associated with incident infarcts.
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Affiliation(s)
- Una Clancy
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carmen Arteaga-Reyes
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Daniela Jaime Garcia
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Will Hewins
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Rachel Locherty
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Maria Del C Valdés Hernández
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Stewart J Wiseman
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Michael S Stringer
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Michael Thrippleton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Francesca M Chappell
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Angela C C Jochems
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Xiaodi Liu
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Yajun Cheng
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Junfang Zhang
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Salvatore Rudilosso
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Agniete Kampaite
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Olivia K L Hamilton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Rosalind Brown
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Mark E Bastin
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Susana Muñoz Maniega
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Iona Hamilton
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Dominic Job
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Fergus N Doubal
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Joanna M Wardlaw
- From the Row Fogo Centre for Research into Ageing and the Brain, Centre for Clinical Brain Sciences, and UK Dementia Research Institute (U.C., C.A.-R., D.J.G., W.H., R.L., M.D.C.V.H., S.J.W., M.S.S., M.T., F.M.C., A.C.C.J., A.K., O.K.L.H., R.B., M.E.B., S.M.M., I.H., D.J., F.N.D., J.M.W.), University of Edinburgh; Division of Neurology (X.L.), Department of Medicine, The University of Hong Kong; Department of Neurology (Y.C.), West China Hospital, Sichuan University, Chengdu, China; Department of Neurology (J.Z.), Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China; Comprehensive Stroke Center (S.R.), Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute, Spain; and MRC/CSO Social and Public Health Sciences Unit (O.K.L.H.), School of Health and Wellbeing, University of Glasgow, United Kingdom
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15
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Xie HY, Chen JL, Xia CQ, Zhang N, Xia ZX, Zhao HY, Huang YH. Association of oral frailty and gait characteristics in patients with cerebral small vessel disease. BMC Neurol 2024; 24:336. [PMID: 39256704 PMCID: PMC11386381 DOI: 10.1186/s12883-024-03848-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 09/03/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND The objectives of this study were twofold: (1) to compare gait characteristics between cerebral small vessel disease (CSVD) patients with low-risk oral frailty (OF) and high-risk OF, particularly during dual-task walking (DTW); (2) to investigate the association of OF, the gait characteristics of DTW, and falls among older adults patients with CSVD. METHODS A total of 126 hospitalized patients diagnosed with CSVD were recruited and classified into a low-risk group (n = 90) and a high-risk group (n = 36) based on OF status in our study. Comprehensive data pertaining to basic parameters (cadence, as well as stride time, velocity and length), variability, asymmetry, and coordination were gathered during both single-task walking (STW) and DTW. Additionally, the number of falls was calculated. Subsequently, t-test or chi-squared test was used for comparison between the two groups. Furthermore, linear regression analysis was employed to elucidate the association of the OF index-8 score and gait parameters during cognitive DTW. Also, logistic regression models were utilized to assess the independent association of OF risk and falls. RESULTS During cognitive DTW, the high-risk group demonstrated inferior performance in terms of basic parameters (p < 0.01), coefficient of variation (CV) of velocity and stride length (p < 0.05), as well as phase coordination index (PCI) when compared with the low-risk group (p < 0.05). Notably, differences in basic gait parameters were observed in cognitive DTW and STW conditions between the two groups (p < 0.01). However, only the high-risk group evinced significant variations in CV and PCI during cognitive DTW, as opposed to those during STW (p < 0.05). Furthermore, our findings also revealed the association of OF, the gait characteristics of cognitive DTW, (p < 0.01) and falls (p < 0.05). CONCLUSION CSVD patients with a high risk of OF need to pay more attention to their gait variability or coordination. Also, they are recommended to undergo training involving dual-task activities while walking in daily life, thereby reducing the deterioration and mitigating the risk of falls. Besides, this study has confirmed an association of OF and DTW gait as well as falls in patients with CSVD.
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Affiliation(s)
- Hong-Yang Xie
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China
| | - Jun-Li Chen
- Department of Hematology, The Fifth Medical Center of PLA General Hospital, Fengtai District, Beijing, 100039, China
| | - Cui-Qiao Xia
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China
| | - Nan Zhang
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China
| | - Zhen-Xi Xia
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China
| | - Hong-Yi Zhao
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China
- Department of Neurology, Number 984 Hospital of the PLA, Haidian District, Beijing, 100094, China
| | - Yong-Hua Huang
- Department of Neurology, The Seven Medical Center of PLA General Hospital, Dongsi Shitiao, Dongcheng District, Nanmencang, Beijing, 100007, China.
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16
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Hohmann A, Zhang K, Mooshage CM, Jende JME, Rotkopf LT, Schlemmer HP, Bendszus M, Wick W, Kurz FT. Whole-Brain Vascular Architecture Mapping Identifies Region-Specific Microvascular Profiles In Vivo. AJNR Am J Neuroradiol 2024; 45:1346-1354. [PMID: 39054290 PMCID: PMC11392379 DOI: 10.3174/ajnr.a8344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/12/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND PURPOSE The novel MR imaging technique of vascular architecture mapping allows in vivo characterization of local changes in cerebral microvasculature, but reference ranges for vascular architecture mapping parameters in healthy brain tissue are lacking, limiting its potential applicability as an MR imaging biomarker in clinical practice. We conducted whole-brain vascular architecture mapping in a large cohort to establish vascular architecture mapping parameter references ranges and identify region-specific cortical and subcortical microvascular profiles. MATERIALS AND METHODS This was a single-center examination of adult patients with unifocal, stable low-grade gliomas with multiband spin- and gradient-echo EPI sequence at 3T using parallel imaging. Voxelwise plotting of resulting values for gradient-echo (R2*) versus spin-echo (R2) relaxation rates during contrast agent bolus administration generates vessel vortex curves that allow the extraction of vascular architecture mapping parameters representative of, eg, vessel type, vessel radius, or CBV in the underlying voxel. Averaged whole-brain parametric maps were calculated for 9 parameters, and VOI analysis was conducted on the basis of a standardized brain atlas and individual cortical GM and WM segmentation. RESULTS Prevalence of vascular risk factors among subjects (n = 106; mean age, 39.2 [SD, 12.5] years; 56 women) was similar to those in the German population. Compared with WM, we found cortical GM to have larger mean vascular calibers (5.80 [SD, 0.59] versus 4.25 [SD, 0.62] P < .001), increased blood volume fraction (20.40 [SD, 4.49] s-1 versus 11.05 [SD, 2.44] s-1; P < .001), and a dominance of venous vessels. Distinct microvascular profiles emerged for cortical GM, where vascular architecture mapping vessel type indicator differed, eg, between the thalamus and cortical GM (mean, -2.47 [SD, 4.02] s-2 versus -5.41 [SD, 2.84] s-2; P < .001). Intraclass correlation coefficient values indicated overall high test-retest reliability for vascular architecture mapping parameter mean values when comparing multiple scans per subject. CONCLUSIONS Whole-brain vascular architecture mapping in the adult brain reveals region-specific microvascular profiles. The obtained parameter reference ranges for distinct anatomic and functional brain areas may be used for future vascular architecture mapping studies on cerebrovascular pathologies and might facilitate early discovery of microvascular changes, in, eg, neurodegeneration and neuro-oncology.
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Affiliation(s)
- Anja Hohmann
- From the Department of Neurology (A.H., W.W.), Heidelberg University Hospital, Heidelberg, Germany
| | - Ke Zhang
- Department of Diagnostic and Interventional Radiology (K.Z.), Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph M Mooshage
- Department of Neuroradiology (C.M.M., J.M.E.J., M.B., F.T.K.), Heidelberg University Hospital, Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology (C.M.M., J.M.E.J., M.B., F.T.K.), Heidelberg University Hospital, Heidelberg, Germany
| | - Lukas T Rotkopf
- Division of Radiology (L.T.R., H.-P.S., F.T.K.) German Cancer Research Center, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology (L.T.R., H.-P.S., F.T.K.) German Cancer Research Center, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology (C.M.M., J.M.E.J., M.B., F.T.K.), Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- From the Department of Neurology (A.H., W.W.), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Research Center, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology (C.M.M., J.M.E.J., M.B., F.T.K.), Heidelberg University Hospital, Heidelberg, Germany
- Division of Radiology (L.T.R., H.-P.S., F.T.K.) German Cancer Research Center, Heidelberg, Germany
- Division of Neuroradiology (F.T.K.), University Hospital Geneva, Geneva, Switzerland
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Wang D, Sun Z, Li Y. Horizontal analysis and longitudinal cohort study of chronic renal failure correlates and cerebral small vessel disease relationship using peak width of skeletonized mean diffusivity. Front Neurol 2024; 15:1461258. [PMID: 39318874 PMCID: PMC11421033 DOI: 10.3389/fneur.2024.1461258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
Background and purpose Peak width of skeletonized mean diffusivity (PSMD) is an MRI-based biomarker that may reflect white matter lesions (WML). PSMD is based on skeletonization of MR DTI data and histogram analysis. Both chronic renal failure (CRF) and WML may be affected by multisystemic small-vessel disorder. We aimed to explore the relationship between PSMD and estimated glomerular filtration rate (eGFR). Methods Fifty followed-up CRF patients matched for age, sex, hypertension and smoking status were enrolled and classified into a progressive group (n = 16) and stable group (n = 34) based on eGFR levels. Longitudinal and horizontal differences of PSMD were compared between the progressive and stable groups at the initial and follow-up time points. Pearson's correlation was used for correlation of eGFR with PSMD and WML (per Fazekas scale score). ROC was used to measure the sensitivity of PSMD and WML score to changes of eGFR. Results At the follow-up time point, PSMD of the progressive group was significantly higher than at the initial time point (p < 0.001), and PSMD of the progressive group was significantly higher than stable group (p < 0.001). PSMD and eGFR were significantly correlated. AUC curves explored that ΔPSMD (PSMD changes at the follow-up and initial time points) and follow-up PSMD was better for the classification of progressive and stable groups. Conclusion PSMD has significant correlation with eGFR, PSMD can reveal a close relationship between WML and CRF.
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Affiliation(s)
| | | | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Guo F, Zhao C, Shou Q, Jin N, Jann K, Shao X, Wang DJ. Assessing Cerebral Microvascular Volumetric Pulsatility with High-Resolution 4D CBV MRI at 7T. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.04.24313077. [PMID: 39281763 PMCID: PMC11398588 DOI: 10.1101/2024.09.04.24313077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Arterial pulsation is crucial for promoting fluid circulation and for influencing neuronal activity. Previous studies assessed the pulsatility index based on blood flow velocity pulsatility in relatively large cerebral arteries of human. Here, we introduce a novel method to quantify the volumetric pulsatility of cerebral microvasculature across cortical layers and in white matter (WM), using high-resolution 4D vascular space occupancy (VASO) MRI with simultaneous recording of pulse signals at 7T. Microvascular volumetric pulsatility index (mvPI) and cerebral blood volume (CBV) changes across cardiac cycles are assessed through retrospective sorting of VASO signals into cardiac phases and estimating mean CBV in resting state (CBV0) by arterial spin labeling (ASL) MRI at 7T. Using data from 11 young (28.4±5.8 years) and 7 older (61.3±6.2 years) healthy participants, we investigated the aging effect on mvPI and compared microvascular pulsatility with large arterial pulsatility assessed by 4D-flow MRI. We observed the highest mvPI in the cerebrospinal fluid (CSF) on the cortical surface (0.19±0.06), which decreased towards the cortical layers as well as in larger arteries. In the deep WM, a significantly increased mvPI (p = 0.029) was observed in the older participants compared to younger ones. Additionally, mvPI in deep WM is significantly associated with the velocity pulsatility index (vePI) of large arteries (r = 0.5997, p = 0.0181). We further performed test-retest scans, non-parametric reliability test and simulations to demonstrate the reproducibility and accuracy of our method. To the best of our knowledge, our method offers the first in vivo measurement of microvascular volumetric pulsatility in human brain which has implications for cerebral microvascular health and its relationship research with glymphatic system, aging and neurodegenerative diseases.
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Affiliation(s)
- Fanhua Guo
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
| | - Chenyang Zhao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
| | - Qinyang Shou
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
| | | | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
| | - Danny Jj Wang
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California
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Borrelli S, Leclercq S, Pasi M, Maggi P. Cerebral small vessel disease and glymphatic system dysfunction in multiple sclerosis: A narrative review. Mult Scler Relat Disord 2024; 91:105878. [PMID: 39276600 DOI: 10.1016/j.msard.2024.105878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/17/2024]
Abstract
As the multiple sclerosis (MS) population ages, the prevalence of vascular comorbidities increases, potentially accelerating disease progression and brain atrophy. Recent studies highlight the prevalence of cerebral small vessel disease (CSVD) in MS, suggesting a potential link between vascular comorbidities and accelerated disability. CSVD affects the brain's small vessels, often leading to identifiable markers on MRI such as enlarged perivascular spaces (EPVS). EPVS are increasingly recognized also in MS and have been associated with vascular comorbidities, lower percentage of MS-specific perivenular lesions, brain atrophy and aging. The exact sequence of event leading to MRI visible EPVS is yet to be determined, but an impaired perivascular brain fluid drainage appears a possible physiopathological explanation for EPVS in both CSVD and MS. In this context, a dysfunction of the brain fluid clearance system - also known as "glymphatic system" - appears associated in MS to aging, neuroinflammation, and vascular dysfunction. Advanced imaging techniques show an impaired glymphatic function in both MS and CSVD. Additionally, lifestyle factors such as physical exercise, diet, and sleep quality appear to influence glymphatic function, potentially revealing novel therapeutic strategies to mitigate microangiopathy and neuroinflammation in MS. This review underscores the potential role of glymphatic dysfunction in the complex and not-yet elucidated interplay between neuroinflammation and CSVD in MS.
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Affiliation(s)
- Serena Borrelli
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium; Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium.
| | - Sophie Leclercq
- Laboratory of Nutritional Psychiatry, Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Marco Pasi
- Stroke Unit, Department of Neurology, CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain, Tours, France
| | - Pietro Maggi
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium; Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10, Brussels 1200, Belgium.
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Mohammadzadeh M, Khoshakhlagh AH, Grafman J. Air pollution: a latent key driving force of dementia. BMC Public Health 2024; 24:2370. [PMID: 39223534 PMCID: PMC11367863 DOI: 10.1186/s12889-024-19918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
Many researchers have studied the role of air pollutants on cognitive function, changes in brain structure, and occurrence of dementia. Due to the wide range of studies and often contradictory results, the present systematic review was conducted to try and clarify the relationship between air pollutants and dementia. To identify studies for this review, a systematic search was conducted in Scopus, PubMed, and Web of Science databases (without historical restrictions) until May 22, 2023. The PECO statement was created to clarify the research question, and articles that did not meet the criteria of this statement were excluded. In this review, animal studies, laboratory studies, books, review articles, conference papers and letters to the editors were avoided. Also, studies focused on the effect of air pollutants on cellular and biochemical changes (without investigating dementia) were also excluded. A quality assessment was done according to the type of design of each article, using the checklist developed by the Joanna Briggs Institute (JBI). Finally, selected studies were reviewed and discussed in terms of Alzheimer's dementia and non-Alzheimer's dementia. We identified 14,924 articles through a systematic search in databases, and after comprehensive reviews, 53 articles were found to be eligible for inclusion in the current systematic review. The results showed that chronic exposure to higher levels of air pollutants was associated with adverse effects on cognitive abilities and the presence of dementia. Studies strongly supported the negative effects of PM2.5 and then NO2 on the brain and the development of neurodegenerative disorders in old age. Because the onset of brain structural changes due to dementia begins decades before the onset of disease symptoms, and that exposure to air pollution is considered a modifiable risk factor, taking preventive measures to reduce air pollution and introducing behavioral interventions to reduce people's exposure to pollutants is advisable.
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Affiliation(s)
- Mahdiyeh Mohammadzadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Climate Change and Health Research Center (CCHRC), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Khoshakhlagh
- Department of Occupational Health Engineering, School of Health, Kashan University of Medical Sciences, Kashan, Iran.
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine & Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
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21
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Wang ZJ, Hu X, Xie YF, Yao WJ, Deng L, Li ZQ, Pu MJ, Lv XN, Hu ZC, Zhang JT, Li Q. Prevalence of small vessel disease and incidental DWI-positive lesions in patients with aneurysmal subarachnoid hemorrhage versus intracerebral hemorrhage. Eur Stroke J 2024; 9:639-647. [PMID: 38372251 PMCID: PMC11418497 DOI: 10.1177/23969873241232327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse. PATIENTS AND METHODS We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated. RESULTS We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, p < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH. DISCUSSION AND CONCLUSION Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.
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Affiliation(s)
- Zi-Jie Wang
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Fang Xie
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Jun Yao
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lan Deng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Jun Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Cheng Hu
- Department of Neurology, People’s Hospital of Hechuan, Chongqing, China
| | - Jiang-Tao Zhang
- Department of Neurology, Chengde Central Hospital, Chengde, Hebei, China
| | - Qi Li
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, China
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22
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Gallina P, Lolli F. Fluctuation in body size and glymphatic system derangement in obesity. Int J Obes (Lond) 2024; 48:1351-1352. [PMID: 38879727 DOI: 10.1038/s41366-024-01567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Pasquale Gallina
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Francesco Lolli
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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23
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Li H, Li Y, Zhong Q, Chen F, Wang H, Li X, Xie Y, Wang X. Dysfunction of neurovascular coupling in patients with cerebral small vessel disease: A combined resting-state fMRI and arterial spin labeling study. Exp Gerontol 2024; 194:112478. [PMID: 38866193 DOI: 10.1016/j.exger.2024.112478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) closely correlates to cognitive impairment, but its pathophysiology and the neurovascular mechanisms of cognitive deficits were unclear. We aimed to explore the dysfunctional patterns of neurovascular coupling (NVC) in patients with CSVD and further investigate the neurovascular mechanisms of CSVD-related cognitive impairment. METHODS Forty-three patients with CSVD and twenty-four healthy controls were recruited. We adopted resting-state functional magnetic resonance imaging combined with arterial spin labeling to investigate the NVC dysfunctional patterns in patients with CSVD. The Human Brain Atlas with 246 brain regions was applied to extract the NVC coefficients for each brain region. Partial correlation analysis and mediation analysis were used to explore the relationship between CSVD pathological features, NVC dysfunctional patterns, and cognitive decline. RESULTS 8 brain regions with NVC dysfunction were found in patients with CSVD (p < 0.025, Bonferroni correction). The NVC dysfunctional patterns in regions of the default mode network and subcortical nuclei were negatively associated with lacunes, white matter hyperintensities burden, and the severity of CSVD (FDR correction, q < 0.05). The NVC decoupling in regions located in the default mode network positively correlated with delayed recall deficits (FDR correction, q < 0.05). Mediation analysis suggested that the decreased NVC pattern of the left superior frontal gyrus partially mediated the impact of white matter hyperintensities on delayed recall (Mediation effect: -0.119; 95%CI: -11.604,-0.458; p < 0.05). CONCLUSION The findings of this study reveal the NVC dysfunctional pattern in patients with CSVD and illustrate the neurovascular mechanism of CSVD-related cognitive impairment. The NVC function in the left superior frontal gyrus may serve as a promising biomarker and therapeutic target for memory deficits in patients with CSVD.
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Affiliation(s)
- Hui Li
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - You Li
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - Qin Zhong
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - Faxiang Chen
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - Hui Wang
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - Xiang Li
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China
| | - Yuanliang Xie
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China.
| | - Xiang Wang
- Department of Radiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430014, China.
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24
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Yang XZ, Huang MY, Han F, Ni J, Zhou LX, Yao M, Zhang DD, Zhu YC. Genome-Wide Mendelian Randomization Study Reveals Druggable Genes for Cerebral Small Vessel Disease. Stroke 2024; 55:2264-2273. [PMID: 39114924 DOI: 10.1161/strokeaha.124.046544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a group of neurological disorders that affect the small blood vessels within the brain, for which no effective treatments are currently available. We conducted a Mendelian randomization (MR) study to identify candidate therapeutic genes for CSVD. METHODS We retrieved genome-wide association study data from 6 recently conducted, extensive investigations focusing on CSVD magnetic resonance imaging markers and performed a 2-sample MR analysis to assess the potential causal effects of gene expression and protein level within druggable genes on CSVD in blood and brain tissues. Colocalization analyses and repeat studies were undertaken to verify the relationship. Additionally, mediation analysis was conducted to explore the potential mechanisms involving druggable genes and known risk factors for CSVD. Finally, phenome-wide MR analyses were applied to evaluate the potential adverse effects related to the identified druggable genes for CSVD treatment. RESULTS Overall, 5 druggable genes consistently showed associations with CSVD in MR analyses across both the discovery and validation cohorts. Notably, the ALDH2 and KLHL24 genes were identified as associated with CSVD in both blood and brain tissues, whereas the genes ADRB1, BTN3A2, and EFEMP1 were exclusively detected in brain tissue. Moreover, mediation analysis elucidated the proportion of the total effects mediated by CSVD risk factors through candidate druggable genes, which ranged from 5.5% to 18.5%, and offered potential explanations for the observed results. A comprehensive phenome-wide MR analysis further emphasized both the therapeutic benefits and potential side effects of targeting these candidate druggable genes. CONCLUSIONS This study provides genetic evidence supporting the potential therapeutic benefits of targeting druggable genes for treating CSVD, which will be useful for prioritizing CSVD drug development.
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Affiliation(s)
- Xin-Zhuang Yang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
- Center for Bioinformatics, National Infrastructures for Translational Medicine, Institute of Clinical Medicine & Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y.)
| | - Mei-Ying Huang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
| | - Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
| | - Li-Xin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
| | - Ding-Ding Zhang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
- Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine & Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (D.-D.Z.)
| | - Yi-Cheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China (X.-Z.Y., M.-Y.H., F.H., J.-N., L.-X.Z., M.Y., D.-D.Z., Y.-C.Z.)
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25
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Schmitzer L, Kaczmarz S, Göttler J, Hoffmann G, Kallmayer M, Eckstein HH, Hedderich DM, Kufer J, Zimmer C, Preibisch C, Hyder F, Sollmann N. Macro- and microvascular contributions to cerebral structural alterations in patients with asymptomatic carotid artery stenosis. J Cereb Blood Flow Metab 2024; 44:1629-1642. [PMID: 38506325 PMCID: PMC11418673 DOI: 10.1177/0271678x241238935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
Atherosclerosis can underly internal carotid artery stenosis (ICAS), a major risk factor for ischemic stroke, as well as small vessel disease (SVD). This study aimed to investigate hemodynamics and structural alterations associated with SVD in ICAS patients. 28 patients with unilateral asymptomatic ICAS and 30 age-matched controls underwent structural (T1-/T2-weighted and diffusion tensor imaging [DTI]) and hemodynamic (pseudo-continuous arterial spin labeling and dynamic susceptibility contrast) magnetic resonance imaging. SVD-related alterations were assessed using free water (FW), FW-corrected DTI, and peak-width of skeletonized mean diffusivity (PSMD). Furthermore, cortical thickness, cerebral blood flow (CBF), and capillary transit time heterogeneity (CTH) were analyzed. Ipsilateral to the stenosis, cortical thickness was significantly decreased in the posterior dorsal cingulate cortex (p = 0.024) and temporal pole (p = 0.028). ICAS patients exhibited elevated PSMD (p = 0.005), FW (p < 0.001), and contralateral alterations in FW-corrected DTI metrics. We found significantly lateralized CBF (p = 0.011) and a tendency for lateralized CTH (p = 0.067) in the white matter (WM) related to ICAS. Elevated PSMD and FW may indicate a link between SVD and WM changes. Contralateral alterations were seen in FW-corrected DTI, whereas hemodynamic and cortical changes were mainly ipsilateral, suggesting SVD might influence global brain changes concurrent with ICAS-related hemodynamic alterations.
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Affiliation(s)
- Lena Schmitzer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dennis Martin Hedderich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jan Kufer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fahmeed Hyder
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center (MRRC), Yale University, New Haven, CT, USA
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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26
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Jiménez-Balado J, Habeck C, Stern Y, Eich T. The relationship between cortical thickness and white matter hyperintensities in mid to late life. Neurobiol Aging 2024; 141:129-139. [PMID: 38909430 PMCID: PMC11313098 DOI: 10.1016/j.neurobiolaging.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Abstract
White matter hyperintensities (WMH) are associated with cortical thinning. Although they are primarily detected in older participants, these lesions can appear in younger and midlife individuals. Here, we tested whether WMH are associated with cortical thinning in relatively younger (26-50 years) and relatively older (58-84) participants who were free of dementia, and how these associations are moderated by WMH localization. WMH were automatically quantified and categorized according to the localization of three classes of white matter tracts: association, commissural and projection fibers. Mediation analyses were used to infer whether differences in cortical thickness between younger and older participants were explained by WMH. Our results revealed that total WMH explained between 20.6 % and 65.5 % of the effect of age on cortical thickness in AD-signature regions including the lateral temporal lobes and supramarginal gyrus, among others. This mediation was slightly stronger for projection WMH, although it was still significant for association and commissural WMH. These results suggest that there is an interplay between vascular and AD causes of cognitive impairment that starts at younger ages.
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Affiliation(s)
- Joan Jiménez-Balado
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA; Neurovascular Research Group, IMIM-Hospital del Mar Medical Research Institute, Carrer del Dr. Aiguader, 88, Barcelona 08003, Spain
| | - Christian Habeck
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Teal Eich
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA USA; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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27
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McNeilly S, Thomson CR, Gonzalez-Trueba L, Sin YY, Granata A, Hamilton G, Lee M, Boland E, McClure JD, Lumbreras-Perales C, Aman A, Kumar AA, Cantini M, Gök C, Graham D, Tomono Y, Anderson CD, Lu Y, Smith C, Markus HS, Abramowicz M, Vilain C, Al-Shahi Salman R, Salmeron-Sanchez M, Hainsworth AH, Fuller W, Kadler KE, Bulleid NJ, Van Agtmael T. Collagen IV deficiency causes hypertrophic remodeling and endothelium-dependent hyperpolarization in small vessel disease with intracerebral hemorrhage. EBioMedicine 2024; 107:105315. [PMID: 39216230 PMCID: PMC11402910 DOI: 10.1016/j.ebiom.2024.105315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/26/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Genetic variants in COL4A1 and COL4A2 (encoding collagen IV alpha chain 1/2) occur in genetic and sporadic forms of cerebral small vessel disease (CSVD), a leading cause of stroke, dementia and intracerebral haemorrhage (ICH). However, the molecular mechanisms of CSVD with ICH and COL4A1/COL4A2 variants remain obscure. METHODS Vascular function and molecular investigations in mice with a Col4a1 missense mutation and heterozygous Col4a2 knock-out mice were combined with analysis of human brain endothelial cells harboring COL4A1/COL4A2 mutations, and brain tissue of patients with sporadic CSVD with ICH. FINDINGS Col4a1 missense mutations cause early-onset CSVD independent of hypertension, with enhanced vasodilation of small arteries due to endothelial dysfunction, vascular wall thickening and reduced stiffness. Mechanistically, the early-onset dysregulated endothelium-dependent hyperpolarization (EDH) is due to reduced collagen IV levels with elevated activity and levels of endothelial Ca2+-sensitive K+ channels. This results in vasodilation via the Na/K pump in vascular smooth muscle cells. Our data support this endothelial dysfunction preceding development of CSVD-associated ICH is due to increased cytoplasmic Ca2+ levels in endothelial cells. Moreover, cerebral blood vessels of patients with sporadic CSVD show genotype-dependent mechanisms with wall thickening and lower collagen IV levels in those harboring common non-coding COL4A1/COL4A2 risk alleles. INTERPRETATION COL4A1/COL4A2 variants act in genetic and sporadic CSVD with ICH via dysregulated EDH, and altered vascular wall thickness and biomechanics due to lower collagen IV levels and/or mutant collagen IV secretion. These data highlight EDH and collagen IV levels as potential treatment targets. FUNDING MRC, Wellcome Trust, BHF.
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Affiliation(s)
- Sarah McNeilly
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Cameron R Thomson
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Laura Gonzalez-Trueba
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yuan Yan Sin
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Alessandra Granata
- Department of Clinical Neurosciences, Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge and Royal Papworth Hospital, Cambridge, UK
| | - Graham Hamilton
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK; Glasgow Polyomics, University of Glasgow, Glasgow, UK
| | - Michelle Lee
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Erin Boland
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - John D McClure
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Cristina Lumbreras-Perales
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Alisha Aman
- School of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Apoorva A Kumar
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; Princess Royal University Hospital, Kings College Hospital NHS Foundation Trust, London, UK
| | - Marco Cantini
- Centre for the Cellular Microenvironment, School of Science and Engineering, University of Glasgow, Glasgow, UK
| | - Caglar Gök
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Delyth Graham
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yasuko Tomono
- Division of Molecular & Cell Biology, Shigei Medical Research Institute, Okayama, Japan
| | - Christopher D Anderson
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yinhui Lu
- Wellcome Centre for Cell Matrix Research, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Colin Smith
- Academic Neuropathology, University of Edinburgh, Edinburgh, UK
| | - Hugh S Markus
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marc Abramowicz
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Catheline Vilain
- Department of Genetics, Hôpital Erasme, ULB Center of Human Genetics, Universite Libre de Bruxelles, Bruxelles, Belgium
| | | | - Manuel Salmeron-Sanchez
- Centre for the Cellular Microenvironment, School of Science and Engineering, University of Glasgow, Glasgow, UK
| | - Atticus H Hainsworth
- Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - William Fuller
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Karl E Kadler
- Wellcome Centre for Cell Matrix Research, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Neil J Bulleid
- School of Molecular Biosciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Tom Van Agtmael
- School of Cardiovascular and Metabolic Health, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK.
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Sun Y, Hu W, Hu Y, Qiu Y, Chen Y, Xu Q, Wei H, Dai Y, Zhou Y. Exploring cognitive related microstructural alterations in normal appearing white matter and deep grey matter for small vessel disease: A quantitative susceptibility mapping study. Neuroimage 2024; 298:120790. [PMID: 39147292 DOI: 10.1016/j.neuroimage.2024.120790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024] Open
Abstract
Brain microstructural alterations possibly occur in the normal-appearing white matter (NAWM) and grey matter of small vessel disease (SVD) patients, and may contribute to cognitive impairment. The aim of this study was to explore cognitive related microstructural alterations in white matter and deep grey matter nuclei in SVD patients using magnetic resonance (MR) quantitative susceptibility mapping (QSM). 170 SVD patients, including 103 vascular mild cognitive impairment (VaMCI) and 67 no cognitive impairment (NCI), and 21 healthy control (HC) subjects were included, all underwent a whole-brain QSM scanning. Using a white matter and a deep grey matter atlas, subregion-based QSM analysis was conducted to identify and characterize microstructural alterations occurring within white matter and subcortical nuclei. Significantly different susceptibility values were revealed in NAWM and in several specific white matter tracts including anterior limb of internal capsule, corticospinal tract, medial lemniscus, middle frontal blade, superior corona radiata and tapetum among VaMCI, NCI and HC groups. However, no difference was found in white matter hyperintensities between VaMCI and NCI. A trend toward higher susceptibility in the caudate nucleus and globus pallidus of VaMCI patients compared to HC, indicating elevated iron deposition in these areas. Interestingly, some of these QSM parameters were closely correlated with both global and specific cognitive function scores, controlling age, gender and education level. Our study suggested that QSM may serve as a useful imaging tool for monitoring cognitive related microstructural alterations in brain. This is especially meaningful for white matter which previously lacks of attention.
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Affiliation(s)
- Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Hu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Hu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuewei Chen
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Renji-UNSW CHeBA Neurocognitive Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qun Xu
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Renji-UNSW CHeBA Neurocognitive Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Health Manage Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering & State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China.
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Wang Y, Li Y, Jiao S, Pan Y, Deng X, Qin Y, Zhao D, Liu Z. Correlation analysis and predictive model construction of metabolic syndrome, complete blood count-derived inflammatory markers, and overall burden of cerebral small vessel disease. Heliyon 2024; 10:e35065. [PMID: 39220940 PMCID: PMC11365336 DOI: 10.1016/j.heliyon.2024.e35065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
Background The high burden of cerebral small vessel disease (CSVD) on neuroimaging is a significant risk factor for stroke, cognitive dysfunction, and emotional disorders. Currently, there is a lack of studies investigating the correlation between metabolic syndrome (MetS), complete blood count-derived inflammatory markers, and total CSVD burden. This study aims to evaluate the total CSVD imaging load using machine learning (ML) algorithms and to explore further the relationship between MetS, complete blood count-derived inflammatory markers, and CSVD load. Methods We included CSVD patients from Xijing Hospital (2012-2022). Univariate and lasso regression analyses identified variables linked to CSVD neuroimaging burden. Six ML models predicted CSVD burden based on MetS and inflammatory markers. Model performance was evaluated using ROCauc, PRauc, DCA, and calibration curves. The SHAP method validated model interpretability. The best-performing model was selected to develop a web-based calculator using the Shiny package. Results The Logistic regression model outperformed others in predicting CSVD burden. The model incorporated MetS, neutrophil-to-lymphocyte ratio (NLR), homocysteine (Hcy), age, smoking status, cystatin C (CysC), uric acid (UA), and prognostic nutritional index (PNI). Conclusion MetS, NLR, Hcy and CSVD high load were positively correlated, and the Logistic regression model could accurately predict the total CSVD load degree.
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Affiliation(s)
- Yang Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yang Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shusheng Jiao
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yuanhang Pan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiwei Deng
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yunlong Qin
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Di Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhirong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Ölmestig J, Mortensen KN, Fagerlund B, Naveed N, Nordling MM, Christensen H, Iversen HK, Poulsen MB, Siebner HR, Kruuse C. Cerebral blood flow and cognition after 3 months tadalafil treatment in small vessel disease (ETLAS-2): study protocol for a randomized controlled trial. Trials 2024; 25:570. [PMID: 39210472 PMCID: PMC11360322 DOI: 10.1186/s13063-024-08402-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Targeted treatment is highly warranted for cerebral small vessel disease, a causal factor of one in four strokes and a major contributor to vascular dementia. Patients with cerebral small vessel disease have impaired cerebral blood flow and vessel reactivity. Tadalafil is a specific phosphodiesterase 5 inhibitor shown to improve vascular reactivity in the brain. METHODS The ETLAS-2 trial is a phase 2 double-blind, randomized placebo-controlled, parallel trial with the feasibility of tadalafil as the primary outcome. The trial aims to include 100 patients with small vessel occlusion stroke or transitory ischemic attacks and signs of cerebral small vessel disease more than 6 months before administration of study medication. Patients are treated for 3 months with tadalafil 20 mg or placebo daily and undergo magnetic resonance imaging (MRI) to evaluate changes in small vessel disease according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) criteria as well as cerebral blood flow, cerebrovascular reactivity, and neurovascular coupling in a functional MRI sub-study. The investigation includes comprehensive cognitive testing using paper-pencil tests and Cambridge Neuropsychological Test Automated Battery (CANTAB) tests in a cognitive sub-study. DISCUSSION The ETLAS-2 trial tests the feasibility of long-term treatment with tadalafil and explores vascular and cognitive effects in cerebral small vessel disease in trial sub-studies. The study aims to propose a new treatment target and improve the understanding of small vessel disease. Currently, 64 patients have been included and the trial is estimated to be completed in the year 2024. TRIAL REGISTRATION Clinicaltrials.gov, NCT05173896. Registered on 30 December 2021.
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Affiliation(s)
- Joakim Ölmestig
- Neurovascular Research Unit, Department of Neurology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
| | - Kristian Nygaard Mortensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
| | - Birgitte Fagerlund
- Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nadia Naveed
- Department of Radiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Mette Maria Nordling
- Department of Radiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Helle Klingenberg Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mai Bang Poulsen
- Department of Neurology, Copenhagen University Hospital-North Zealand, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital-Amager and Hvidovre, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit, Department of Neurology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Brain and Spinal Cord Injury, Neuroscience Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
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31
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Yang S, Sun Z, Sun D, Yu C, Guo Y, Sun D, Pang Y, Pei P, Yang L, Millwood IY, Walters RG, Chen Y, Du H, Lu Y, Burgess S, Avery D, Clarke R, Chen J, Chen Z, Li L, Lv J. Associations of polygenic risk scores with risks of stroke and its subtypes in Chinese. Stroke Vasc Neurol 2024; 9:399-406. [PMID: 37640499 PMCID: PMC7616400 DOI: 10.1136/svn-2023-002428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Previous studies, mostly focusing on the European population, have reported polygenic risk scores (PRSs) might achieve risk stratification of stroke. We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population. METHODS Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set (n=22 191) and a population-based testing set (n=72 150). Four previously developed PRSs were included, and new PRSs for stroke and its subtypes were developed. The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set. Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes (ischaemic stroke (IS), intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH)). RESULTS In the testing set, during 872 919 person-years of follow-up, 8514 incident stroke events were documented. The PRSs of any stroke (AS) and IS were both positively associated with risks of AS, IS and ICH (p<0.05). The HR for per SD increment (HRSD) of PRSAS was 1.10 (95% CI 1.07 to 1.12), 1.10 (95% CI 1.07 to 1.12) and 1.13 (95% CI 1.07 to 1.20) for AS, IS and ICH, respectively. The corresponding HRSD of PRSIS was 1.08 (95% CI 1.06 to 1.11), 1.08 (95% CI 1.06 to 1.11) and 1.09 (95% CI 1.03 to 1.15). PRSICH was positively associated with the risk of ICH (HRSD=1.07, 95% CI 1.01 to 1.14). PRSSAH was not associated with risks of stroke and its subtypes. The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification. CONCLUSIONS In this Chinese population, the association strengths of current PRSs with risks of stroke and its subtypes were moderate, suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population.
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Affiliation(s)
- Songchun Yang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhijia Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Dong Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yu Guo
- Fuwai Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yuanjie Pang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Pei Pei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robin G Walters
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yan Lu
- NCDs Prevention and Control Department, Suzhou CDC, Suzhou, Jiangsu, China
| | - Sushila Burgess
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Daniel Avery
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Robert Clarke
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
- State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing, China
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Li Y, Cho SM, Avadhani R, Ali H, Hao Y, Murthy SB, Goldstein JN, Xia F, Hu X, Ullman NL, Awad I, Hanley D, Ziai WC. Cerebral small vessel disease modifies outcomes after minimally invasive surgery for intracerebral haemorrhage. Stroke Vasc Neurol 2024; 9:446-456. [PMID: 37949482 PMCID: PMC11420921 DOI: 10.1136/svn-2023-002463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) for spontaneous supratentorial intracerebral haemorrhage (ICH) is controversial but may be beneficial if end-of-treatment (EOT) haematoma volume is reduced to ≤15 mL. We explored whether MRI findings of cerebral small vessel disease (CSVD) modify the effect of MIS on long-term outcomes. METHODS Prespecified blinded subgroup analysis of 288 subjects with qualified imaging sequences from the phase 3 Minimally Invasive Surgery Plus Alteplase for Intracerebral Haemorrhage Evacuation (MISTIE) trial. We tested for heterogeneity in the effects of MIS and MIS+EOT volume ≤15 mL on the trial's primary outcome of good versus poor function at 1 year by the presence of single CSVD features and CSVD scores using multivariable models. RESULTS Of 499 patients enrolled in MISTIE III, 288 patients had MRI, 149 (51.7%) randomised to MIS and 139 (48.3%) to standard medical care (SMC). Median (IQR) ICH volume was 42 (30-53) mL. In the full MRI cohort, there was no statistically significant heterogeneity in the effects of MIS versus SMC on 1-year outcomes by any specific CSVD feature or by CSVD scores (all Pinteraction >0.05). In 94 MIS patients with EOT ICH volume ≤15 mL, significant reduction in odds of poor outcome was found with cerebral amyloid angiopathy score <2 (OR, 0.14 (0.05-0.42); Pinteraction=0.006), absence of lacunes (OR, 0.37 (0.18-0.80); Pinteraction=0.02) and absence of severe white matter hyperintensities (WMHs) (OR, 0.22 (0.08-0.58); Pinteraction=0.03). CONCLUSIONS Following successful haematoma reduction by MIS, we found significantly lower odds of poor functional outcome with lower total burden of CSVD in addition to absence of lacunes and severe WMHs. CSVD features may have utility for prognostication and patient selection in clinical trials of MIS.
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Affiliation(s)
- Yunke Li
- The George Institute for Global Health, Beijing, China
| | - Sung-Min Cho
- Department of Neurology, Division of Neurocritical Care, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Radhika Avadhani
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Hassan Ali
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Yi Hao
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Santosh B Murthy
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fan Xia
- Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital of Medicine, Chengdu, Sichuan, China
| | - Natalie L Ullman
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Issam Awad
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Daniel Hanley
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | - Wendy C Ziai
- Department of Neurology, Division of Neurocritical Care, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Neurology, Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
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Ogbu I, Menon T, Chahil V, Kahlon A, Devanand D, Kalra DK. Sleep Disordered Breathing and Neurocognitive Disorders. J Clin Med 2024; 13:5001. [PMID: 39274214 PMCID: PMC11396397 DOI: 10.3390/jcm13175001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders.
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Affiliation(s)
- Ikechukwu Ogbu
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Tushar Menon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Vipanpreet Chahil
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | - Amrit Kahlon
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
| | | | - Dinesh K Kalra
- Department of Cardiology, University of Louisville, Louisville, KY 40202, USA
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Li N, Hu YD, Jiang Y, Ling L, Wang CH, Shao JM, Li SB, Di WY. Integrating clinical and biochemical markers: a novel nomogram for predicting lacunes in cerebral small vessel disease. Front Aging Neurosci 2024; 16:1404836. [PMID: 39246593 PMCID: PMC11377284 DOI: 10.3389/fnagi.2024.1404836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
Background Lacunes, a characteristic feature of cerebral small vessel disease (CSVD), are critical public health concerns, especially in the aging population. Traditional neuroimaging techniques often fall short in early lacune detection, prompting the need for more precise predictive models. Methods In this retrospective study, 587 patients from the Neurology Department of the Affiliated Hospital of Hebei University who underwent cranial MRI were assessed. A nomogram for predicting lacune incidence was developed using LASSO regression and binary logistic regression analysis for variable selection. The nomogram's performance was quantitatively assessed using AUC-ROC, calibration plots, and decision curve analysis (DCA) in both training (n = 412) and testing (n = 175) cohorts. Results Independent predictors identified included age, gender, history of stroke, carotid atherosclerosis, hypertension, creatinine, and homocysteine levels. The nomogram showed an AUC-ROC of 0.814 (95% CI: 0.791-0.870) for the training set and 0.805 (95% CI: 0.782-0.843) for the testing set. Calibration and DCA corroborated the model's clinical value. Conclusion This study introduces a clinically useful nomogram, derived from binary logistic regression, that significantly enhances the prediction of lacunes in patients undergoing brain MRI for various indications, potentially advancing early diagnosis and intervention. While promising, its retrospective design and single-center context are limitations that warrant further research, including multi-center validation.
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Affiliation(s)
- Ning Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Ya-Dong Hu
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Ye Jiang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Li Ling
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Chu-Han Wang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Jia-Min Shao
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Si-Bo Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
| | - Wei-Ying Di
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, China
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Solé-Guardia G, Luijten M, Janssen E, Visch R, Geenen B, Küsters B, Claassen JAHR, Litjens G, de Leeuw FE, Wiesmann M, Kiliaan AJ. Deep learning-based segmentation in MRI-(immuno)histological examination of myelin and axonal damage in normal-appearing white matter and white matter hyperintensities. Brain Pathol 2024:e13301. [PMID: 39175459 DOI: 10.1111/bpa.13301] [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: 04/12/2024] [Accepted: 07/17/2024] [Indexed: 08/24/2024] Open
Abstract
The major vascular cause of dementia is cerebral small vessel disease (SVD). Its diagnosis relies on imaging hallmarks, such as white matter hyperintensities (WMH). WMH present a heterogenous pathology, including myelin and axonal loss. Yet, these might be only the "tip of the iceberg." Imaging modalities imply that microstructural alterations underlie still normal-appearing white matter (NAWM), preceding the conversion to WMH. Unfortunately, direct pathological characterization of these microstructural alterations affecting myelinated axonal fibers in WMH, and especially NAWM, is still missing. Given that there are no treatments to significantly reduce WMH progression, it is important to extend our knowledge on pathological processes that might already be occurring within NAWM. Staining of myelin with Luxol Fast Blue, while valuable, fails to assess subtle alterations in white matter microstructure. Therefore, we aimed to quantify myelin surrounding axonal fibers and axonal- and microstructural damage in detail by combining (immuno)histochemistry with polarized light imaging (PLI). To study the extent (of early) microstructural damage from periventricular NAWM to the center of WMH, we refined current analysis techniques by using deep learning to define smaller segments of white matter, capturing increasing fluid-attenuated inversion recovery signal. Integration of (immuno)histochemistry and PLI with post-mortem imaging of the brains of individuals with hypertension and normotensive controls enables voxel-wise assessment of the pathology throughout periventricular WMH and NAWM. Myelin loss, axonal integrity, and white matter microstructural damage are not limited to WMH but already occur within NAWM. Notably, we found that axonal damage is higher in individuals with hypertension, particularly in NAWM. These findings highlight the added value of advanced segmentation techniques to visualize subtle changes occurring already in NAWM preceding WMH. By using quantitative MRI and advanced diffusion MRI, future studies may elucidate these very early mechanisms leading to neurodegeneration, which ultimately contribute to the conversion of NAWM to WMH.
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Affiliation(s)
- Gemma Solé-Guardia
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Matthijs Luijten
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Esther Janssen
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Ruben Visch
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Bram Geenen
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Benno Küsters
- Department of Pathology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen A H R Claassen
- Department of Geriatrics, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Radboud Alzheimer Center, Nijmegen, The Netherlands
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Geert Litjens
- Department of Pathology, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Computational Pathology Group, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Nijmegen, The Netherlands
| | - Maximilian Wiesmann
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Medical Imaging, Anatomy, Research Institute for Medical Innovation, Radboud University Medical Center, Donders Institute for Brain, Cognition & Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
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Song Y, Xu J, Geng W, Yin L, Wang J, Zhao J. Association and causal impact of TERT genetic variants on peripheral blood leukocyte telomere length and cerebral small vessel disease risk in a Chinese Han population: a mendelian randomization analysis. Orphanet J Rare Dis 2024; 19:309. [PMID: 39180127 PMCID: PMC11342532 DOI: 10.1186/s13023-024-03316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/08/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Previous observational studies have highlighted potential relationships between the telomerase reverse transcriptase (TERT) gene, short leukocyte telomere length (LTL), and cerebrovascular disease. However, it remains to be established as to whether TERT gene variants are associated with an elevated risk of cerebral small vessel disease (CSVD), and whether there is a causal relationship between LTL and CSVD. METHODS Five TERT single nucleotide polymorphisms (SNPs) were analyzed in 307 CSVD patients and 320 healthy controls in whom LTL values were quantified. Allele models and four genetic models were used to explore the relationship between these SNP genotypes and CSVD risk. A Mendelian randomization analysis of CSVD risk was then performed using LTL-related SNPs and the polygenic risk score (PRS) constructed from these SNPs as genetic instrumental variables to predict the causal relationship between LTL and CSVD risk. RESULTS Model association analyses identified two SNPs that were significantly associated with CSVD risk. LTL was significantly correlated with age (P < 0.001), and the MR analysis revealed an association between short LTL and an elevated risk of CSVD. PRS-based genetic prediction of short LTLs was also significantly related to an elevated CSVD risk. CONCLUSION Multiple genetic models and MR results indicate that TERT gene SNPs may be related to an elevated risk of CSVD, and that shorter LTL may be causally linked to such CSVD risk.
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Affiliation(s)
- Ying Song
- Department of Neurology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia Autonomous Region, 028000, China
| | - Jialiang Xu
- Department of Cerebrovascular Disease Treatment Center, The People's Hospital of Liaoning Province, Shenyang, Liaoning Province, 110002, China
| | - Wanru Geng
- Department of Neurology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia Autonomous Region, 028000, China
| | - Long Yin
- Department of Neurology, Affiliated Hospital of Inner Mongolia Minzu University, Tongliao, Inner Mongolia Autonomous Region, 028000, China
| | - Jialu Wang
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, 110001, China.
| | - JiuHan Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, 110001, China.
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Xie Y, Liu S, Wang X, Huang H, Wang M, Qu W, Yu Z, Wang W, Luo X. Lipids, Apolipoproteins, Lipid-Lowering Drugs, and the Risk of Cerebral Small Vessel Disease: A Mendelian Randomization Study. J Am Heart Assoc 2024; 13:e032409. [PMID: 39158561 DOI: 10.1161/jaha.123.032409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/16/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Serum lipids are causally involved in the occurrence of atherosclerosis, but their roles in cerebral small vessel disease remain unclear. This study aimed to investigate the causal roles of lipid or apolipoprotein traits in cerebral small vessel disease and to determine the effects of lipid-lowering interventions on this disease. METHODS AND RESULTS Data on genetic instruments of lipids/apolipoproteins, as well as characteristic cerebral small vessel disease manifestations, including small vessel stroke (SVS) and white matter hyperintensity (WMH), were obtained from publicly genome-wide association studies. Through 2-sample Mendelian randomization analyses, it was found that decreased levels of high-density lipoprotein cholesterol (odds ratio [OR], 0.85, P=0.007) and apolipoprotein A-I (OR, 0.83, P=0.005), as well as increased level of triglycerides (OR, 1.16, P=0.025) were associated with a higher risk of SVS. A low level of high-density lipoprotein cholesterol (OR, 0.93, P=0.032) was associated with larger WMH volume. Specifically, the genetically determined expressions of lipid fractions in various size-defined lipoprotein particles were more closely related to the risk of SVS than WMH. Moreover, it was found that the hypertension trait ranked at the top in mediating the causal effect of hyperlipidemia on SVS and WMH by using Mendelian randomization-based mediation analysis. For drug-target Mendelian randomization, the low-density lipoprotein cholesterol-reducing genetic variation alleles at HMGCR and NL1CL1 genes and the high-density lipoprotein cholesterol-raising genetic variation alleles at the CETP gene were predicted to decrease the risk of SVS. CONCLUSIONS The present Mendelian randomization study indicates that genetically determined hyperlipidemia is closely associated with a higher risk of cerebral small vessel disease, especially SVS. Lipid-lowering drugs could be potentially considered for the therapies and preventions of SVS rather than WMH.
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Affiliation(s)
- Yi Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Shuai Liu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College Huazhong University of Science and Technology Wuhan China
| | - Xinyue Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
- Key Laboratory of Neurological Diseases of the Chinese Ministry of Education, School of Basic Medicine, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology Wuhan China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction Huazhong University of Science and Technology Wuhan China
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Li Z, Miao L, Zhang T, Thomas AM, Li S. Causal relationship of inflammatory cytokines and serum metabolites in cerebral small vessel disease: a two-step Mendelian randomization study. Eur J Neurol 2024:e16443. [PMID: 39150083 DOI: 10.1111/ene.16443] [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: 04/06/2024] [Revised: 07/28/2024] [Accepted: 08/01/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the causal relationships of inflammatory cytokines and serum metabolites in cerebral small vessel disease (CSVD). METHODS Bidirectional Mendelian randomization was first conducted to screen inflammatory cytokines and serum metabolites that were associated with imaging features of CSVD, including white matter hyperintensities, recent small subcortical infarcts, cortical cerebral microinfarcts, cerebral microbleeds, lacunes and enlarged perivascular spaces. Sensitivity analyses were performed to evaluate the robustness and pleiotropy of these results. Subsequently, inflammatory cytokines and serum metabolites that were associated with CSVD were subjected to functional enrichment. Finally, mediation analysis was employed to investigate whether inflammatory cytokines or serum metabolites acted as an intermediary for the other in their causal relationship with CSVD. RESULTS Of the inflammatory cytokines, five were risk factors (e.g., tumour-necrosis-factor-related apoptosis-inducing ligand) and five (e.g., fibroblast growth factor 19) were protective factors for CSVD. Eleven serum metabolites that increased CSVD risk and 13 metabolites that decreased CSVD risk were also identified. The majority of these markers of CSVD susceptibility were lipid metabolites. Natural killer cell receptor sub-type 2B4 was determined to act as a mediating factor of an unidentified metabolite for the enlargement of perivascular spaces. CONCLUSION Several inflammatory cytokines and serum metabolites had causal relationships with imaging features of CSVD. A natural killer cell receptor mediated in part the promotional effect of a metabolite on perivascular space enlargement.
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Affiliation(s)
- Zidong Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lu Miao
- Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Tianyi Zhang
- School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Aline M Thomas
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
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Liu X, Li X, Wang X, Xu A. Causal effect of cerebral small vessel disease on unexplained dizziness: A Mendelian randomization study. J Stroke Cerebrovasc Dis 2024; 33:107948. [PMID: 39153583 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Previous cohort studies have suggested an association between cerebral small vessel disease (cSVD) and "unexplained dizziness". The causality of this link remains uncertain, but it would be of significant clinical importance, considering the substantial number of patients presenting with unexplained dizziness is large. We aimed to investigate the causal effect of cSVD-related phenotypes on unexplained dizziness using a Mendelian randomization approach. METHODS Genetic instruments for each cSVD-related phenotype - white matter hyperintensity (WMH) volume, lacunar stroke (LS), perivascular spaces (PVS), and cerebral microbleeds (CMBs) - as well as unexplained dizziness were identified through large-scale genome-wide association studies. We conducted 2-sample Mendelian randomization analyses. The random-effects inverse-variance weighted (IVW) method was chosen for the primary analysis. For sensitivity analyses, we employed the weighted-median, MR-Egger, MR pleiotropy residual sum and outlier (MR-PRESSO), and leave-one-out analysis methods were implemented for the sensitivity analyses. RESULTS We successfully identified a significant causal effect of WMH volume on unexplained dizziness (odds ratio [95% CI], 1.12 [1.01-1.23]). However, we were unable to detect any significant causal effects of the other cSVD-related phenotypes on unexplained dizziness, with odds ratios [95% CI] of 1.03 [0.98-1.09] for LS, 0.75 [0.55-1.02] for white matter PVS, 1.02 [0.68-1.52] for basal ganglia PVS, 0.80 [0.43-1.51] for hippocampal PVS, 0.95 [0.90-1.00] for lobar CMBs, and 0.97 [0.92-1.01] for mixed CMBs respectively. The results from the sensitivity analyses were generally consistent with those of the primary analyses. CONCLUSIONS This MR study supports a causal relationship between WMH, a phenotype associated with cSVD, and the risk of unexplained dizziness, but does not support such a relationship between other cSVD-related phenotypes and unexplained dizziness. These findings require further validation through randomized controlled trials, larger cohort studies, and MR studies based on more extensive GWASs.
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Affiliation(s)
- Xinjian Liu
- Department of Neurology, The First Affiliated Hospital of Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China; Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong 518000, China
| | - Xiuwen Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, Guangdong 518000, China
| | - Anding Xu
- Department of Neurology, The First Affiliated Hospital of Jinan University, No. 601 West Huangpu Avenue, Tianhe District, Guangzhou 510630, China.
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Baniewicz E, Peterkin N, Luby M, Kern KC, Gottesman RF, Latour LL, Turtzo LC. Age-associated gadolinium leakage into ocular structures in patients with acute traumatic brain injury. J Neurol Sci 2024; 463:123149. [PMID: 39088894 PMCID: PMC11348874 DOI: 10.1016/j.jns.2024.123149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND Gadolinium Leakage into Ocular Structures (GLOS) is common following acute cerebrovascular events. The objective of this study was to investigate the occurrence of GLOS in an acute traumatic brain injury (TBI) cohort without acute cerebrovascular injury and to explore associated factors. METHODS Enrolled acute TBI patients had a baseline MRI ≤48 h of injury (TP1) and follow-up MRI ≤72 h after baseline (TP2). Vitreous chamber enhancement and signal intensity ratios (SIRs) were calculated using pre- and post-contrast Fluid Attenuated Inversion Recovery (FLAIR). White matter hyperintensities (WMHs) were assessed using the Fazekas scale. RESULTS Of the 128 TBI patients included, median age was 47 years, 70% male, and 66% presented with Glasgow Coma Scale of 15. No GLOS was detected at TP1 but was present in 23% of patients at TP2. GLOS+ patients were older (68 years [56-76] vs 39 years [27-53], p < 0.001), more likely to report falls as injury mechanism (62% vs 36%, p = 0.006), report history of hypertension (41% vs 19%, p = 0.025), and had a higher burden of WMHs (59% vs 14% with a total Fazekas ≥2, p < 0.001). Quantitative SIRs confirmed qualitative assessments: GLOS+ patients had higher SIRs at TP2 (0.43 vs 0.22, p < 0.001). Age (OR 3.28, 95%CI [1.88-5.71], p < 0.001) and prior TBI history (OR 4.99, 95%CI [1.46-17.06], p = 0.010) were independent predictors of GLOS. When age was removed, total Fazekas score (OR 2.53, 95%CI [1.60-4.00], p < 0.001) was an independent predictor of GLOS. CONCLUSIONS GLOS is primarily associated with age and may serve as another imaging marker of chronic vascular disease.
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Affiliation(s)
- Emily Baniewicz
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA
| | - Nicole Peterkin
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA
| | - Marie Luby
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA
| | - Kyle C Kern
- Stroke, Cognition, and Neuroepidemiology Section, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room 4D37A, Bethesda, MD 20892, USA; Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Rebecca F Gottesman
- Stroke, Cognition, and Neuroepidemiology Section, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room 4D37A, Bethesda, MD 20892, USA
| | - Lawrence L Latour
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA
| | - L Christine Turtzo
- Acute Cerebrovascular Diagnostics Unit, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Room B1D733, Bethesda, MD 20892, USA.
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Zhou M, Zhou Y, Jing J, Wang M, Jin A, Cai X, Meng X, Liu T, Wang Y, Wang Y, Pan Y. Insulin resistance and white matter microstructural abnormalities in nondiabetic adult: A population-based study. Int J Stroke 2024:17474930241266796. [PMID: 38916129 DOI: 10.1177/17474930241266796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Insulin resistance (IR) is of growing concern yet its association with white matter integrity remains controversial. We aimed to investigate the association between IR and white matter integrity in nondiabetic adults. METHODS This cross-sectional analysis was conducted based on the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. A total of 1709 nondiabetic community-dwelling adults with available diffusion-weighted imaging based on brain magnetic resonance imaging and completed oral glucose tolerance test were included. IR was measured noninvasively by insulin sensitivity indices (ISI), including ISIcomposite and ISI0,120, as well as homeostasis model assessment of insulin resistance (HOMA-IR). White matter microstructure abnormalities were identified by diffusion-weighted imaging along with tract-based spatial statistical analysis to compare diffusion metrics between groups. The multivariable linear regression models were applied to measure the association between white matter microstructure abnormalities and IR. RESULTS A total of 1709 nondiabetic individuals with a mean age of 60.8 ± 6.4 years and 54.1% female were included. We found that IR was associated with a significant increase in mean diffusivity, axial diffusivity, and radial diffusivity extensively in cerebral white matter in regions such as the anterior corona radiata, superior corona radiata, anterior limb of internal capsule, external capsule, and body of corpus callosum. The pattern of associations was more marked for ISIcomposite and ISI0,120. However, the effect of IR on white matter integrity was attenuated after, in addition, adjustment for history of hypertension and cardiovascular disease and antihypertensive medication use. CONCLUSION Our findings indicate a significant association between IR and white matter microstructural abnormalities in nondiabetic middle-aged community residents, while these associations were greatly influenced by the history of hypertension and cardiovascular disease, and antihypertensive medication use. Further investigation is needed to clarify the role of IR in white matter integrity, whereas prophylactic strategies of maintaining a low IR status may ameliorate disturbances in white matter integrity. DATA ACCESSIBILITY STATEMENT The data that support the findings of this study are available from the corresponding authors upon reasonable request.
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Affiliation(s)
- Mengyuan Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yijun Zhou
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, Lishui Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- National Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- National Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Björnfot C, Eklund A, Larsson J, Hansson W, Birnefeld J, Garpebring A, Qvarlander S, Koskinen LOD, Malm J, Wåhlin A. Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults - A 4D flow MRI study. J Cereb Blood Flow Metab 2024; 44:1343-1351. [PMID: 38315044 PMCID: PMC11342729 DOI: 10.1177/0271678x241230741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66-85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV's stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.
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Affiliation(s)
- Cecilia Björnfot
- Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Anders Eklund
- Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
| | - Jenny Larsson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - William Hansson
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Johan Birnefeld
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Garpebring
- Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Sara Qvarlander
- Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Lars-Owe D Koskinen
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Jan Malm
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Anders Wåhlin
- Department of Diagnostics and Intervention, Radiation Physics, Biomedical Engineering, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging (UFBI), Umeå University, Umeå, Sweden
- Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
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Meng P, Liu T, Zhong Z, Fang R, Qiu F, Luo Y, Yang K, Cai H, Mei Z, Zhang X, Ge J. A novel rat model of cerebral small vessel disease based on vascular risk factors of hypertension, aging, and cerebral hypoperfusion. Hypertens Res 2024; 47:2195-2210. [PMID: 38872026 DOI: 10.1038/s41440-024-01741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
Cerebral small vessel disease (CSVD) is a major cause of vascular cognitive impairment and functional loss in elderly patients. Progressive remodeling of cerebral microvessels due to arterial hypertension or other vascular risk factors, such as aging, can cause dementia or stroke. Typical imaging characteristics of CSVD include cerebral microbleeds (CMB), brain atrophy, small subcortical infarctions, white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS). Nevertheless, no animal models that reflect all the different aspects of CSVD have been identified. Here, we generated a new CSVD animal model using D-galactose (D-gal) combined with cerebral hypoperfusion in spontaneously hypertensive rats (SHR), which showed all the hallmark pathological features of CSVD and was based on vascular risk factors. SHR were hypodermically injected with D-gal (400 mg/kg/d) and underwent modified microcoil bilateral common carotid artery stenosis surgery. Subsequently, neurological assessments and behavioral tests were performed, followed by vascular ultrasonography, electron microscopy, flow cytometry, and histological analyses. Our rat model showed multiple cerebrovascular pathologies, such as CMB, brain atrophy, subcortical small infarction, WMH, and EPVS, as well as the underlying causes of CSVD pathology, including oxidative stress injury, decreased cerebral blood flow, structural and functional damage to endothelial cells, increased blood-brain barrier permeability, and inflammation. The use of this animal model will help identify new therapeutic targets and subsequently aid the development and testing of novel therapeutic interventions. Main process of the study: Firstly, we screened for optimal conditions for mimicking aging by injecting D-gal into rats for 4 and 8 weeks. Subsequently, we performed modified microcoil BCAS intervention for 4 and 8 weeks in rats to screen for optimal hypoperfusion conditions. Finally, based on these results, we combined D-gal for 8 weeks and modified microcoil BCAS for 4 weeks to explore the changes in SHR.
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Affiliation(s)
- Pan Meng
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Tongtong Liu
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ziyan Zhong
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Rui Fang
- Hunan Academy of Chinese Medicine, Changsha, Hunan, China
| | - Feng Qiu
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yan Luo
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Kailin Yang
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Huzhi Cai
- First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhigang Mei
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China.
| | - Xi Zhang
- The Second People's Hospital of Hunan Province, Changsha, Hunan, China.
| | - Jinwen Ge
- Hunan Academy of Chinese Medicine, Changsha, Hunan, China.
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Wu L, Wang Z, Zhou X, Kong Q, Zhang Y, Xu S, Huang H, Luo X. Mismatch of MRI White Matter Hyperintensities and Gait Function in Patients With Cerebral Small Vessel Disease. J Magn Reson Imaging 2024; 60:550-558. [PMID: 37921545 DOI: 10.1002/jmri.29121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is closely related to gait disorders. Previous studies have found a negative correlation between the severity of MRI white matter hyperintensities (WMH) and gait speed. However, not every individual with WMH experiences a gait disorder. PURPOSE To investigate the mechanisms underlying the mismatch between the severity of MRI WMH and gait impairment, in particular in subjects with severe WMH (Fazekas 3, scale 0-3) resulting from vascular disease. STUDY TYPE Cohort. POPULATION 54 subjects with severe WMH and gait disorder (WMH-GD; 29 males) and 114 subjects with severe WMH with no gait disorder (WMH-nGD; 60 males). FIELD STRENGTH/SEQUENCE 3T/diffusion tensor imaging (DTI), and T1-weighted, T2-weighted, FLAIR, DWI, SWI. ASSESSMENT Trace-based spatial statistics analysis (TBSS) approach (fractional anisotropy, FA; mean diffusivity; radial diffusivity; axial diffusivity); Cognitive assessment; Conventional MRI markers of CSVD (WMH, enlarged perivascular spaces, lacunae, and cerebral microbleeds); Gait parameters (gait speed; cadence; stride length; gait cycle duration; step duration; time-up-and-go test, TUG). Gait disorder was defined as a TUG time exceeding 12 sec. STATISTICAL TESTS The t-tests, Mann-Whitney U tests, Chi-square tests, and partial correlation analysis (Pearson or Spearman) were used. P < 0.05 with threshold-free cluster enhancement corrected was considered statistically significant for TBSS. RESULTS After adjusting for age, sex, height, and other conventional MRI markers of CSVD, the WMH-nGD group showed significantly decreased FA values in the corpus callosum, bilateral superior longitudinal fasciculus, left corona radiata, and left posterior thalamic radiation. There was a significant association between FA values and TUG time, gait speed, and stride length in multiple WM tracts, independent of other conventional CSVD markers. DATA CONCLUSION This study provides evidence for microstructural damage of specific fibers in WMH-GD subjects compared to WMH-nGD subjects. This may explain the mismatch between WMH and gait impairment in subjects with severe WMH. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ziyue Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xirui Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianqian Kong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhang H, Cao P, Mak HKF, Hui ES. The structural-functional-connectivity coupling of the aging brain. GeroScience 2024; 46:3875-3887. [PMID: 38443539 PMCID: PMC11226573 DOI: 10.1007/s11357-024-01106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Aging primarily affects memory and executive functions, a relationship that may be underpinned by the fact that almost all adults over 60 years old develop small vessel disease (SVD). The fact that a wide range of neuropathologies could only explain up to 43% of the variation in age-related cognitive impairment suggests that other factors, such as cognitive reserve, may play a role in the brain's resilience against aging-related cognitive decline. This study aims to examine the relationship between structural-functional-connectivity coupling (SFC), and aging, cognitive abilities and reserve, and SVD-related neuropathologies using a cohort of n = 176 healthy elders from the Harvard Aging Brain Study. The SFC is a recently proposed biomarker that reflects the extent to which anatomical brain connections can predict coordinated neural activity. After controlling for the effect of age, sex, and years of education, global SFC, as well as the intra-network SFC of the dorsolateral somatomotor and dorsal attention networks, and the inter-network SFC between dorsolateral somatomotor and frontoparietal networks decreased with age. The global SFC decreased with total cognitive score. There were significant interaction effects between years of education versus white matter hyperintensities and between years of education versus cerebral microbleeds on inter-network SFC. Enlarged perivascular space in basal ganglia was associated with higher inter-network SFC. Our results suggest that cognitive ability is associated with brain coupling at the global level and cognitive reserve with brain coupling at the inter-functional-brain-cluster level with interaction effect from white matter hyperintensities and cerebral microbleed in a cohort of healthy elderlies.
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Affiliation(s)
- Hui Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Intelligent Wearable Systems, The Hong Kong Polytechnic University, Hong Kong, China
| | - Peng Cao
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Henry K F Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
- Alzheimer's Disease Research Network, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Edward S Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
- CU Lab for AI in Radiology (CLAIR), The Chinese University of Hong Kong, Hong Kong, China.
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Muir RT, Smith EE. The Spectrum of Cerebral Small Vessel Disease: Emerging Pathophysiologic Constructs and Management Strategies. Neurol Clin 2024; 42:663-688. [PMID: 38937035 DOI: 10.1016/j.ncl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Cerebral small vessel disease (CSVD) is a spectrum of disorders that affect small arterioles, venules, cortical and leptomeningeal vessels, perivascular spaces, and the integrity of neurovascular unit, blood brain barrier, and surrounding glia and neurons. CSVD is an important cause of lacunar ischemic stroke and sporadic hemorrhagic stroke, as well as dementia-which will constitute some of the most substantive population and public health challenges over the next century. This article provides an overview of updated pathophysiologic frameworks of CSVD; discusses common and underappreciated clinical and neuroimaging manifestations of CSVD; and reviews emerging genetic risk factors linked to sporadic CSVD.
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Affiliation(s)
- Ryan T Muir
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
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Haidegger M, Klock N, Kneihsl M, Fandler-Höfler S, Eppinger S, Eller K, Seiler S, Enzinger C, Gattringer T. Recurrent cerebrovascular events after recent small subcortical infarction. J Neurol 2024; 271:5055-5063. [PMID: 38802623 PMCID: PMC11319362 DOI: 10.1007/s00415-024-12460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Recent small subcortical infarcts (RSSI) are the neuroimaging hallmark feature of small vessel disease (SVD)-related acute lacunar stroke. Long-term data on recurrent cerebrovascular events including their aetiology after RSSI are scarce. PATIENTS AND METHODS This retrospective study included all consecutive ischaemic stroke patients with an MRI-confirmed RSSI (in the supply area of a small single brain artery) at University Hospital Graz between 2008 and 2013. We investigated associations between clinical and SVD features on MRI (STRIVE criteria) and recurrent cerebrovascular events, using multivariable Cox regression adjusted for age, sex, vascular risk factors and MRI parameters. RESULTS We analysed 332 consecutive patients (mean age 68 years, 36% women; median follow-up time 12 years). A recurrent ischaemic cerebrovascular event occurred in 70 patients (21.1%; 54 ischaemic strokes, 22 transient ischaemic attacks) and was mainly attributed to SVD (68%). 26 patients (7.8%) developed intracranial haemorrhage. In multivariable analysis, diabetes (HR 2.43, 95% CI 1.44-3.88), severe white matter hyperintensities (HR 1.97, 95% CI 1.14-3.41), and cerebral microbleeds (HR 1.89, 95% CI 1.32-3.14) on baseline MRI were related to recurrent ischaemic stroke/TIA, while presence of cerebral microbleeds increased the risk for intracranial haemorrhage (HR 3.25, 95% CI 1.39-7.59). A widely used SVD summary score indicated high risks of recurrent ischaemic (HR 1.22, 95% CI 1.01-1.49) and haemorrhagic cerebrovascular events (HR 1.57, 95% CI 1.11-2.22). CONCLUSION Patients with RSSI have a substantial risk for recurrent cerebrovascular events-particularly those with coexisting chronic SVD features. Recurrent events are mainly related to SVD again.
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Affiliation(s)
- Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Nina Klock
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Sebastian Eppinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
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Deasy L, Laurent-Chabalier S, Wacongne A, Parvu T, Mura T, Thouvenot E, Renard D. Diagnostic Accuracy of Posterior/Anterior Periventricular WMH Ratio to Differentiate CAA From Hypertensive Arteriopathy. Stroke 2024; 55:2086-2093. [PMID: 38920025 DOI: 10.1161/strokeaha.123.046379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/11/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Periventricular white matter hyperintensities (PVWMHs) in cerebral amyloid angiopathy (CAA) have been reported posterior predominant using semiautomated segmentation method and logarithmic transformation. We aimed to compare PVWMH extent and posterior/anterior distribution between patients with CAA and patients with hypertensive arteriopathy with radiological tools available in daily practice. METHODS We retrospectively analyzed confluent PVWMH directly adjacent to lateral ventricles on axial FLAIR (fluid-attenuated inversion recovery) from 108 patients with CAA and 99 patients with hypertensive arteriopathy presenting with hemorrhage-related symptoms consecutively recruited in our stroke database (Nîmes University Hospital, France) between January 2015 and March 2022. For each of the left (L), right (R), anterior (A), and posterior (P) horns of lateral ventricles, the maximal distance between the outer PVWMH border and ventricle border was measured. The sum of anterior left PVWMH and anterior right PVWMH, and posterior left PVWMH and posterior right PVWMH resulted in anterior and posterior extent, respectively. RESULTS Compared with hypertensive arteriopathy, patients with CAA were older (median, 77 versus 71; P=0.0010) and less frequently male (46% versus 64%; P=0.012) and had less frequent hypertension (45% versus 63%; P=0.013) and more chronic hemorrhages (P<0.0001). CAA showed slightly more extensive anterior right PVWMH (median, 6.50 versus 5.90 mm; P=0.034), far more extensive (all P<0.0001) posterior left PVWMH (median, 13.95 versus 6.95 mm), posterior right PVWMH (median, 14.15 versus 5.45 mm), posterior (median, 27.95 versus 13.00 mm), and total (median, 39.60 versus 24.65 mm) PVWMH, and higher posterior/anterior ratios (median, 1.82 versus 1.01). Age-/sex-adjusted model predicting CAA incorporating total PVWMH extent and posterior/anterior ratios for the given score (-4.3683+0.0268×PVWMH-T+0.3749×posterior/anterior PVWMH ratio+0.0394×age+0.3046 when female) showed highest area under the curve (0.76 [0.70-0.83]), with a 72% [62.50-80.99] sensitivity and 76% [67.18-84.12] specificity. Values above the optimal threshold of 0.22 for the score showed a crude relative risk of 2.75 (2.26-2.37; P<0.0001). CONCLUSIONS Severe posterior PVWMH and high posterior/anterior PVWMH ratio assessed by radiological tools used in daily practice are associated with probable CAA versus hypertensive arteriopathy. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05486897.
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Affiliation(s)
- Louise Deasy
- Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (S.L.-C., T.M.), CHU Nîmes, Université de Montpellier, France
| | - Anne Wacongne
- Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France
| | - Teodora Parvu
- Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (S.L.-C., T.M.), CHU Nîmes, Université de Montpellier, France
| | - Eric Thouvenot
- Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France
- Institut de Génomique Fonctionnelle, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 5203, Institut National de la Santé et de la Recherche Médicale (INSERM) 1191, Université de Montpellier, France (E.T.)
| | - Dimitri Renard
- Department of Neurology (L.D., A.W., T.P., E.T., D.R.), CHU Nîmes, Université de Montpellier, France
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Chen P, Liu T, Wei Y, Ma Z, Lu T, Lan S, Xie J, Mo S. Associations between semi-quantitative evaluation of intracranial arterial calcification and total cerebral small vessel disease burden score: a retrospective case-control study. Front Neurol 2024; 15:1417186. [PMID: 39144704 PMCID: PMC11322091 DOI: 10.3389/fneur.2024.1417186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
Background and purpose Arteriosclerotic cerebral small vessel disease (aCSVD) is a cause of cognitive impairment, dementia, and stroke. Developing a better understanding of the risk factor of aCSVD is key to reducing the incidence of these conditions. This study investigated the association between intracranial arterial calcification (IAC) and total cerebral small vessel disease (CSVD) burden score. Materials and methods This is a retrospective study, the subjects were transient ischemic attack (TIA) or acute ischemic stroke (AIS) patients. The data of 303 inpatients admitted to our study hospital between December 2018 and July 2020 were analyzed. Four imaging markers of CSVD (lacunes, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces) were evaluated by magnetic resonance imaging, and a total CSVD burden score was calculated. The experimental group was divided into four subgroups according to total CSVD burden score (1-4 points). Patients without CSVD (0 points) served as the control group. Head computerized tomography (CT) scans were used to assess ICA, using Babiarz's method. The correlations between IAC and single imaging markers of CSVD were determined using Spearman's rank correlation. Binary logic regression analysis and multivariate ordered logic regression analysis were used to determine the associations between IAC and aCSVD. Results IAC was positively correlated with total CSVD burden score (r = 0.681), deep white matter hyperintensities (r = 0.539), periventricular white matter hyperintensities (r = 0.570), cerebral microbleeds (r = 0.479), lacunes (r = 0.541), and enlarged perivascular spaces (r = 0.554) (all p < 0.001). After adjusting for the confounding factors of age, diabetes, and hypertension, aCSVD was independently associated with IAC grade 1-2 [odds ratio (OR) = 23.747, 95% confidence interval (CI) = 8.376-67.327] and IAC grade 3-4 (OR = 30.166, 95% CI = 8.295-109.701). aCSVD severity was independently associated with IAC grade 3-4 (OR = 4.697, 95% CI = 1.349-16.346). Conclusion IAC is associated with the total CSVD burden score and single imaging signs.
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Affiliation(s)
- Peng Chen
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Tiejun Liu
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Yin Wei
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Zhen Ma
- Department of Ultrasound, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Tao Lu
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Suxi Lan
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Jinling Xie
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
| | - Shen Mo
- Department of Radiology, Guangxi International Zhuang Medicine Hospital, Nanning, China
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50
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Kitagawa K, Toi S, Hosoya M, Seki M, Yamagishi S, Hoshino T, Yoshizawa H. Small vessel disease burden predicts incident stroke and all-cause death, but not acute coronary event. Hypertens Res 2024:10.1038/s41440-024-01797-2. [PMID: 39085463 DOI: 10.1038/s41440-024-01797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/18/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
Abstract
Total small vessel disease (SVD) score is used to measure the burden of SVD by incorporating four established neuroimaging markers; white matter hyperintensity, lacune, cerebral microbleed, and enlarged perivascular space, ranging from 0 to 4. Whether total SVD scores predict all vascular outcomes remains unclear. This study aimed to clarify the predictive value of the total SVD score for incident stroke, mortality, and acute coronary syndrome in independent outpatients with vascular risk factors. We derived data from The Tokyo Women's Medical University Cerebrovascular Disease registry, a prospective observational registry in which 1011 patients with evidence of cerebral vessel disease on magnetic resonance imaging were enrolled. They were followed up until March 2023. The primary outcomes were stroke, all-cause death, and acute coronary syndrome (ACS). After excluding those with a modified Rankin scale score >1, Mini-mental State Examination score <24, and missing T2* images, 692 patients were included. During a median follow-up period of 4.6 years, stroke, ACS, and all-cause death occurred in 52, 24, and 45 patients, respectively. In multivariate analysis, the total SVD score was independently associated with stroke, and all-cause death but not with acute coronary syndrome. Both cutoff values of the total SVD score for stroke, and all-cause death were 1. In conclusion, the total SVD score could predict stroke and mortality but not acute coronary syndrome. Our results suggest intensive management of patients with a total SVD score ≥1 to prevent stroke and all-cause death. Patients with higher total SVD scores were significantly more likely to have a stroke (A; P = 0.012) than those with lower total SVD scores. However, no association was observed between total SVD scores and acute coronary syndrome (B, P = 0.604). For incident stroke, total SVD scores of 1 and 2 were the cutoff levels.
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Affiliation(s)
- Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
- Suita Municipal Hospital, Suita, Japan.
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Megumi Hosoya
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Misa Seki
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Sae Yamagishi
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hiroshi Yoshizawa
- Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan
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