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Wheeler KV, Irimia A, Braskie MN. Using Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer's Disease. J Alzheimers Dis 2024; 97:1479-1502. [PMID: 38306032 DOI: 10.3233/jad-230553] [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] [Indexed: 02/03/2024]
Abstract
Cerebral amyloid angiopathy (CAA) is characterized by amyloid-β aggregation in the media and adventitia of the leptomeningeal and cortical blood vessels. CAA is one of the strongest vascular contributors to Alzheimer's disease (AD). It frequently co-occurs in AD patients, but the relationship between CAA and AD is incompletely understood. CAA may drive AD risk through damage to the neurovascular unit and accelerate parenchymal amyloid and tau deposition. Conversely, early AD may also drive CAA through cerebrovascular remodeling that impairs blood vessels from clearing amyloid-β. Sole reliance on autopsy examination to study CAA limits researchers' ability to investigate CAA's natural disease course and the effect of CAA on cognitive decline. Neuroimaging allows for in vivo assessment of brain function and structure and can be leveraged to investigate CAA staging and explore its associations with AD. In this review, we will discuss neuroimaging modalities that can be used to investigate markers associated with CAA that may impact AD vulnerability including hemorrhages and microbleeds, blood-brain barrier permeability disruption, reduced cerebral blood flow, amyloid and tau accumulation, white matter tract disruption, reduced cerebrovascular reactivity, and lowered brain glucose metabolism. We present possible areas for research inquiry to advance biomarker discovery and improve diagnostics.
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Affiliation(s)
- Koral V Wheeler
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
- Department of Biomedical Engineering, Corwin D. Denney Research Center, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Meredith N Braskie
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina Del Rey, CA, USA
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Yang R, Li J, Qin Y, Zhao L, Liu R, Yang F, Jiang G. A bibliometric analysis of cerebral microbleeds and cognitive impairment. Brain Cogn 2023; 169:105999. [PMID: 37262941 DOI: 10.1016/j.bandc.2023.105999] [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: 03/23/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Cerebral microbleeds (CMBs) are imaging markers for small cerebral vascular diseases, which can accumulate and impact the corresponding brain networks. CMBs can affect cognitive function, including executive function, information processing speed, and visuospatial memory. Bibliometrics is a scientific and innovative method that can analyze and visualize the scientific field quantitatively. In this study, we aimed to use bibliometric analysis to demonstrate the relationship and mechanisms between CMBs and cognitive impairment. Furthermore, we reviewed the relationship between CMBs and different cognitive disorders. The use of bibliometrics can help further clarify this relationship. METHODS We retrieved articles on CMBs and cognitive impairment from the Web of Science Core Collection. The keywords (such as stroke, dementia, and cerebral amyloid angiopathy), authors, countries, institutions and journals, in the field were visually analyzed using VOSviewer software and bibliometric websites. RESULTS This bibliometric analysis reveals the related trends of CMBs in the field of cognitive impairment. CMBs, along with other small vascular lesions, constitute the basis of cognitive impairment, and studying CMBs is essential to understand the mechanisms underlying cognitive impairment. CONCLUSION This bibliometric analysis reveals a strong link between CMBs and cognitive impairment-related diseases and that specific brain networks were affected by CMBs. This provides further insights into the possible mechanisms and causes of CMBs and cognitive impairment. The direct and indirect damage (such as oxidative stress and neuroinflammation) to the brain caused by CMBs, destruction of the frontal-subcortical circuits, elevated Cystatin C levels, and iron deposition are involved in the occurrence and development of cognitive impairment. CMBs may be a potential marker for detecting, quantifying, and predicting cognitive impairment.
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Affiliation(s)
- Rui Yang
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia Li
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yaya Qin
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Zhao
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Rong Liu
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Fanhui Yang
- Department of Nuclear Medicine, Affiliated Hospital of North Sichuan Medical College North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Guohui Jiang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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Perosa V, Rotta J, Yakupov R, Kuijf HJ, Schreiber F, Oltmer JT, Mattern H, Heinze HJ, Düzel E, Schreiber S. Implications of quantitative susceptibility mapping at 7 Tesla MRI for microbleeds detection in cerebral small vessel disease. Front Neurol 2023; 14:1112312. [PMID: 37006483 PMCID: PMC10050564 DOI: 10.3389/fneur.2023.1112312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundCerebral microbleeds (MBs) are a hallmark of cerebral small vessel disease (CSVD) and can be found on T2*-weighted sequences on MRI. Quantitative susceptibility mapping (QSM) is a postprocessing method that also enables MBs identification and furthermore allows to differentiate them from calcifications.AimsWe explored the implications of using QSM at submillimeter resolution for MBs detection in CSVD.MethodsBoth 3 and 7 Tesla (T) MRI were performed in elderly participants without MBs and patients with CSVD. MBs were quantified on T2*-weighted imaging and QSM. Differences in the number of MBs were assessed, and subjects were classified in CSVD subgroups or controls both on 3T T2*-weighted imaging and 7T QSM.Results48 participants [mean age (SD) 70.9 (8.8) years, 48% females] were included: 31 were healthy controls, 6 probable cerebral amyloid angiopathy (CAA), 9 mixed CSVD, and 2 were hypertensive arteriopathy [HA] patients. After accounting for the higher number of MBs detected at 7T QSM (Median = Mdn; Mdn7T−QSM = 2.5; Mdn3T−T2 = 0; z = 4.90; p < 0.001) and false positive MBs (6.1% calcifications), most healthy controls (80.6%) demonstrated at least one MB and more MBs were discovered in the CSVD group.ConclusionsOur observations suggest that QSM at submillimeter resolution improves the detection of MBs in the elderly human brain. A higher prevalence of MBs than so far known in healthy elderly was revealed.
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Affiliation(s)
- Valentina Perosa
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Valentina Perosa
| | - Johanna Rotta
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Renat Yakupov
- Institute of Cognitive Neurology and Dementia Research (IKND), Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Jan T. Oltmer
- Athinoula A. Martinos Center, Massachusetts General Hospital, Department of Radiology, Boston, MA, United States
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Physics, Otto-von-Guericke University, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Emrah Düzel
- Institute of Cognitive Neurology and Dementia Research (IKND), Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
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Vázquez-Justes D, Aguirregoicoa I, Fernandez L, Carnes-Vendrell A, Dakterzada F, Sanjuan L, Mena A, Piñol-Ripoll G. Clinical impact of microbleeds in patients with Alzheimer's disease. BMC Geriatr 2022; 22:774. [PMID: 36175849 PMCID: PMC9520821 DOI: 10.1186/s12877-022-03456-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Cerebral microbleeds (CMBs) are more frequent in patients with Alzheimer’s disease (AD) than in the general population. However, their clinical significance remains poorly understood. We carried out a multimodal approach to evaluate the impact of CMBs at a clinical, neuropsychological, and survival level, as well as on core AD biomarkers in the cerebrospinal fluid (CSF) in AD patients. Methods We prospectively recruited 98 patients with mild-moderate AD. At baseline, they underwent brain MRI, and AD CSF biomarkers and APOE genotypes were analysed. An extensive neuropsychological battery was performed at baseline and after 1 year of follow-up. We analysed the stroke incidence and mortality with survival analyses. Results Forty-eight (48.5%) patients had at least one CMBs. Eight (8.2%) patients had strictly nonlobar CMBs, 39 (40.2%) had any lobar CMB locations. The incidence of stroke was higher in AD patients with lobar CMBs than in those without CMBs (p < 0.05). Mortality did not differ among groups (p > 0.05). At the cognitive level, CMBs patients deteriorated more rapidly at 12 months according to MMSE scores, with no differences observed at 24 months. We did not observe differences in the other tests, except for an increase in caregiver burden in the CMBs group. The presence of cerebral amyloidosis and APOE ε4 were associated with a greater presence of CMBs. Conclusion CMBs are associated with an increased risk of ischemic stroke in AD patients without differences in mortality. Patients with CMBs did not seem to have different consequences associated with cognitive decline except for an increase in caregiver overload.
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Affiliation(s)
- Daniel Vázquez-Justes
- Neurology Department, Clinical Neuroscience Research Group, IRBLleida-Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Iván Aguirregoicoa
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Leandre Fernandez
- Radiology Department, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Anna Carnes-Vendrell
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Faride Dakterzada
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain
| | - Laura Sanjuan
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Andreu Mena
- Radiology Department, Hospital General Barbastro, Salud Aragón, Barbastro, Spain
| | - Gerard Piñol-Ripoll
- Unitat Trastorns Cognitius, Clinical Neuroscience Research, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain. .,Cognitive Disorders Unit, Hospital Universitari Santa Maria, Rovira Roure n° 44. 25198, Lleida, Spain.
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Nehra G, Bauer B, Hartz AMS. Blood-brain barrier leakage in Alzheimer's disease: From discovery to clinical relevance. Pharmacol Ther 2022; 234:108119. [PMID: 35108575 PMCID: PMC9107516 DOI: 10.1016/j.pharmthera.2022.108119] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia. AD brain pathology starts decades before the onset of clinical symptoms. One early pathological hallmark is blood-brain barrier dysfunction characterized by barrier leakage and associated with cognitive decline. In this review, we summarize the existing literature on the extent and clinical relevance of barrier leakage in AD. First, we focus on AD animal models and their susceptibility to barrier leakage based on age and genetic background. Second, we re-examine barrier dysfunction in clinical and postmortem studies, summarize changes that lead to barrier leakage in patients and highlight the clinical relevance of barrier leakage in AD. Third, we summarize signaling mechanisms that link barrier leakage to neurodegeneration and cognitive decline in AD. Finally, we discuss clinical relevance and potential therapeutic strategies and provide future perspectives on investigating barrier leakage in AD. Identifying mechanistic steps underlying barrier leakage has the potential to unravel new targets that can be used to develop novel therapeutic strategies to repair barrier leakage and slow cognitive decline in AD and AD-related dementias.
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Affiliation(s)
- Geetika Nehra
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Bjoern Bauer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Anika M S Hartz
- Sanders-Brown Center on Aging, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, USA.
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Montandon ML, Herrmann FR, Garibotto V, Rodriguez C, Haller S, Giannakopoulos P. Microbleeds and Medial Temporal Atrophy Determine Cognitive Trajectories in Normal Aging: A Longitudinal PET-MRI Study. J Alzheimers Dis 2021; 77:1431-1442. [PMID: 32925053 DOI: 10.3233/jad-200559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The cognitive trajectories in normal aging may be affected by medial temporal atrophy (MTA) and amyloid burden, as well as vascular pathologies such as cortical microbleeds (CMB) and white matter hyperintensities (WMH). OBJECTIVE We addressed here the role of imaging markers in their prediction in a real-world situation. METHODS We performed a 4.5-year longitudinal study in 90 older community-dwellers coupling two neuropsychological assessments, MTA estimated with the Schelten's scale, number of CMB, and WMH evaluated with the Fazekas score at inclusion and follow-up, visual rating of amyloid PET and glucose hypometabolism at follow-up, and APOE genotyping. Regression models were built to explore the association between the continuous cognitive score (CCS) and imaging parameters. RESULTS The number of strictly lobar CMB at baseline (4 or more) was related to a 5.5-fold increase of the risk of cognitive decrement. This association persisted in multivariable models explaining 10.6% of the CCS decrease variance. MTA, and Fazekas score at baseline and amyloid positivity or abnormal FDG PET, were not related to the cognitive outcome. The increase of right MTA at follow-up was the only correlate of CCS decrease both in univariate and multivariable models explaining 9.2% of its variance. CONCLUSION The present data show that the accumulation of more than four CMB is associated with significant cognitive decrement over time in highly educated elderly persons. They also reveal that the progressive deterioration of cognitive performance within the age-adjusted norms is also related to the increase of visually assessed MTA.
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Affiliation(s)
- Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Switzerland
| | - François R Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Diagnostic Department, Geneva University Hospitals and University of Geneva, Switzerland
| | - Cristelle Rodriguez
- Department of Psychiatry, University of Geneva, Switzerland.,Medical Direction, University of Geneva Hospitals, Geneva, Switzerland
| | - Sven Haller
- CIRD - Centre d'Imagerie Rive Droite in Geneva, Switzerland.,Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.,Department of Neuroradiology, Faculty of Medicine of the University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, University of Geneva, Switzerland.,Medical Direction, University of Geneva Hospitals, Geneva, Switzerland
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Wang M, Hu HY, Wang ZT, Ou YN, Qu Y, Ma YH, Dong Q, Tan L, Yu JT. Association of cerebral microbleeds with risks of cognitive impairment and dementia: A systematic review and meta-analysis of prospective studies. BRAIN DISORDERS 2021. [DOI: 10.1016/j.dscb.2021.100010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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8
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Donaghy PC, Firbank M, Mitra D, Petrides G, Lloyd J, Barnett N, Olsen K, Thomas AJ, O'Brien JT. Microbleeds in dementia with Lewy bodies. J Neurol 2020; 267:1491-1498. [PMID: 32016624 PMCID: PMC7184053 DOI: 10.1007/s00415-020-09736-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Microbleeds are associated with the development of dementia in older people and are common in Alzheimer's disease (AD). Their prevalence and clinical importance in dementia with Lewy bodies (DLB) is unclear. The objective of this study was to compare the rates of microbleeds in DLB with those in AD and healthy older people, and investigate associations between microbleeds and amyloid deposition, vascular risk and disease severity in DLB. METHODS DLB (n = 30), AD (n = 18) and control (n = 20) participants underwent clinical assessment at baseline and 1 year in this longitudinal observational study. 3T MRI (including T2* susceptibility weighted imaging) and florbetapir PET were carried out at baseline. Microbleeds were rated visually and a standardised uptake value ratio (SUVR) was calculated from florbetapir PET scans. RESULTS 40% of DLB subjects had microbleeds compared with 50% of AD and 15% of controls. Compared to DLB without microbleeds, those with microbleeds had higher systolic BP (156 ± 26 v. 135 ± 19 mmHg; p = 0.03), but did not have greater levels of vascular disease or amyloid deposition (SUVR 1.25 ± 0.24 v. 1.25 ± 0.22; p = 0.33). There was evidence of less severe dementia in DLB participants with microbleeds, but these differences may have been driven by a shorter disease duration in those with microbleeds. CONCLUSION The presence of microbleeds in DLB is associated with higher blood pressure, but not with other measures of vascular disease or amyloid deposition. The relationship between microbleeds and clinical presentation remains unclear.
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Affiliation(s)
- Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - George Petrides
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Bergeron S, Chen Y, Auger F, Deguil J, Durieux N, Skrobala E, Barus R, Potey C, Cordonnier C, Pasquier F, Ravasi L, Bordet R, Gautier S. Role of cortical microbleeds in cognitive impairment: In vivo behavioral and imaging characterization of a novel murine model. J Cereb Blood Flow Metab 2019; 39:1015-1025. [PMID: 29333917 PMCID: PMC6547192 DOI: 10.1177/0271678x17752765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
Cerebral microbleeds (CMBs) could contribute to cognitive impairment in the general population and in patients with dementia. We designed a study to (i) develop a murine model of CMBs, (ii) assess whether CMBs affect cognition in this model and (iii) assess whether this model is sensitive to pharmacological modulation. Male C57Bl6/J mice were stereotactically administered collagenase to induce cortical lesion analysed by MRI at 24 h. CMB-mice were assessed at six weeks post-lesion for cognitive performances (Barnes maze and Touchscreen automated paired-associated learning (PAL) task) and for cerebral metabolism (in vivo PET/CT with fluorodeoxyglucose (FDG)). CMB-model sensitivity to pharmacological modulation was assessed by administering atorvastatin (5 mg/kg/day) over the follow-up period. CMB mice were compared to naïve littermates. Collagenase at 0.8 µU/µl appeared suitable to induce reproducible and reliable CMBs. At six weeks, a decline in learning, spatial and visuospatial memory was significantly observed in CMB-mice. Brain metabolism was impaired in all cortex, striatum and the ipsilateral dentate gyrus. A significant improvement in cognition performances was depicted under atorvastatin. In this novel murine model of CMBs, we validated that CMBs lowered cognitive performances and affected regional metabolism. We also proved that this CMB-model is sensitive to pharmacological modulation.
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Affiliation(s)
- Sandrine Bergeron
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Yaohua Chen
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Florent Auger
- Univ. Lille, Inserm, CHU Lille, In Vivo
Imaging Core Facility, Lille, France
| | - Julie Deguil
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Nicolas Durieux
- Univ. Lille, Inserm, CHU Lille, In Vivo
Imaging Core Facility, Lille, France
| | - Emilie Skrobala
- Univ. Lille Labex DISTALZ, CHU Lille,
Biostatistics Platform, and memory clinic, Lille, France
| | - Romain Barus
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Camille Potey
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Florence Pasquier
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Laura Ravasi
- Univ. Lille, Inserm, CHU Lille, In Vivo
Imaging Core Facility, Lille, France
| | - Régis Bordet
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
| | - Sophie Gautier
- Univ. Lille, Inserm, CHU Lille,
Degenerative and Vascular Cognitive Disorders, Lille, France
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Boomsma JMF, Exalto LG, Barkhof F, van den Berg E, de Bresser J, Heinen R, Leeuwis AE, Prins ND, Scheltens P, Weinstein HC, van der Flier WM, Biessels GJ. How Do Different Forms of Vascular Brain Injury Relate to Cognition in a Memory Clinic Population: The TRACE-VCI Study. J Alzheimers Dis 2019; 68:1273-1286. [PMID: 30909212 DOI: 10.3233/jad-180696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Memory clinic patients frequently present with different forms of vascular brain injury due to different etiologies, often co-occurring with Alzheimer's disease (AD) pathology. OBJECTIVE We studied how cognition was affected by different forms of vascular brain injury, possibly in interplay with AD pathology. METHODS We included 860 memory clinic patients with vascular brain injury on magnetic resonance imaging (MRI), receiving a standardized evaluation including cerebrospinal fluid (CSF) biomarker analyses (n = 541). The cognitive profile of patients with different forms of vascular brain injury on MRI (moderate/severe white matter hyperintensities (WMH) (n = 398), microbleeds (n = 368), lacunar (n = 188) and non-lacunar (n = 96) infarct(s), macrobleeds (n = 16)) was assessed by: 1) comparison of all these different forms of vascular brain injury with a reference group (patients with only mild WMH (n = 205) without other forms of vascular brain injury), using linear regression analyses also stratified for CSF biomarker AD profile and 2) multivariate linear regression analysis. RESULTS The cognitive profile was remarkably similar across groups. Compared to the reference group effect sizes on all domains were <0.2 with narrow 95% confidence intervals, except for non-lacunar infarcts on information processing speed (age, sex, and education adjusted mean difference from reference group (β: - 0.26, p = 0.05). Results were similar in the presence (n = 300) or absence (n = 241) of biomarker co-occurring AD pathology. In multivariate linear regression analysis, higher WMH burden was related to a slightly worse performance on attention and executive functioning (β: - 0.08, p = 0.02) and working memory (β: - 0.08, p = 0.04). CONCLUSION Although different forms of vascular brain injury have different etiologies and different patterns of cerebral damage, they show a largely similar cognitive profile in memory clinic patients regardless of co-occurring AD pathology.
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Cerebral microbleeds are associated with cognitive decline early after ischemic stroke. J Neurol 2019; 266:1091-1094. [PMID: 30761422 DOI: 10.1007/s00415-019-09236-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/02/2019] [Accepted: 02/05/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE The present study aimed to investigate whether cerebral microbleeds (CMB) are associated with vascular cognitive decline (VCD) already in the early course after ischemic stroke, and-if so-whether distinct cognitive domains are affected more preferentially by CMB. METHODS In a prospective cohort study, cognitive performance was examined in 33 stroke patients showing ≥ 1 CMB on MRI. Matched for age, gender, clinical and radiological characteristics, 33 stroke survivors without CMB served as a control group. Neuropsychological testing was performed in both groups six months after the index event using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD)-plus test battery. RESULTS CMB-positive stroke patients showed more severe cognitive decline in mini mental state test compared to the control group (p = 0.024). Regarding the episodic memory, CMB-positive patients reached lower scores in Word-List-Learning- (p = 0.009) and the Word-List-Recognition-test (p = 0.006), whereas the findings in Word-List-Recall-test were similar in both groups. While semantic fluency is not more affected in CMB-positive than in CMB-negative patients, those with CMB reveal a significantly impaired phonemic fluency (p = 0.007). Concerning the visuospatial abilities, stroke patients with CMB showed restricted recall of recently learned visual information. Only slight differences between both groups were found in any test investigating the participants' executive functions. CONCLUSION Cognitive abilities are more severely impaired in CMB-positive stroke patients compared to CMB-free controls, whereby memory-associated functions are most affected. CMB might be associated with post-stroke cognitive decline, particularly with impaired memory and phonemic fluency.
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Charidimou A, Shams S, Romero JR, Ding J, Veltkamp R, Horstmann S, Eiriksdottir G, van Buchem MA, Gudnason V, Himali J, Gurol ME, Viswanathan A, Imaizumi T, Vernooij MW, Seshadri S, Greenberg SM, Benavente OR, Launer LJ, Shoamanesh A. Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1). Int J Stroke 2018; 13:454-468. [PMID: 29338604 PMCID: PMC6123529 DOI: 10.1177/1747493017751931] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, "high risk" elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58-2.89 and adj-HR: 2.09; 95% CI: 1.71-2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68-8.08 and adj-HR: 3.93; 95% CI: 2.71-5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24-1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00-1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.
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Affiliation(s)
- Andreas Charidimou
- Department of Neurology, Harvard Medical School, J. Philip
Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA,
USA
- Cochrane Methods, Individual Patient Data Meta-analysis
Group
| | - Sara Shams
- Department of Clinical Science, Intervention, and
Technology, Division of Medical Imaging and Technology, Karolinska Institutet,
Stockholm, Sweden; Department of Radiology, Karolinska University Hospital,
Stockholm, Sweden
| | - Jose R Romero
- Department of Neurology, Boston University School of
Medicine, and the NHLBI’s Framingham Heart Study, Framingham,
Massachusetts
| | - Jie Ding
- Laboratory of Epidemiology and Population Sciences,
National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Roland Veltkamp
- Department of Neurology, University of Heidelberg,
Heidelberg, Germany
- Department of Stroke Medicine, Division of Brain Sciences,
Imperial College London, London, UK
| | - Solveig Horstmann
- Department of Neurology, University of Heidelberg,
Heidelberg, Germany
| | | | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center,
Leiden, the Netherlands
| | | | - JayandraJ Himali
- Department of Neurology, Boston University School of
Medicine, and the NHLBI’s Framingham Heart Study, Framingham,
Massachusetts
- Department of Biostatistics, Boston University School of
Public Health, Boston, MA, USA
| | - M Edip Gurol
- Department of Neurology, Harvard Medical School, J. Philip
Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA,
USA
| | - Anand Viswanathan
- Department of Neurology, Harvard Medical School, J. Philip
Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA,
USA
| | - Toshio Imaizumi
- Department of Neurosurgery, Kushiro City General
Hospital, Kushiro, Japan
| | - Meike W Vernooij
- Department of Epidemiology and Department of Radiology
and Nuclear Medicine; Erasmus MC University Medical Center, Rotterdam, the
Netherlands
| | - Sudha Seshadri
- Department of Neurology, Boston University School of
Medicine, and the NHLBI’s Framingham Heart Study, Framingham,
Massachusetts
| | - Steven M Greenberg
- Department of Neurology, Harvard Medical School, J. Philip
Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA,
USA
| | - Oscar R Benavente
- Division of Neurology, Department of Medicine, Stroke and
Cerebrovascular Health Program, University of British Columbia, UBC Hospital,
Vancouver, British Columbia, Canada
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences,
National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University
and Population Health Research Institute, Hamilton, Ontario, Canada
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Love S, Miners JS. Small vessel disease, neurovascular regulation and cognitive impairment: post-mortem studies reveal a complex relationship, still poorly understood. Clin Sci (Lond) 2017; 131:1579-1589. [PMID: 28667060 DOI: 10.1042/cs20170148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2023]
Abstract
The contribution of vascular disease to cognitive impairment is under-recognized and the pathogenesis is poorly understood. This information gap has multiple causes, including a lack of post-mortem validation of clinical diagnoses of vascular cognitive impairment (VCI) or vascular dementia (VaD), the exclusion of cases with concomitant neurodegenerative disease when diagnosing VCI/VaD, and a lack of standardization of neuropathological assessment protocols for vascular disease. Other contributors include a focus on end-stage destructive lesions to the exclusion of more subtle types of diffuse brain injury, on structural abnormalities of arteries and arterioles to the exclusion of non-structural abnormalities and capillary damage, and the use of post-mortem sampling strategies that are biased towards the identification of neurodegenerative pathologies. Recent studies have demonstrated the value of detailed neuropathology in characterizing vascular contributions to cognitive impairment (e.g. in diabetes), and highlight the importance of diffuse white matter changes, capillary damage and vasoregulatory abnormalities in VCI/VaD. The use of standardized, evidence-based post-mortem assessment protocols and the inclusion of biochemical as well as morphological methods in neuropathological studies should improve the accuracy of determination of the contribution of vascular disease to cognitive impairment and clarify the relative contribution of different pathogenic processes to the tissue damage.
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Affiliation(s)
- Seth Love
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K.
| | - J Scott Miners
- Dementia Research Group, School of Clinical Sciences, University of Bristol, Learning and Research Level 1, Southmead Hospital, Bristol BS10 5NB, U.K
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