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Wei W, Ma D, Li L, Zhang L. Cognitive impairment in cerebral small vessel disease induced by hypertension. Neural Regen Res 2024; 19:1454-1462. [PMID: 38051887 PMCID: PMC10883517 DOI: 10.4103/1673-5374.385841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 12/07/2023] Open
Abstract
ABSTRACT Hypertension is a primary risk factor for the progression of cognitive impairment caused by cerebral small vessel disease, the most common cerebrovascular disease. However, the causal relationship between hypertension and cerebral small vessel disease remains unclear. Hypertension has substantial negative impacts on brain health and is recognized as a risk factor for cerebrovascular disease. Chronic hypertension and lifestyle factors are associated with risks for stroke and dementia, and cerebral small vessel disease can cause dementia and stroke. Hypertension is the main driver of cerebral small vessel disease, which changes the structure and function of cerebral vessels via various mechanisms and leads to lacunar infarction, leukoaraiosis, white matter lesions, and intracerebral hemorrhage, ultimately resulting in cognitive decline and demonstrating that the brain is the target organ of hypertension. This review updates our understanding of the pathogenesis of hypertension-induced cerebral small vessel disease and the resulting changes in brain structure and function and declines in cognitive ability. We also discuss drugs to treat cerebral small vessel disease and cognitive impairment.
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Affiliation(s)
- Weipeng Wei
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Denglei Ma
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lin Li
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Lan Zhang
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Geriatric Medical Research Center; Beijing Engineering Research Center for Nervous System Drugs; National Center for Neurological Disorders; National Clinical Research Center for Geriatric Diseases, Beijing, China
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2
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Wang Z, Li X, Wang J, Yang W, Dove A, Lu W, Qi X, Sindi S, Xu W. Association of past and current sleep duration with structural brain differences: A large population-based study from the UK Biobank. Sleep Med 2024; 119:179-186. [PMID: 38692219 DOI: 10.1016/j.sleep.2024.04.033] [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: 12/24/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE This study aimed to examine the association between past/current sleep duration and macro-/micro-structural brain outcomes and explore whether hypertension or social activity plays a role in such association. METHODS Within the UK Biobank, 40 436 dementia-free participants (age 40-70 years) underwent a baseline assessment followed by a brain magnetic resonance imaging (MRI) scan 9 years later. Past (baseline) and current (MRI scans) sleep duration (hours/day) were recorded and classified as short (≤5), intermediate (6-8), and long (≥9). Brain structural volumes and diffusion markers were assessed by MRI scans. RESULTS Compared with past intermediate sleep, past short sleep was related to smaller cortex volumes (standardized β [95 % CI]: -0.04 [-0.07, -0.02]) and lower regional fractional anisotropy (FA) (-0.08 [-0.13, -0.03]), while past long sleep was related to smaller regional subcortical volumes (standardized β: -0.04 to -0.07 for thalamus, accumbens, and hippocampus). Compared to current intermediate sleep, current short sleep was associated with smaller cortex volumes (-0.03 [-0.05, -0.01]), greater white matter hyperintensities (WMH) volumes (0.04 [0.01, 0.08]), and lower regional FA (-0.07 [-0.11, -0.02]). However, current long sleep was related to smaller total brain (-0.03 [-0.05, -0.02]), grey matter (-0.05 [-0.07, -0.03]), cortex (-0.05 [-0.07, -0.03]), regional subcortical volumes [standardized β: -0.05 to -0.09 for putamen, thalamus, hippocampus, and accumbens]), greater WMH volumes (0.06 [0.03, 0.09]), as well as lower regional FA (-0.05 [-0.09, -0.02]). The association between current long sleep duration and poor brain health was stronger among people with hypertension or low frequency of social activity (all Pinteraction <0.05). CONCLUSIONS Both past and current short/long sleep are associated with smaller brain volume and poorer white matter health in the brain, especially in individuals with hypertension and low frequency of social activity. Our findings highlight the need to maintain 6-8 h' sleep duration for healthy brain aging.
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Affiliation(s)
- Zhiyu Wang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xuerui Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin Geriatrics Institute, Tianjin, China
| | - Jiao Wang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenzhe Yang
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Wenli Lu
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiuying Qi
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Ageing Epidemiology Research Unit (AGE), School of Public Health, Faculty of Medicine, Imperial College London, UK
| | - Weili Xu
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Fabiani G. Enlarged Perivascular Spaces: From Incidental Findings to a New Biomarker. Neurology 2024; 102:e209601. [PMID: 38833651 DOI: 10.1212/wnl.0000000000209601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Affiliation(s)
- Giorgio Fabiani
- From the Sociedade Hospitalar Angelina Caron, Campina Grande do Sul and Hospital de Clinicas - Federal University of Parana, Curitiba, Brazil
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Kim S, Na HK, Sun Y, Yoon YJ, Chung SJ, Sohn YH, Lyoo CH, Lee PH. Regional Burden of Enlarged Perivascular Spaces and Cognition and Neuropsychiatric Symptoms in Drug-Naive Patients With Parkinson Disease. Neurology 2024; 102:e209483. [PMID: 38833653 DOI: 10.1212/wnl.0000000000209483] [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] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although the potential role of enlarged perivascular spaces (EPVSs) in Parkinson disease (PD) is increasingly recognized, whether EPVSs located in different anatomical regions exert differential effects on clinical manifestation remains uncertain. We investigated the regional EPVS burden and its association with cognition and neuropsychiatric symptoms (NPSs) in newly diagnosed PD population. METHODS In this retrospective, cross-sectional study, EPVS in the temporal lobe (T-EPVS), centrum semiovale (CS-EPVS), and basal ganglia (BG-EPVS) were visually rated in drug-naive patients with PD who underwent magnetic resonance imaging, dopamine transporter (DAT) scans, neuropsychological assessments, and Neuropsychiatric Inventory Questionnaire at baseline. Cognitive performance, NPS burden, vascular risk factors, small vessel disease (SVD) imaging markers, and DAT availability were compared across groups dichotomized by their regional EPVS burden (cutoff for high-degree vs low-degree: >10 for T-EPVS/BG-EPVS and >20 for CS-EPVS). RESULTS A total of 480 patients with PD (123 without cognitive impairment, 291 with mild cognitive impairment, and 66 with dementia) were included. The proportion of high-degree T-EPVS (p for trend <0.001) and BG-EPVS (p for trend = 0.001) exhibited an increasing trend across the cognitive spectrum, corresponding to worsening cognition. Compared with the low-degree group, the high-degree BG-EPVS group showed higher SVD burden (moderate-to-severe white matter hyperintensity [14.8% vs 40.5%, p < 0.001], lacune [10.3% vs 30.7%, p < 0.001], and cerebral microbleeds [8.1% vs 22.2%, p < 0.001]), greater atrophy in cortical gray matter (40.73% ± 1.09% vs 39.96% ± 1.20% of intracranial volume, p < 0.001), and lower cognitive performance (in language [-0.22 ± 1.18 vs -0.53 ± 1.29, p = 0.013], and visual memory domains [-0.24 ± 0.97 vs -0.61 ± 0.96, p = 0.009]). The high-degree T-EPVS group presented with greater NPS burden in decreased motivation (0.61 ± 1.78 vs 1.35 ± 2.36, p = 0.007), affective dysregulation (0.88 ± 2.13 vs 2.36 ± 3.53, p < 0.001), and impulse dyscontrol (0.43 ± 1.67 vs 1.74 ± 4.29, p < 0.001), compared with the low-degree T-EPVS group. Meanwhile, the burden of CS-EPVS did not reveal any differences in cognition or NPS. DISCUSSION BG-EPVS and T-EPVS seem to exert differential effects on cognition and NPS in patients with PD. Investigating the EPVS profile in distinct anatomical regions may be useful in disentangling the heterogeneity within PD.
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Affiliation(s)
- Seokhyun Kim
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Kyu Na
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeeun Sun
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeo Jun Yoon
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Hyoung Lyoo
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Pang H, Wang J, Yu Z, Yu H, Li X, Bu S, Zhao M, Jiang Y, Liu Y, Fan G. Glymphatic function from diffusion-tensor MRI to predict conversion from mild cognitive impairment to dementia in Parkinson's disease. J Neurol 2024:10.1007/s00415-024-12525-8. [PMID: 38913186 DOI: 10.1007/s00415-024-12525-8] [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: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Although brain glymphatic dysfunction is a contributing factor to the cognitive deficits in Parkinson's disease (PD), its role in the longitudinal progression of cognitive dysfunction remains unknown. OBJECTIVE To investigate the glymphatic function in PD with mild cognitive impairment (MCI) that progresses to dementia (PDD) and to determine its predictive value in identifying individuals at high risk for developing dementia. METHODS We included 64 patients with PD meeting criteria for MCI and categorized them as either progressed to PDD (converters) (n = 29) or did not progress to PDD (nonconverters) (n = 35), depending on whether they developed dementia during follow-up. Meanwhile, 35 age- and gender-matched healthy controls (HC) were included. Bilateral diffusion-tensor imaging analysis along the perivascular space (DTI-ALPS) indices and enlarged perivascular spaces (EPVS) volume fraction in bilateral centrum semiovale, basal ganglia (BG), and midbrain were compared among the three groups. Correlations among the DTI-ALPS index and EPVS, as well as cognitive performance were analyzed. Additionally, we investigated the mediation effect of EPVS on DTI-ALPS and cognitive function. RESULTS PDD converters had lower cognitive composites scores in the executive domains than did nonconverters (P < 0.001). Besides, PDD converters had a significantly lower DTI-ALPS index in the left hemisphere (P < 0.001) and a larger volume fraction of BG-PVS (P = 0.03) compared to HC and PDD nonconverters. Lower DTI-ALPS index and increased BG-PVS volume fraction were associated with worse performance in the global cognitive performance and executive function. However, there was no significant mediating effect. Receiver operating characteristic analysis revealed that the DTI-ALPS could effectively identify PDD converters with an area under the curve (AUC) of 0.850. CONCLUSION The reduction of glymphatic activity, measured by the DTI-ALPS, could potentially be used as a non-invasive indicator in forecasting high risk of dementia conversion before the onset of dementia in PD patients.
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Affiliation(s)
- Huize Pang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Juzhou Wang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ziyang Yu
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Hongmei Yu
- Department of Neurology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaolu Li
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuting Bu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Mengwan Zhao
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yueluan Jiang
- MR Research Collaboration, Siemens Healthineers, Beijing, China
| | - Yu Liu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guoguang Fan
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Pramotton FM, Spitz S, Kamm RD. Challenges and Future Perspectives in Modeling Neurodegenerative Diseases Using Organ-on-a-Chip Technology. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2403892. [PMID: 38922799 DOI: 10.1002/advs.202403892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/01/2024] [Indexed: 06/28/2024]
Abstract
Neurodegenerative diseases (NDDs) affect more than 50 million people worldwide, posing a significant global health challenge as well as a high socioeconomic burden. With aging constituting one of the main risk factors for some NDDs such as Alzheimer's disease (AD) and Parkinson's disease (PD), this societal toll is expected to rise considering the predicted increase in the aging population as well as the limited progress in the development of effective therapeutics. To address the high failure rates in clinical trials, legislative changes permitting the use of alternatives to traditional pre-clinical in vivo models are implemented. In this regard, microphysiological systems (MPS) such as organ-on-a-chip (OoC) platforms constitute a promising tool, due to their ability to mimic complex and human-specific tissue niches in vitro. This review summarizes the current progress in modeling NDDs using OoC technology and discusses five critical aspects still insufficiently addressed in OoC models to date. Taking these aspects into consideration in the future MPS will advance the modeling of NDDs in vitro and increase their translational value in the clinical setting.
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Affiliation(s)
- Francesca Michela Pramotton
- Department of Mechanical Engineering and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sarah Spitz
- Department of Mechanical Engineering and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Roger D Kamm
- Department of Mechanical Engineering and Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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7
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Waymont JMJ, Valdés Hernández MDC, Bernal J, Duarte Coello R, Brown R, Chappell FM, Ballerini L, Wardlaw JM. Systematic review and meta-analysis of automated methods for quantifying enlarged perivascular spaces in the brain. Neuroimage 2024; 297:120685. [PMID: 38914212 DOI: 10.1016/j.neuroimage.2024.120685] [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: 03/18/2024] [Revised: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 06/26/2024] Open
Abstract
Research into magnetic resonance imaging (MRI)-visible perivascular spaces (PVS) has recently increased, as results from studies in different diseases and populations are cementing their association with sleep, disease phenotypes, and overall health indicators. With the establishment of worldwide consortia and the availability of large databases, computational methods that allow to automatically process all this wealth of information are becoming increasingly relevant. Several computational approaches have been proposed to assess PVS from MRI, and efforts have been made to summarise and appraise the most widely applied ones. We systematically reviewed and meta-analysed all publications available up to September 2023 describing the development, improvement, or application of computational PVS quantification methods from MRI. We analysed 67 approaches and 60 applications of their implementation, from 112 publications. The two most widely applied were the use of a morphological filter to enhance PVS-like structures, with Frangi being the choice preferred by most, and the use of a U-Net configuration with or without residual connections. Older adults or population studies comprising adults from 18 years old onwards were, overall, more frequent than studies using clinical samples. PVS were mainly assessed from T2-weighted MRI acquired in 1.5T and/or 3T scanners, although combinations using it with T1-weighted and FLAIR images were also abundant. Common associations researched included age, sex, hypertension, diabetes, white matter hyperintensities, sleep and cognition, with occupation-related, ethnicity, and genetic/hereditable traits being also explored. Despite promising improvements to overcome barriers such as noise and differentiation from other confounds, a need for joined efforts for a wider testing and increasing availability of the most promising methods is now paramount.
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Affiliation(s)
- Jennifer M J Waymont
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK.
| | - José Bernal
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK; German Centre for Neurodegenerative Diseases (DZNE), Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Germany
| | - Roberto Duarte Coello
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK
| | | | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, the University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK; UK Dementia Research Institute Centre at the University of Edinburgh, UK
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Eide PK. Neurosurgery and the glymphatic system. Acta Neurochir (Wien) 2024; 166:274. [PMID: 38904802 PMCID: PMC11192689 DOI: 10.1007/s00701-024-06161-4] [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: 05/02/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
The discovery of the glymphatic system has fundamentally altered our comprehension of cerebrospinal fluid transport and the removal of waste from brain metabolism. In the past decade, since its initial characterization, research on the glymphatic system has surged exponentially. Its potential implications for central nervous system disorders have sparked significant interest in the field of neurosurgery. Nonetheless, ongoing discussions and debates persist regarding the concept of the glymphatic system, and our current understanding largely relies on findings from experimental animal studies. This review aims to address several key inquiries: What methodologies exist for evaluating glymphatic function in humans today? What is the current evidence supporting the existence of a human glymphatic system? Can the glymphatic system be considered distinct from the meningeal-lymphatic system? What is the human evidence for glymphatic-meningeal lymphatic system failure in neurosurgical diseases? Existing literature indicates a paucity of techniques available for assessing glymphatic function in humans. Thus far, intrathecal contrast-enhanced magnetic resonance imaging (MRI) has shown the most promising results and have provided evidence for the presence of a glymphatic system in humans, albeit with limitations. It is, however, essential to recognize the interconnection between the glymphatic and meningeal lymphatic systems, as they operate in tandem. There are some human studies demonstrating deteriorations in glymphatic function associated with neurosurgical disorders, enriching our understanding of their pathophysiology. However, the translation of this knowledge into clinical practice is hindered by the constraints of current glymphatic imaging modalities.
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Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, Nydalen, Pb 4950 N-0424, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
- KG Jebsen Centre for Brain Fluid Research, University of Oslo, Oslo, Norway.
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9
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Elias-Mas A, Wang JY, Rodríguez-Revenga L, Kim K, Tassone F, Hessl D, Rivera SM, Hagerman R. Enlarged perivascular spaces and their association with motor, cognition, MRI markers and cerebrovascular risk factors in male fragile X premutation carriers. J Neurol Sci 2024; 461:123056. [PMID: 38772058 DOI: 10.1016/j.jns.2024.123056] [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: 10/11/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/23/2024]
Abstract
FMR1 premutation carriers (55-200 CGG repeats) are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder associated with motor and cognitive impairment. Bilateral hyperintensities of the middle cerebellar peduncles (MCP sign) are the major radiological hallmarks of FXTAS. In the general population, enlarged perivascular spaces (PVS) are biomarkers of small vessel disease and glymphatic dysfunction and are associated with cognitive decline. Our aim was to determine if premutation carriers show higher ratings of PVS than controls and whether enlarged PVS are associated with motor and cognitive impairment, MRI features of neurodegeneration, cerebrovascular risk factors and CGG repeat length. We evaluated 655 MRIs (1-10 visits/participant) from 229 carriers (164 with FXTAS and 65 without FXTAS) and 133 controls. PVS in the basal ganglia (BG-EPVS), centrum semiovale, and midbrain were evaluated with a semiquantitative scale. Mixed-effects models were used for statistical analysis adjusting for age. In carriers with FXTAS, we revealed that (1) BG-PVS ratings were higher than those of controls and carriers without FXTAS; (2) BG-PVS severity was associated with brain atrophy, white matter hyperintensities, enlarged ventricles, FXTAS stage and abnormal gait; (3) age-related increase in BG-PVS was associated with cognitive dysfunction; and (4) PVS ratings of all three regions showed robust associations with CGG repeat length and were higher in carriers with the MCP sign than carriers without the sign. This study demonstrates clinical relevance of PVS in FXTAS especially in the basal ganglia region and suggests microangiopathy and dysfunctional cerebrospinal fluid circulation in FXTAS physiopathology.
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Affiliation(s)
- Andrea Elias-Mas
- Radiology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain; Institute for Research and Innovation Parc Taulí (I3PT), Sabadell, Spain; Genetics Doctorate Program, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Jun Yi Wang
- Center for Mind and Brain, University of California Davis, CA, United States.
| | - Laia Rodríguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain; CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Kyoungmi Kim
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - Flora Tassone
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - David Hessl
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - Susan M Rivera
- Center for Mind and Brain, University of California Davis, CA, United States; MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Psychology, University of Maryland, College Park, MD, United States.
| | - Randi Hagerman
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, United States.
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10
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Bergs J, Morr AS, Silva RV, Infante-Duarte C, Sack I. The Networking Brain: How Extracellular Matrix, Cellular Networks, and Vasculature Shape the In Vivo Mechanical Properties of the Brain. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2402338. [PMID: 38874205 DOI: 10.1002/advs.202402338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Mechanically, the brain is characterized by both solid and fluid properties. The resulting unique material behavior fosters proliferation, differentiation, and repair of cellular and vascular networks, and optimally protects them from damaging shear forces. Magnetic resonance elastography (MRE) is a noninvasive imaging technique that maps the mechanical properties of the brain in vivo. MRE studies have shown that abnormal processes such as neuronal degeneration, demyelination, inflammation, and vascular leakage lead to tissue softening. In contrast, neuronal proliferation, cellular network formation, and higher vascular pressure result in brain stiffening. In addition, brain viscosity has been reported to change with normal blood perfusion variability and brain maturation as well as disease conditions such as tumor invasion. In this article, the contributions of the neuronal, glial, extracellular, and vascular networks are discussed to the coarse-grained parameters determined by MRE. This reductionist multi-network model of brain mechanics helps to explain many MRE observations in terms of microanatomical changes and suggests that cerebral viscoelasticity is a suitable imaging marker for brain disease.
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Affiliation(s)
- Judith Bergs
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anna S Morr
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Rafaela V Silva
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Lindenberger Weg 80, 13125, Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Robert-Rössle-Straße 10, 13125, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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11
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Burles F, Willson M, Townes P, Yang A, Iaria G. Preliminary evidence of high prevalence of cerebral microbleeds in astronauts with spaceflight experience. Front Physiol 2024; 15:1360353. [PMID: 38948081 PMCID: PMC11211603 DOI: 10.3389/fphys.2024.1360353] [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: 12/22/2023] [Accepted: 05/21/2024] [Indexed: 07/02/2024] Open
Abstract
Long-duration spaceflight poses a variety of health risks to astronauts, largely resulting from extended exposure to microgravity and radiation. Here, we assessed the prevalence and incidence of cerebral microbleeds in sixteen astronauts before and after a typical 6-month mission on board the International Space Station Cerebral microbleeds are microhemorrhages in the brain, which are typically interpreted as early evidence of small vessel disease and have been associated with cognitive impairment. We identified evidence of higher-than-expected microbleed prevalence in astronauts with prior spaceflight experience. However, we did not identify a statistically significant increase in microbleed burden up to 7 months after spaceflight. Altogether, these preliminary findings suggest that spaceflight exposure may increase microbleed burden, but this influence may be indirect or occur over time courses that exceed 1 year. For health monitoring purposes, it may be valuable to acquire neuroimaging data that are able to detect the occurrence of microbleeds in astronauts following their spaceflight missions.
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Affiliation(s)
- Ford Burles
- Canadian Space Health Research Network, Calgary, AB, Canada
- Neurolab, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Morgan Willson
- Departments of Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Parker Townes
- Canadian Space Health Research Network, Calgary, AB, Canada
- Neurolab, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Allison Yang
- Canadian Space Health Research Network, Calgary, AB, Canada
- Neurolab, Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Giuseppe Iaria
- Canadian Space Health Research Network, Calgary, AB, Canada
- Neurolab, Department of Psychology, University of Calgary, Calgary, AB, Canada
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12
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Oltmer J, Mattern H, Beck J, Yakupov R, Greenberg SM, Zwanenburg JJ, Arts T, Düzel E, van Veluw SJ, Schreiber S, Perosa V. Enlarged perivascular spaces in the basal ganglia are associated with arteries not veins. J Cereb Blood Flow Metab 2024:271678X241260629. [PMID: 38863151 DOI: 10.1177/0271678x241260629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Enlarged perivascular spaces (EPVS) are common in cerebral small vessel disease (CSVD) and have been identified as a marker of dysfunctional brain clearance. However, it remains unknown if the enlargement occurs predominantly around arteries or veins. We combined in vivo ultra-high-resolution MRI and histopathology to investigate the spatial relationship of veins and arteries with EPVS within the basal ganglia (BG). Furthermore, we assessed the relationship between the EPVS and measures of blood-flow (blood-flow velocity, pulsatility index) in the small arteries of the BG. Twenty-four healthy controls, twelve non-CAA CSVD patients, and five probable CAA patients underwent a 3 tesla [T] and 7T MRI-scan, and EPVS, arteries, and veins within the BG were manually segmented. Furthermore, the scans were co-registered. Six autopsy-cases were also assessed. In the BG, EPVS were significantly closer to and overlapped more frequently with arteries than with veins. Histological analysis showed a higher proportion of BG EPVS surrounding arteries than veins. Finally, the pulsatility index of BG arteries correlated with EPVS volume. Our results are in line with previous works and establish a pathophysiological relationship between arteries and EPVS, contributing to elucidating perivascular clearance routes in the human brain.
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Affiliation(s)
- Jan Oltmer
- Athinoula A. Martinos Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Department of Digital Health & Innovation, Vivantes Netzwerk für Gesundheit GmbH, Berlin, Germany
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Department of Biomedical Magnetic Resonance (BMMR), Institute for Physics, Otto-von-Guericke-University, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
| | - Julia Beck
- Department of Neurology, Otto-Von-Guericke University, Magdeburg, Germany
| | - Renat Yakupov
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaco Jm Zwanenburg
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tine Arts
- Center for Image Sciences, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Susanne J van Veluw
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, MassGeneral Institute for Neurodegenerative Disease, Charlestown, MA, USA
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefanie Schreiber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany
- Department of Neurology, Otto-Von-Guericke University, Magdeburg, Germany
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Valentina Perosa
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Borrelli S, Guisset F, Vanden Bulcke C, Stölting A, Bugli C, Lolli V, Du Pasquier R, van Pesch V, Absinta M, Pasi M, Maggi P. Enlarged perivascular spaces are associated with brain microangiopathy and aging in multiple sclerosis. Mult Scler 2024:13524585241256881. [PMID: 38850029 DOI: 10.1177/13524585241256881] [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: 06/09/2024]
Abstract
BACKGROUND Growing evidence links brain-MRI enlarged perivascular spaces (EPVS) and multiple sclerosis (MS), but their role remains unclear. OBJECTIVE This study aimed to investigate the cross-sectional associations of EPVS with several neuroinflammatory and neurodegenerative features in a large multicentric-MS cohort. METHODS In total, 207 patients underwent 3T axial-T2-weighted brain-MRI for EPVS assessment (EPVS dichotomized into high/low according to ⩾ 2/< 2 rating categories). MRI biomarkers included brain-predicted age and brain-predicted age difference (brain-PAD), central vein sign (CVS)-positive lesion percentage (CVS%), paramagnetic rim and cortical lesions, T2-lesion load, and brain volumetry. The variable relative importance for EPVS-category prediction was explored using a classification random forest approach. RESULTS High EPVS patients were older (49 vs 44 years, p = 0.003), had ⩾ 1 vascular risk factors (VRFs; p = 0.005), lower CVS% (67% vs 78%, p < 0.001), reduced brain volumes (whole brain: 0.63 vs 0.73, p = 0.01; gray matter: 0.36 vs 0.40; p = 0.002), and older brain-predicted age (58 vs 50 years, p < 0.001). No differences were found for neuroinflammatory markers. After adjusting for age and VFRs (multivariate analyses), the high EPVS category correlated with lower CVS% (odds ratio (OR) = 0.98, 95% confidence interval (CI) = 0.96-0.99; p = 0.02), lower whole brain (OR = 0.01, 95% CI = 0.0003-0.5; p = 0.02), gray matter (OR = 0.0004, 95% CI = 0.0000004-0.4; p = 0.03) volumes, and higher brain-PAD (OR = 1.05, 95% CI = 1.01-1.09; p = 0.02). Random forest identified brain-PAD as the most important predictor of high EPVS. CONCLUSION EPVS in MS likely reflect microangiopathic disease rather than neuroinflammation, potentially contributing to accelerated neurodegeneration.
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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
| | - François Guisset
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Colin Vanden Bulcke
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/ICTEAM Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Anna Stölting
- Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium
| | - Céline Bugli
- Plateforme technologique de Support en Méthodologie et Calcul Statistique, Université catholique de Louvain, Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium
| | - Renaud Du Pasquier
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Vincent van Pesch
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Martina Absinta
- Vita-Salute San Raffaele University, Milan, Italy/Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy/Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - 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/Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland/Department of Neurology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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14
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Gallina P, Porfirio B, Caini S, Lolli F, Scollato A. Aqueductal CSF stroke volume is associated with the burden of perivascular space enlargement in chronic adult hydrocephalus. Sci Rep 2024; 14:12966. [PMID: 38839864 PMCID: PMC11153584 DOI: 10.1038/s41598-024-63926-8] [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: 09/14/2023] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
The inflow of CSF into perivascular spaces (PVS) in the brain is crucial for clearing waste molecules. Inefficiency in PVS flow leads to neurodegeneration. Failure of PVS flushing is associated with CSF flow impairment in the intracranial hydrodynamic condition of CSF hypo-pulsatility. However, enlarged PVS (ePVS), a finding indicative of PVS flow dysfunction, is also present in patients with derangement of CSF dynamics characterized by CSF hyper-pulsatility, which increases CSF flow. Intriguingly, two opposite intracranial hydrodynamic conditions would lead to the same result of impairing the PVS flushing. To investigate this issue, we assessed the subsistence of a dysfunctional interplay between CSF and PVS flows and, if the case, the mechanisms preventing a hyper-pulsatile brain from providing an effective PVS flushing. We analyzed the association between phase contrast MRI aqueductal CSF stroke volume (aqSV), a proxy of CSF pulsatility, and the burden of ePVS in chronic adult hydrocephalus, a disease involving a broad spectrum of intracranial hydrodynamics disturbances. In the 147 (85 males, 62 females) patients, the age at diagnosis ranged between 28 and 88 years (median 73 years). Ninety-seven patients had tri-ventriculomegaly and 50 tetra-ventriculomegaly. According to the extent of ePVS, 113 patients had a high ePVS burden, while 34 had a low ePVS burden. aqSV, which ranged between 0 and 562 μL (median 86 μL), was increased with respect to healthy subjects. Patients presenting with less ePVS burden had higher aqSV (p < 0.002, corrected for the multiple comparisons) than those with higher ePVS burden. The present study confirmed the association between CSF dynamics and PVS flow disturbances and demonstrated this association in intracranial hyper-pulsatility. Further studies should investigate the association between PVS flow failure and CSF hypo- and hyper-pulsatility as responsible/co-responsible for glymphatic failure in other neurodegenerative diseases, particularly in diseases in which CSF disturbances can be corrected, as in chronic adult hydrocephalus.
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Affiliation(s)
- Pasquale Gallina
- Neurosurgery Unit, CTO Hospital, Careggi University Hospital, Largo P Palagi 1, 50139, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Berardino Porfirio
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network, Florence, Italy
| | - Francesco Lolli
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
- Neurophysiology Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Scollato
- Neurosurgery Unit, "Cardinale Panico" Hospital, Tricase, Lecce, Italy
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15
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Zhuo J, Raghavan P, Jiang L, Roys S, Tchoquessi RLN, Chen H, Wickwire EM, Parikh GY, Schwartzbauer GT, Grattan LM, Wang Z, Gullapalli RP, Badjatia N. Longitudinal Assessment of Glymphatic Changes Following Mild Traumatic Brain Injury: Insights from PVS burden and DTI-ALPS Imaging. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.01.24307927. [PMID: 38854000 PMCID: PMC11160843 DOI: 10.1101/2024.06.01.24307927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Traumatic brain injury (TBI) even in the mild form may result in long-lasting post-concussion symptoms. TBI is also a known risk to late-life neurodegeneration. Recent studies suggest that dysfunction in the glymphatic system, responsible for clearing protein waste from the brain, may play a pivotal role in the development of dementia following TBI. Given the diverse nature of TBI, longitudinal investigations are essential to comprehending the dynamic changes in the glymphatic system and its implications for recovery. In this prospective study, we evaluated two promising glymphatic imaging markers, namely the enlarged perivascular space (ePVS) burden and Diffusion Tensor Imaging-based ALPS index, in 44 patients with mTBI at two early post-injury time points: approximately 14 days (14Day) and 6-12 months (6-12Mon) post-injury, while also examining their associations with post-concussion symptoms. Additionally, 37 controls, comprising both orthopedic patients and healthy individuals, were included for comparative analysis. Our key findings include: 1) White matter ePVS burden (WM-ePVS) and ALPS index exhibit significant correlations with age. 2) Elevated WM-ePVS burden in acute mTBI (14Day) is significantly linked to a higher number of post-concussion symptoms, particularly memory problems. 3) The increase in the ALPS index from acute (14Day) to the chronic (6-12Mon) phases in mTBI patients correlates with improvement in sleep measures. Furthermore, incorporating WM-ePVS burden and the ALPS index from acute phase enhances the prediction of chronic memory problems beyond socio-demographic and basic clinical information, highlighting their distinct roles in assessing glymphatic structure and activity. Early evaluation of glymphatic function could be crucial for understanding TBI recovery and developing targeted interventions to improve patient outcomes.
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Affiliation(s)
- Jiachen Zhuo
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Prashant Raghavan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Li Jiang
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Steven Roys
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rosy Linda Njonkou Tchoquessi
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Hegang Chen
- Department of Epidemiology & public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Emerson M. Wickwire
- Department of Psychiatry & Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Gunjan Y. Parikh
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Gary T. Schwartzbauer
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Lynn M. Grattan
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Ze Wang
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rao P. Gullapalli
- Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Neeraj Badjatia
- Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
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16
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Xie F, Zhou C, Jin H, Xing W, Wang D. Bilateral glymphatic dysfunction and its association with disease duration in unilateral temporal lobe epilepsy patients with hippocampal sclerosis. Epilepsy Behav 2024; 155:109777. [PMID: 38640726 DOI: 10.1016/j.yebeh.2024.109777] [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: 10/24/2023] [Revised: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE In this study, the diffusion tensor imaging along perivascular space analysis (DTI-ALPS) technique was utilized to evaluate the functional changes in the glymphatic system of the bilateral hemispheres in patients with unilateral temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS). The aim was to gain insights into the alterations in the glymphatic system function in TLE patients. METHODS A total of 61 unilateral TLE patients with HS and 53 healthy controls (HCs) from the Department of Neurosurgery at Xiangya Hospital were included in the study. All subjects underwent DTI using the same 3 T MR Scanner, and the DTI-ALPS index was calculated. Differences in the DTI-ALPS index between TLE patients and HCs were evaluated, along with the correlation between the DTI-ALPS index of TLE and clinical features of epilepsy. These features included age, age of onset, seizure duration, and neuropsychological scores. RESULTS Compared to the bilateral means of the HCs, both the ipsilateral and contralateral DTI-ALPS index of the TLE patients were significantly decreased (TLE ipsilateral 1.41 ± 0.172 vs. HC bilateral mean: 1.49 ± 0.116, p = 0.006; TLE contralateral: 1.42 ± 0.158 vs. HC bilateral mean: 1.49 ± 0.116, p = 0.015). The ipsilateral DTI-ALPS index in TLE patients showed a significant negative correlation with disease duration (r = -0.352, p = 0.005). CONCLUSIONS The present study suggests the presence of bilateral dysfunctions in the glymphatic system and also highlight a laterality feature in these dysfunctions. Additionally, the study found a significant negative correlation between the ipsilateral DTI-ALPS index and disease duration, underscoring the significance of early effective interventions and indicating potential for the development of innovative treatments targeting the glymphatic system.
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Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunyao Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Jin
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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17
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Rutten JW, Cerfontaine MN, Dijkstra KL, Mulder AA, Vreijling J, Kruit M, Koning RI, de Bot ST, van Nieuwenhuizen KM, Baelde HJ, Berendse HW, Mei LH, Ruijter GJG, Baas F, Jost CR, van Duinen SG, Nibbeling EAR, Gravesteijn G, Lesnik Oberstein SAJ. Bi-allelic NIT1 variants cause a brain small vessel disease characterized by movement disorders, massively dilated perivascular spaces, and intracerebral hemorrhage. Genet Med 2024; 26:101105. [PMID: 38430071 DOI: 10.1016/j.gim.2024.101105] [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: 10/18/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To describe a recessively inherited cerebral small vessel disease, caused by loss-of-function variants in Nitrilase1 (NIT1). METHODS We performed exome sequencing, brain magnetic resonance imaging, neuropathology, electron microscopy, western blotting, and transcriptomic and metabolic analyses in 7 NIT1-small vessel disease patients from 5 unrelated pedigrees. RESULTS The first identified patients were 3 siblings, compound heterozygous for the NIT1 c.727C>T; (p.Arg243Trp) variant and the NIT1 c.198_199del; p.(Ala68∗) variant. The 4 additional patients were single cases from 4 unrelated pedigrees and were all homozygous for the NIT1 c.727C>T; p.(Arg243Trp) variant. Patients presented in mid-adulthood with movement disorders. All patients had striking abnormalities on brain magnetic resonance imaging, with numerous and massively dilated basal ganglia perivascular spaces. Three patients had non-lobar intracerebral hemorrhage between age 45 and 60, which was fatal in 2 cases. Western blotting on patient fibroblasts showed absence of NIT1 protein, and metabolic analysis in urine confirmed loss of NIT1 enzymatic function. Brain autopsy revealed large electron-dense deposits in the vessel walls of small and medium sized cerebral arteries. CONCLUSION NIT1-small vessel disease is a novel, autosomal recessively inherited cerebral small vessel disease characterized by a triad of movement disorders, massively dilated basal ganglia perivascular spaces, and intracerebral hemorrhage.
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Affiliation(s)
- Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kyra L Dijkstra
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Vreijling
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark Kruit
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roman I Koning
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Susanne T de Bot
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W Berendse
- Department of Neurology, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leon H Mei
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - George J G Ruijter
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sjoerd G van Duinen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther A R Nibbeling
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Li N, Shao JM, Jiang Y, Wang CH, Li SB, Wang DC, Di WY. Unraveling the Predictors of Enlarged Perivascular Spaces: A Comprehensive Logistic Regression Approach in Cerebral Small Vessel Disease. Int J Gen Med 2024; 17:2513-2525. [PMID: 38846346 PMCID: PMC11155382 DOI: 10.2147/ijgm.s464356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
Background This study addresses the predictive modeling of Enlarged Perivascular Spaces (EPVS) in neuroradiology and neurology, focusing on their impact on Cerebral Small Vessel Disease (CSVD) and neurodegenerative disorders. Methods A retrospective analysis was conducted on 587 neurology inpatients, utilizing LASSO regression for variable selection and logistic regression for model development. The study included comprehensive demographic, medical history, and laboratory data analyses. Results The model identified key predictors of EPVS, including Age, Hypertension, Stroke, Lipoprotein a, Platelet Large Cell Ratio, Uric Acid, and Albumin to Globulin Ratio. The predictive nomogram demonstrated strong efficacy in EPVS risk assessment, validated through ROC curve analysis, calibration plots, and Decision Curve Analysis. Conclusion The study presents a novel, robust EPVS predictive model, providing deeper insights into EPVS mechanisms and risk factors. It underscores the potential for early diagnosis and improved management strategies in neuro-radiology and neurology, highlighting the need for future research in diverse populations and longitudinal settings.
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Affiliation(s)
- Ning Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - Jia-Min Shao
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - Ye Jiang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - Chu-Han Wang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - Si-Bo Li
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - De-Chao Wang
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
| | - Wei-Ying Di
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei Province, People’s Republic of China
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19
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van Veluw SJ, Benveniste H, Bakker ENTP, Carare RO, Greenberg SM, Iliff JJ, Lorthois S, Van Nostrand WE, Petzold GC, Shih AY, van Osch MJP. Is CAA a perivascular brain clearance disease? A discussion of the evidence to date and outlook for future studies. Cell Mol Life Sci 2024; 81:239. [PMID: 38801464 PMCID: PMC11130115 DOI: 10.1007/s00018-024-05277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/20/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The brain's network of perivascular channels for clearance of excess fluids and waste plays a critical role in the pathogenesis of several neurodegenerative diseases including cerebral amyloid angiopathy (CAA). CAA is the main cause of hemorrhagic stroke in the elderly, the most common vascular comorbidity in Alzheimer's disease and also implicated in adverse events related to anti-amyloid immunotherapy. Remarkably, the mechanisms governing perivascular clearance of soluble amyloid β-a key culprit in CAA-from the brain to draining lymphatics and systemic circulation remains poorly understood. This knowledge gap is critically important to bridge for understanding the pathophysiology of CAA and accelerate development of targeted therapeutics. The authors of this review recently converged their diverse expertise in the field of perivascular physiology to specifically address this problem within the framework of a Leducq Foundation Transatlantic Network of Excellence on Brain Clearance. This review discusses the overarching goal of the consortium and explores the evidence supporting or refuting the role of impaired perivascular clearance in the pathophysiology of CAA with a focus on translating observations from rodents to humans. We also discuss the anatomical features of perivascular channels as well as the biophysical characteristics of fluid and solute transport.
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Affiliation(s)
- Susanne J van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Helene Benveniste
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Erik N T P Bakker
- Department of Biomedical Engineering, Amsterdam University Medical Center, Location AMC, Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Roxana O Carare
- Clinical Neurosciences, University of Southampton, Southampton, UK
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey J Iliff
- VA Puget Sound Health Care System, University of Washington, Seattle, WA, USA
| | - Sylvie Lorthois
- Institut de Mécanique Des Fluides de Toulouse, IMFT, Université de Toulouse, CNRS, Toulouse, France
| | - William E Van Nostrand
- Department of Biomedical and Pharmaceutical Science, George & Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
| | - Gabor C Petzold
- German Center for Neurodegenerative Disease, Bonn, Germany
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Andy Y Shih
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Research Institute, University of Washington, Seattle, WA, USA
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20
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Delle C, Wang X, Nedergaard M. The Ocular Glymphatic System-Current Understanding and Future Perspectives. Int J Mol Sci 2024; 25:5734. [PMID: 38891923 PMCID: PMC11172116 DOI: 10.3390/ijms25115734] [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: 04/16/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The ocular glymphatic system subserves the bidirectional polarized fluid transport in the optic nerve, whereby cerebrospinal fluid from the brain is directed along periarterial spaces towards the eye, and fluid from the retina is directed along perivenous spaces following upon its axonal transport across the glial lamina. Fluid homeostasis and waste removal are vital for retinal function, making the ocular glymphatic fluid pathway a potential route for targeted manipulation to combat blinding ocular diseases such as age-related macular degeneration, diabetic retinopathy, and glaucoma. Several lines of work investigating the bidirectional ocular glymphatic transport with varying methodologies have developed diverging mechanistic models, which has created some confusion about how ocular glymphatic transport should be defined. In this review, we provide a comprehensive summary of the current understanding of the ocular glymphatic system, aiming to address misconceptions and foster a cohesive understanding of the topic.
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Affiliation(s)
- Christine Delle
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark;
| | - Xiaowei Wang
- Center for Translational Neuromedicine, University of Rochester Medical Center, Elmwood Avenue 601, Rochester, NY 14642, USA;
- Department of Ophthalmology, University of California, 10 Koret Way, San Francisco, CA 94117, USA
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark;
- Center for Translational Neuromedicine, University of Rochester Medical Center, Elmwood Avenue 601, Rochester, NY 14642, USA;
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21
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Gustafson D, Kalaria R, O'Brien J, van den Brink H, Hilal S, Marseglia A, ter Telgte A, Skoog I. VasCog 2023: 20 years of research on vascular behavioural and cognitive disorders. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100224. [PMID: 38868624 PMCID: PMC11167242 DOI: 10.1016/j.cccb.2024.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024]
Abstract
This Commentary describes the 20th Anniversary of VasCog 2023, held in Gothenburg, Sweden.
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Affiliation(s)
- D.R. Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, MSC 1213, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - R. Kalaria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - J. O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, United Kingdom
| | - H. van den Brink
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S. Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - A. Marseglia
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - A. ter Telgte
- VASCage – Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - I. Skoog
- Center for Ageing and Health, Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Bae S, Liu K, Pouliopoulos AN, Ji R, Jiménez-Gambín S, Yousefian O, Kline-Schoder AR, Batts AJ, Tsitsos FN, Kokossis D, Mintz A, Honig LS, Konofagou EE. Transcranial Blood-Brain Barrier Opening in Alzheimer's Disease Patients Using a Portable Focused Ultrasound System with Real-Time 2-D Cavitation Mapping. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.12.21.23300222. [PMID: 38196636 PMCID: PMC10775403 DOI: 10.1101/2023.12.21.23300222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Focused ultrasound (FUS) in combination with microbubbles has recently shown great promise in facilitating blood-brain barrier (BBB) opening for drug delivery and immunotherapy in Alzheimer's disease (AD). However, it is currently limited to systems integrated within the MRI suites or requiring post-surgical implants, thus restricting its widespread clinical adoption. In this pilot study, we investigate the clinical safety and feasibility of a portable, non-invasive neuronavigation-guided FUS (NgFUS) system with integrated real-time 2-D microbubble cavitation mapping. Methods A phase 1 clinical study with mild to moderate AD patients (N=6) underwent a single session of microbubble-mediated NgFUS to induce transient BBB opening (BBBO). Microbubble activity under FUS was monitored with real-time 2-D cavitation maps and dosing to ensure the efficacy and safety of the NgFUS treatment. Post-operative MRI was used for BBB opening and closure confirmation as well as safety assessment. Changes in AD biomarker levels in both blood serum and extracellular vesicles (EVs) were evaluated, while changes in amyloid-beta (Aβ) load in the brain were assessed through 18F-Florbetapir PET. Results BBBO was achieved in 5 out of 6 subjects with an average volume of 983±626 mm3 following FUS at the right frontal lobe both in white and gray matter regions. The outpatient treatment was completed within 34.8±10.7 min. Cavitation dose significantly correlated with the BBBO volume (R2>0.9, N=4), demonstrating the portable NgFUS system's capability of predicting opening volumes. The cavitation maps co-localized closely with the BBBO location, representing the first report of real-time transcranial 2-D cavitation mapping in the human brain. Larger opening volumes correlated with increased levels of AD biomarkers, including Aβ42 (R2=0.74), Tau (R2=0.95), and P-Tau181 (R2=0.86), assayed in serum-derived EVs sampled 3 days after FUS (N=5). From PET scans, subjects showed a lower Aβ load increase in the treated frontal lobe region compared to the contralateral region. Reduction in asymmetry standardized uptake value ratios (SUVR) correlated with the cavitation dose (R2>0.9, N=3). Clinical changes in the mini-mental state examination over 6 months were within the expected range of cognitive decline with no additional changes observed as a result of FUS. Conclusion We showed the safety and feasibility of this cost-effective and time-efficient portable NgFUS treatment for BBBO in AD patients with the first demonstration of real-time 2-D cavitation mapping. The cavitation dose correlated with BBBO volume, a slowed increase in pathology, and serum detection of AD proteins. Our study highlights the potential for accessible FUS treatment in AD, with or without drug delivery.
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Affiliation(s)
- Sua Bae
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Keyu Liu
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | | | - Robin Ji
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | | | - Omid Yousefian
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | | | - Alec J. Batts
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Fotios N. Tsitsos
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Danae Kokossis
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Akiva Mintz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Lawrence S. Honig
- Department of Neurology and Taub Institute, Columbia University Irving Medical Center 10032, New York, NY, USA
| | - Elisa E. Konofagou
- Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA
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23
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Liu H, Meng L, Wang J, Qin C, Feng R, Chen Y, Chen P, Zhu Q, Ma M, Teng J, Ding X. Enlarged perivascular spaces in alcohol-related brain damage induced by dyslipidemia. J Cereb Blood Flow Metab 2024:271678X241251570. [PMID: 38700501 DOI: 10.1177/0271678x241251570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Perivascular spaces (PVSs) as the anatomical basis of the glymphatic system, are increasingly recognized as potential imaging biomarkers of neurological conditions. However, it is not clear whether enlarged PVSs are associated with alcohol-related brain damage (ARBD). We aimed to investigate the effect of long-term alcohol exposure on dyslipidemia and the glymphatic system in ARBD. We found that patients with ARBD exhibited significantly enlargement of PVSs in the frontal cortex and basal ganglia, as well as a notable increased levels of total cholesterol (TC) and triglycerides (TG). The anatomical changes of the glymphatic drainage system mentioned above were positively associated with TC and TG. To further explore whether enlarged PVSs affects the function of the glymphatic system in ARBD, we constructed long alcohol exposure and high fat diet mice models. The mouse model of long alcohol exposure exhibited increased levels of TC and TG, enlarged PVSs, the loss of aquaporin-4 polarity caused by reactive astrocytes and impaired glymphatic drainage function which ultimately caused cognitive deficits, in a similar way as high fat diet leading to impairment in glymphatic drainage. Our study highlights the contribution of dyslipidemia due to long-term alcohol abuse in the impairment of the glymphatic drainage system.
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Affiliation(s)
- Han Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Lin Meng
- Department of Neurology, Zhengzhou Central Hospital, Zhengzhou, Henan 450000, China
| | - Jiuqi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Chi Qin
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Renyi Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Yongkang Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Pei Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Qingyong Zhu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Mingming Ma
- Department of Neurology, Henan Provincial People's Hospital, Zhengzhou, Henan 450000, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
| | - Xuebing Ding
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China
- Henan Key Laboratory of Chronic Disease Prevention and Therapy & Intelligent Health Management, Henan 450052, China
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24
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Li H, Jacob MA, Cai M, Kessels RPC, Norris DG, Duering M, De Leeuw FE, Tuladhar AM. Perivascular Spaces, Diffusivity Along Perivascular Spaces, and Free Water in Cerebral Small Vessel Disease. Neurology 2024; 102:e209306. [PMID: 38626373 DOI: 10.1212/wnl.0000000000209306] [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] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have linked the MRI measures of perivascular spaces (PVSs), diffusivity along the perivascular spaces (DTI-ALPS), and free water (FW) to cerebral small vessel disease (SVD) and SVD-related cognitive impairments. However, studies on the longitudinal associations between the three MRI measures, SVD progression, and cognitive decline are lacking. This study aimed to explore how PVS, DTI-ALPS, and FW contribute to SVD progression and cognitive decline. METHODS This is a cohort study that included participants with SVD who underwent neuroimaging and cognitive assessment, specifically measuring Mini-Mental State Examination (MMSE), cognitive index, and processing speed, at 2 time points. Three MRI measures were quantified: PVS in basal ganglia (BG-PVS) volumes, FW fraction, and DTI-ALPS. We performed a latent change score model to test inter-relations between the 3 MRI measures and linear regression mixed models to test their longitudinal associations with the changes of other SVD MRI markers and cognitive performances. RESULTS In baseline assessment, we included 289 participants with SVD, characterized by a median age of 67.0 years and 42.9% women. Of which, 220 participants underwent the follow-up assessment, with a median follow-up time of 3.4 years. Baseline DTI-ALPS was associated with changes in BG-PVS volumes (β = -0.09, p = 0.030), but not vice versa (β = -0.08, p = 0.110). Baseline BG-PVS volumes were associated with changes in white matter hyperintensity (WMH) volumes (β = 0.33, p-corrected < 0.001) and lacune numbers (β = 0.28, p-corrected < 0.001); FW fraction was associated with changes in WMH volumes (β = 0.30, p-corrected < 0.001), lacune numbers (β = 0.28, p-corrected < 0.001), and brain volumes (β = -0.45, p-corrected < 0.001); DTI-ALPS was associated with changes in WMH volumes (β = -0.20, p-corrected = 0.002) and brain volumes (β = 0.23, p-corrected < 0.001). Furthermore, baseline FW fraction was associated with decline in MMSE score (β = -0.17, p-corrected = 0.006); baseline FW fraction and DTI-ALPS were associated with changes in cognitive index (FW fraction: β = -0.25, p-corrected < 0.001; DTI-ALPS: β = 0.20, p-corrected = 0.001) and processing speed over time (FW fraction: β = -0.29, p-corrected < 0.001; DTI-ALPS: β = 0.21, p-corrected < 0.001). DISCUSSION Our results showed that increased BG-PVS volumes, increased FW fraction, and decreased DTI-ALPS are related to progression of MRI markers of SVD, along with SVD-related cognitive decline over time. These findings may suggest that the glymphatic dysfunction is related to SVD progression, but further studies are needed.
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Affiliation(s)
- Hao Li
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Mina A Jacob
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Mengfei Cai
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Roy P C Kessels
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - David G Norris
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Marco Duering
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Frank-Erik De Leeuw
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
| | - Anil Man Tuladhar
- From the Department of Neurology (H.L., M.A.J., M.C., F.-E.D.L., A.M.T.), Radboud University Medical Center, Donders Center for Medical Neurosciences, Nijmegen, the Netherlands; Department of Neurology (M.C.), Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Donders Institute for Brain (R.P.C.K.), Cognition and Behaviour, Radboud University, Nijmegen; Vincent van Gogh Institute for Psychiatry (R.P.C.K.), Venray; Department of Medical Psychology and Radboudumc Alzheimer Center (R.P.C.K.), Radboud University Medical Center; Donders Institute for Brain (D.G.N.), Cognition and Behaviour, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands; Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering (M.D.), University of Basel, Switzerland; and Institute for Stroke and Dementia Research (ISD) (M.D.), University Hospital, LMU Munich, Germany
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25
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Pacholko A, Iadecola C. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension 2024; 81:991-1007. [PMID: 38426329 PMCID: PMC11023809 DOI: 10.1161/hypertensionaha.123.21356] [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: 03/02/2024]
Abstract
Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.
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Affiliation(s)
- Anthony Pacholko
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
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26
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Hu Z, Li Z, Shi Y, Liu S, Shen Y, Hu F, Li Q, Liu X, Gou X, Chen Z, Yang D. Advancements in investigating the role of cerebral small vein loss in Alzheimer's disease-related pathological changes. Neurol Sci 2024; 45:1875-1883. [PMID: 38133856 DOI: 10.1007/s10072-023-07208-7] [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: 08/16/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
Alzheimer's disease (AD) is the prevailing type of dementia in the elderly, yet a comprehensive comprehension of its precise underlying mechanisms remains elusive. The investigation of the involvement of cerebral small veins in the advancement of AD has yet to be sufficiently explored in previous studies, primarily due to constraints associated with pathological staining techniques. However, recent research has provided valuable insights into multiple pathophysiological occurrences concerning cerebral small veins in AD, which may manifest sequentially, concurrently, or in a self-perpetuating manner. These events are presumed to be among the initial processes in the disease's progression. The impact of cerebral small vein loss on amyloid beta (Aβ) clearance through the glial lymphatic system is noteworthy. There exists a potential interdependence between collagen deposition and Aβ deposition in cerebral small veins. The compromised functionality of cerebral small veins can result in decreased cerebral perfusion pressure, potentially leading to cerebral tissue ischemia and edema. Additionally, the reduction of cerebral small veins may facilitate the infiltration of inflammatory factors into the brain parenchyma, thereby eliciting neuroinflammatory responses. Susceptibility-weighted imaging (SWI) is a valuable modality for the efficient assessment of cerebral small veins, precisely the deep medullary vein (DMV), and holds promise for the identification of precise and reliable imaging biomarkers for AD. This review presents a comprehensive overview of the current advancements and obstacles to the impairment of cerebral small veins in AD. Additionally, we emphasize future research avenues and the importance of conducting further investigations in this domain.
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Affiliation(s)
- Zhenzhu Hu
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Zhaoying Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Yu Shi
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Shanyu Liu
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Yuling Shen
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Fangfang Hu
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Qingqing Li
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Xu Liu
- Department of Neurology, Xuzhou Cancer Hospital, Xuzhou, 221000, Jiangsu, China
| | - Xinyu Gou
- Department of Neurology, Guang'an People's Hospital, Guang'an, 638001, China
| | - Zhenwei Chen
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China.
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27
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Li X, Lin Z, Liu C, Bai R, Wu D, Yang J. Glymphatic Imaging in Pediatrics. J Magn Reson Imaging 2024; 59:1523-1541. [PMID: 37819198 DOI: 10.1002/jmri.29040] [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: 06/29/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
The glymphatic system, which facilitates cerebrospinal fluid (CSF) flow through the brain parenchyma, is important for brain development and waste clearance. Advances in imaging techniques, particularly magnetic resonance imaging, have make it possible to evaluate glymphatic structures and functions in vivo. Recently, several studies have focused on the development and alterations of the glymphatic system in pediatric disorders. This review discusses the development of the glymphatic system, advances of imaging techniques and their applications in pediatric disorders. First, the results of the reviewed studies indicate that the development of the glymphatic system is a long-lasting process that continues into adulthood. Second, there is a need for improved glymphatic imaging techniques that are non-invasive and fast to improve suitability for pediatric applications, as some of existing methods use contrast injection and are susceptible to motion artifacts from long scanning times. Several novel techniques are potentially feasible for pediatric patients and may be used in the future. Third, the glymphatic dysfunction is associated with a large number of pediatric disorders, although only a few have recently been investigated. In conclusion, research on the pediatric glymphatic system remains an emerging field. The preliminary applications of glymphatic imaging techniques have provided unique insight into the pathological mechanism of pediatric diseases, but mainly limited in visualization of enlarged perivascular spaces and morphological measurements on CSF volumes. More in-depth studies on glymphatic functions are required to improve our understanding of the mechanisms underlying brain development and pediatric diseases. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Xianjun Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zixuan Lin
- Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Congcong Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruiliang Bai
- Interdisciplinary Institute of Neuroscience and Technology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dan Wu
- Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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28
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Kamagata K, Saito Y, Andica C, Uchida W, Takabayashi K, Yoshida S, Hagiwara A, Fujita S, Nakaya M, Akashi T, Wada A, Kamiya K, Hori M, Aoki S. Noninvasive Magnetic Resonance Imaging Measures of Glymphatic System Activity. J Magn Reson Imaging 2024; 59:1476-1493. [PMID: 37655849 DOI: 10.1002/jmri.28977] [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: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
The comprehension of the glymphatic system, a postulated mechanism responsible for the removal of interstitial solutes within the central nervous system (CNS), has witnessed substantial progress recently. While direct measurement techniques involving fluorescence and contrast agent tracers have demonstrated success in animal studies, their application in humans is invasive and presents challenges. Hence, exploring alternative noninvasive approaches that enable glymphatic research in humans is imperative. This review primarily focuses on several noninvasive magnetic resonance imaging (MRI) techniques, encompassing perivascular space (PVS) imaging, diffusion tensor image analysis along the PVS, arterial spin labeling, chemical exchange saturation transfer, and intravoxel incoherent motion. These methodologies provide valuable insights into the dynamics of interstitial fluid, water permeability across the blood-brain barrier, and cerebrospinal fluid flow within the cerebral parenchyma. Furthermore, the review elucidates the underlying concept and clinical applications of these noninvasive MRI techniques, highlighting their strengths and limitations. It addresses concerns about the relationship between glymphatic system activity and pathological alterations, emphasizing the necessity for further studies to establish correlations between noninvasive MRI measurements and pathological findings. Additionally, the challenges associated with conducting multisite studies, such as variability in MRI systems and acquisition parameters, are addressed, with a suggestion for the use of harmonization methods, such as the combined association test (COMBAT), to enhance standardization and statistical power. Current research gaps and future directions in noninvasive MRI techniques for assessing the glymphatic system are discussed, emphasizing the need for larger sample sizes, harmonization studies, and combined approaches. In conclusion, this review provides invaluable insights into the application of noninvasive MRI methods for monitoring glymphatic system activity in the CNS. It highlights their potential in advancing our understanding of the glymphatic system, facilitating clinical applications, and paving the way for future research endeavors in this field. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Saito
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Faculty of Health Data Science, Juntendo University, Chiba, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kaito Takabayashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Seina Yoshida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Moto Nakaya
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Toshiaki Akashi
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihiko Wada
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Faculty of Health Data Science, Juntendo University, Chiba, Japan
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29
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Dörner M, Seebach K, Heneka MT, Menze I, von Känel R, Euler S, Schreiber F, Arndt P, Neumann K, Hildebrand A, John AC, Tyndall A, Kirchebner J, Tacik P, Jansen R, Grimm A, Henneicke S, Perosa V, Meuth SG, Peters O, Hellmann-Regen J, Preis L, Priller J, Spruth EJ, Schneider A, Fliessbach K, Wiltfang J, Jessen F, Rostamzadeh A, Glanz W, Schulze JB, Schiebler SLF, Buerger K, Janowitz D, Perneczky R, Rauchmann BS, Teipel S, Kilimann I, Laske C, Munk MH, Spottke A, Roy-Kluth N, Wagner M, Frommann I, Lüsebrink F, Dechent P, Hetzer S, Scheffler K, Kleineidam L, Stark M, Schmid M, Ersözlü E, Brosseron F, Ewers M, Schott BH, Düzel E, Ziegler G, Mattern H, Schreiber S, Bernal J. Inferior Frontal Sulcal Hyperintensities on Brain MRI Are Associated with Amyloid Positivity beyond Age-Results from the Multicentre Observational DELCODE Study. Diagnostics (Basel) 2024; 14:940. [PMID: 38732354 PMCID: PMC11083612 DOI: 10.3390/diagnostics14090940] [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: 04/03/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Inferior frontal sulcal hyperintensities (IFSHs) on fluid-attenuated inversion recovery (FLAIR) sequences have been proposed to be indicative of glymphatic dysfunction. Replication studies in large and diverse samples are nonetheless needed to confirm them as an imaging biomarker. We investigated whether IFSHs were tied to Alzheimer's disease (AD) pathology and cognitive performance. We used data from 361 participants along the AD continuum, who were enrolled in the multicentre DELCODE study. The IFSHs were rated visually based on FLAIR magnetic resonance imaging. We performed ordinal regression to examine the relationship between the IFSHs and cerebrospinal fluid-derived amyloid positivity and tau positivity (Aβ42/40 ratio ≤ 0.08; pTau181 ≥ 73.65 pg/mL) and linear regression to examine the relationship between cognitive performance (i.e., Mini-Mental State Examination and global cognitive and domain-specific performance) and the IFSHs. We controlled the models for age, sex, years of education, and history of hypertension. The IFSH scores were higher in those participants with amyloid positivity (OR: 1.95, 95% CI: 1.05-3.59) but not tau positivity (OR: 1.12, 95% CI: 0.57-2.18). The IFSH scores were higher in older participants (OR: 1.05, 95% CI: 1.00-1.10) and lower in males compared to females (OR: 0.44, 95% CI: 0.26-0.76). We did not find sufficient evidence linking the IFSH scores with cognitive performance after correcting for demographics and AD biomarker positivity. IFSHs may reflect the aberrant accumulation of amyloid β beyond age.
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Affiliation(s)
- Marc Dörner
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (S.E.); (J.B.S.); (S.L.F.S.)
| | - Katharina Seebach
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
| | - Michael T. Heneka
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 4367 Belvaux, Luxembourg;
| | - Inga Menze
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (S.E.); (J.B.S.); (S.L.F.S.)
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (S.E.); (J.B.S.); (S.L.F.S.)
| | - Frank Schreiber
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Philipp Arndt
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Katja Neumann
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Annkatrin Hildebrand
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Anna-Charlotte John
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Anthony Tyndall
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland;
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, University of Zurich, 8032 Zurich, Switzerland;
| | - Pawel Tacik
- Department of Parkinson’s Disease, Sleep and Movement Disorders, University Hospital Bonn, 53127 Bonn, Germany;
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
| | - Robin Jansen
- Department of Neurology, Heinrich Heine University, 40225 Düsseldorf, Germany; (R.J.); (S.G.M.)
| | - Alexander Grimm
- Center for Neurology, Tuebingen University Hospital and Hertie-Institute for Clinical Brain Research, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Solveig Henneicke
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
| | - Valentina Perosa
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Sven G. Meuth
- Department of Neurology, Heinrich Heine University, 40225 Düsseldorf, Germany; (R.J.); (S.G.M.)
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 10117 Berlin, Germany; (O.P.); (J.H.-R.); (J.P.); (E.J.S.); (E.E.)
- Institute of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 14129 Berlin, Germany;
| | - Julian Hellmann-Regen
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 10117 Berlin, Germany; (O.P.); (J.H.-R.); (J.P.); (E.J.S.); (E.E.)
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site Berlin, 10785 Berlin, Germany
| | - Lukas Preis
- Institute of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 14129 Berlin, Germany;
| | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 10117 Berlin, Germany; (O.P.); (J.H.-R.); (J.P.); (E.J.S.); (E.E.)
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University Munich, 81675 Munich, Germany
- UK Dementia Research Institute (UK DRI), University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Eike Jakob Spruth
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 10117 Berlin, Germany; (O.P.); (J.H.-R.); (J.P.); (E.J.S.); (E.E.)
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 37075 Goettingen, Germany; (J.W.); (B.H.S.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, 37075 Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Psychiatry, Medical Faculty, University of Cologne, 50924 Cologne, Germany;
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
| | - Ayda Rostamzadeh
- Department of Psychiatry, Medical Faculty, University of Cologne, 50924 Cologne, Germany;
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
| | - Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (S.E.); (J.B.S.); (S.L.F.S.)
| | - Sarah Lavinia Florence Schiebler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (S.E.); (J.B.S.); (S.L.F.S.)
| | - Katharina Buerger
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 81377 Munich, Germany; (K.B.); (R.P.); (M.E.)
- Institute of Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Daniel Janowitz
- Institute of Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 81377 Munich, Germany; (K.B.); (R.P.); (M.E.)
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 81377 Munich, Germany;
- Munich Cluster for Systems Neurology (SyNergy) Munich, 81377 Munich, Germany
- Ageing Epidemiology Research Unit (AGE), School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Boris-Stephan Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, 81377 Munich, Germany;
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield S10 2HQ, UK
- Department of Neuroradiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 18147 Rostock, Germany; (S.T.); (I.K.)
- Department of Psychosomatic Medicine, Rostock University Medical Center, 18147 Rostock, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 18147 Rostock, Germany; (S.T.); (I.K.)
- Department of Psychosomatic Medicine, Rostock University Medical Center, 18147 Rostock, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 72076 Tuebingen, Germany; (C.L.); (M.H.M.)
- Section for Dementia Research, Department of Psychiatry and Psychotherapy, Hertie Institute for Clinical Brain Research, University of Tuebingen, 72076 Tuebingen, Germany
| | - Matthias H. Munk
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 72076 Tuebingen, Germany; (C.L.); (M.H.M.)
- Department of Psychiatry and Psychotherapy, University of Tuebingen, 72076 Tuebingen, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Neurology, University of Bonn, 53127 Bonn, Germany
| | - Nina Roy-Kluth
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Ingo Frommann
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Falk Lüsebrink
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
| | - Peter Dechent
- MR-Research in Neurosciences, Department of Cognitive Neurology, Georg-August-University Goettingen, 37073 Gottingen, Germany;
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité—Universitätsmedizin Berlin, 14129 Berlin, Germany;
| | - Klaus Scheffler
- Department for Biomedical Magnetic Resonance, University of Tuebingen, 72076 Tuebingen, Germany;
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Melina Stark
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Department of Cognitive Disorders and Old Age Psychiatry, University Hospital Bonn, 53127 Bonn, Germany
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
- Institute for Medical Biometry, University Hospital Bonn, 53127 Bonn, Germany
| | - Ersin Ersözlü
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 10117 Berlin, Germany; (O.P.); (J.H.-R.); (J.P.); (E.J.S.); (E.E.)
- Institute of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 14129 Berlin, Germany;
| | - Frederic Brosseron
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 53127 Bonn, Germany; (A.S.); (K.F.); (F.J.); (A.S.); (N.R.-K.); (M.W.); (I.F.); (L.K.); (M.S.); (M.S.); (F.B.)
| | - Michael Ewers
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 81377 Munich, Germany; (K.B.); (R.P.); (M.E.)
- Institute of Stroke and Dementia Research (ISD), University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Björn H. Schott
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 37075 Goettingen, Germany; (J.W.); (B.H.S.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, University of Goettingen, 37075 Goettingen, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Gabriel Ziegler
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Center for Behavioural Brain Sciences (CBBS), 39120 Magdeburg, Germany
- Biomedical Magnetic Resonance, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Stefanie Schreiber
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (K.N.); (A.H.); (A.-C.J.)
- Center for Behavioural Brain Sciences (CBBS), 39120 Magdeburg, Germany
| | - Jose Bernal
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany; (K.S.); (I.M.); (F.S.); (P.A.); (S.H.); (W.G.); (F.L.); (E.D.); (G.Z.); (H.M.); (S.S.); (J.B.)
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, 39120 Magdeburg, Germany
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Deike K, Decker A, Scheyhing P, Harten J, Zimmermann N, Paech D, Peters O, Freiesleben SD, Schneider LS, Preis L, Priller J, Spruth E, Altenstein S, Lohse A, Fliessbach K, Kimmich O, Wiltfang J, Bartels C, Hansen N, Jessen F, Rostamzadeh A, Düzel E, Glanz W, Incesoy EI, Butryn M, Buerger K, Janowitz D, Ewers M, Perneczky R, Rauchmann BS, Teipel S, Kilimann I, Goerss D, Laske C, Munk MH, Spottke A, Roy N, Wagner M, Roeske S, Heneka MT, Brosseron F, Ramirez A, Dobisch L, Wolfsgruber S, Kleineidam L, Yakupov R, Stark M, Schmid MC, Berger M, Hetzer S, Dechent P, Scheffler K, Petzold GC, Schneider A, Effland A, Radbruch A. Machine Learning-Based Perivascular Space Volumetry in Alzheimer Disease. Invest Radiol 2024:00004424-990000000-00211. [PMID: 38652067 DOI: 10.1097/rli.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Impaired perivascular clearance has been suggested as a contributing factor to the pathogenesis of Alzheimer disease (AD). However, it remains unresolved when the anatomy of the perivascular space (PVS) is altered during AD progression. Therefore, this study investigates the association between PVS volume and AD progression in cognitively unimpaired (CU) individuals, both with and without subjective cognitive decline (SCD), and in those clinically diagnosed with mild cognitive impairment (MCI) or mild AD. MATERIALS AND METHODS A convolutional neural network was trained using manually corrected, filter-based segmentations (n = 1000) to automatically segment the PVS in the centrum semiovale from interpolated, coronal T2-weighted magnetic resonance imaging scans (n = 894). These scans were sourced from the national German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study. Convolutional neural network-based segmentations and those performed by a human rater were compared in terms of segmentation volume, identified PVS clusters, as well as Dice score. The comparison revealed good segmentation quality (Pearson correlation coefficient r = 0.70 with P < 0.0001 for PVS volume, detection rate in cluster analysis = 84.3%, and Dice score = 59.0%). Subsequent multivariate linear regression analysis, adjusted for participants' age, was performed to correlate PVS volume with clinical diagnoses, disease progression, cerebrospinal fluid biomarkers, lifestyle factors, and cognitive function. Cognitive function was assessed using the Mini-Mental State Examination, the Comprehensive Neuropsychological Test Battery, and the Cognitive Subscale of the 13-Item Alzheimer's Disease Assessment Scale. RESULTS Multivariate analysis, adjusted for age, revealed that participants with AD and MCI, but not those with SCD, had significantly higher PVS volumes compared with CU participants without SCD (P = 0.001 for each group). Furthermore, CU participants who developed incident MCI within 4.5 years after the baseline assessment showed significantly higher PVS volumes at baseline compared with those who did not progress to MCI (P = 0.03). Cognitive function was negatively correlated with PVS volume across all participant groups (P ≤ 0.005 for each). No significant correlation was found between PVS volume and any of the following parameters: cerebrospinal fluid biomarkers, sleep quality, body mass index, nicotine consumption, or alcohol abuse. CONCLUSIONS The very early changes of PVS volume may suggest that alterations in PVS function are involved in the pathophysiology of AD. Overall, the volumetric assessment of centrum semiovale PVS represents a very early imaging biomarker for AD.
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Affiliation(s)
- Katerina Deike
- From the German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (K.D., A.D., K.F., O.K., F.J., Annika Spottke, N.R., M.W., S.R., M.T.H., F.B., Alfredo Ramirez, S.W., L.K., M.S., M.C.S., G.C.P., Anja Schneider, Alexander Radbruch); Department of Neuroradiology, University Hospital, Bonn, Germany (K.D., P.S., D.P., Alexander Radbruch); Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University Hospital Bonn, Bonn, Germany (J.H., N.Z., K.F., M.W., Alfredo Ramirez, S.W., L.K., Anja Schneider); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.P.); German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany (O.P., S.D.F., J.P., E.S., S.A.); Institute of Psychiatry and Psychotherapy, Charité-Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (O.P., S.D.F., L.-S.S., L.P.); Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany (J.P., E.S., S.A., A.L.); Department of Psychiatry and Psychotherapy, School of Medicine, Munich, Germany (J.P.); University of Edinburgh and UK DRI, Edinburgh, United Kingdom (J.P.); German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany (J.W.); Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany (J.W., C.B., N.H.); Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal (J.W.); Department of Psychiatry, University of Cologne, Cologne, Germany (F.J., Ayda Rostamzadeh); Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany (F.J., Alfredo Ramirez); German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany (E.D., W.G., E.I.I., Michaela Butryn, L.D., R.Y.); Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany (E.D., W.G., E.I.I., Michaela Butryn); Department for Psychiatry and Psychotherapy, University Clinic Magdeburg, Magdeburg, Germany (E.I.I.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (K.B., M.E., R.P.); Institute for Stroke and Dementia Research, LMU Munich, Germany (K.B., D.J., M.E.); Department of Psychiatry and Psychotherapy, LMU Munich, Germany (R.P., B.-S.R.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom (R.P.); Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom (R.P., B.-S.R.); Department of Neuroradiology, University Hospital Munich, Munich, Germany (B.-S.R.); German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany (S.T., I.K., D.G.); Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany (S.T., I.K., D.G.); German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany (C.L., M.H.M.); Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Tübingen, Germany (C.L.); Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen Germany (M.H.M.); Department of Neurology, University of Bonn, Bonn, Germany (Annika Spottke); Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Cologne, Germany (Alfredo Ramirez); Department of Psychiatry and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, TX (Alfredo Ramirez); Institute for Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany (M.C.S., Moritz Berger); Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin, Berlin, Germany (S.H.); MR-Research in Neurosciences, Department of Cognitive Neurology, Göttingen, Germany (P.D.); Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany (K.S.); Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany (G.C.P.); and Institute for Applied Mathematics, University of Bonn, Bonn, Germany (A.E.)
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Li H, Li B, Luo W, Qi X, Hao Y, Yang C, Li W, Li J, Hua Z, Guo T, Zheng Z, Yu X, Liu L, Zhao J, Li T, Huang D, Hu J, Li Z, Wang F, Li H, Ma C, Ji F. Regulation of interstitial fluid flow in adventitia along vasculature by heartbeat and respiration. iScience 2024; 27:109407. [PMID: 38532885 PMCID: PMC10963235 DOI: 10.1016/j.isci.2024.109407] [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: 12/06/2023] [Revised: 01/29/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Converging studies showed interstitial fluid (ISF) adjacent to blood vessels flows in adventitia along vasculature into heart and lungs. We aim to reveal circulatory pathways and regulatory mechanism of such adventitial ISF flow in rat model. By MRI, real-time fluorescent imaging, micro-CT, and histological analysis, ISF was found to flow in adventitial matrix surrounded by fascia and along systemic vessels into heart, then flow into lungs via pulmonary arteries and back to heart via pulmonary veins, which was neither perivascular tissues nor blood or lymphatic vessels. Under physiological conditions, speckle-like adventitial ISF flow rate was positively correlated with heart rate, increased when holding breath, became pulsative during heavy breathing. During cardiac or respiratory cycle, each dilation or contraction of heart or lungs can generate to-and-fro adventitial ISF flow along femoral veins. Discovered regulatory mechanisms of adventitial ISF flow along vasculature by heart and lungs will revolutionize understanding of cardiovascular system.
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Affiliation(s)
- Hongyi Li
- Research Center for Interstitial Fluid Circulation, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Bei Li
- Research Center for Interstitial Fluid Circulation, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Wenqi Luo
- Department of Cardiac Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xi Qi
- Peking University Fifth School of Clinical Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - You Hao
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, P.R. China
| | - Chaozhi Yang
- School of Computer Science and Technology, China University of Petroleum (East China), Qingdao 266580, P.R. China
| | - Wenqing Li
- Research Center for Interstitial Fluid Circulation, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jiazheng Li
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Zhen Hua
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Tan Guo
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Zhijian Zheng
- Department of Acupuncture, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xue Yu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Lei Liu
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jianping Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Tiantian Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Dahai Huang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Jun Hu
- Key Lab of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201210, P.R. China
- Shanghai Synchrotron Radiation Facility, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, P.R. China
| | - Zongmin Li
- School of Computer Science and Technology, China University of Petroleum (East China), Qingdao 266580, P.R. China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Hua Li
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, P.R. China
| | - Chao Ma
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College, Beijing 100005, P.R. China
- Chinese Institute for Brain Research, Beijing 100005, P.R. China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Huang X, Hou B, Wang J, Li J, Shang L, Mao C, Dong L, Liu C, Feng F, Gao J, Peng B. Assessment of cheese sign and its association with vascular risk factors: Data from PUMCH dementia cohort. Chin Med J (Engl) 2024; 137:830-836. [PMID: 37415546 PMCID: PMC10997233 DOI: 10.1097/cm9.0000000000002785] [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: 12/06/2022] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND In the clinic, practitioners encounter many patients with an abnormal pattern of dense punctate magnetic resonance imaging (MRI) signal in the basal ganglia, a phenomenon known as "cheese sign". This sign is reported as common in cerebrovascular diseases, dementia, and old age. Recently, cheese sign has been speculated to consist of dense perivascular space (PVS). This study aimed to assess the lesion types of cheese sign and analyze the correlation between this sign and vascular disease risk factors. METHODS A total of 812 patients from Peking Union Medical College Hospital (PUMCH) dementia cohort were enrolled. We analyzed the relationship between cheese sign and vascular risk. For assessing cheese sign and defining its degree, the abnormal punctate signals were classified into basal ganglia hyperintensity (BGH), PVS, lacunae/infarctions and microbleeds, and counted separately. Each type of lesion was rated on a four-level scale, and then the sum was calculated; this total was defined as the cheese sign score. Fazekas and Age-Related White Matter Changes (ARWMC) scores were used to evaluate the paraventricular, deep, and subcortical gray/white matter hyperintensities. RESULTS A total of 118 patients (14.5%) in this dementia cohort were found to have cheese sign. Age (odds ratio [OR]: 1.090, 95% confidence interval [CI]: 1.064-1.120, P <0.001), hypertension (OR: 1.828, 95% CI: 1.123-2.983, P = 0.014), and stroke (OR: 1.901, 95% CI: 1.092-3.259, P = 0.025) were risk factors for cheese sign. There was no significant relationship between diabetes, hyperlipidemia, and cheese sign. The main components of cheese sign were BGH, PVS, and lacunae/infarction. The proportion of PVS increased with cheese sign severity. CONCLUSIONS The risk factors for cheese sign were hypertension, age, and stroke. Cheese sign consists of BGH, PVS, and lacunae/infarction.
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Affiliation(s)
- Xinying Huang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jie Wang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jie Li
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Li Shang
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Chenhui Mao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Liling Dong
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Caiyan Liu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing Gao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Bin Peng
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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Miyazaki M, Malis V, Yamamoto A, Kungsamutr J, McEvoy LK, McDonald MA, Bae WC. Physical Exercise Alters Egress Pathways for Intrinsic CSF Outflow: An Investigation Performed with Spin-labeling MR Imaging. Magn Reson Med Sci 2024; 23:171-183. [PMID: 36908171 PMCID: PMC11024710 DOI: 10.2463/mrms.mp.2023-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE Cerebrospinal fluid (CSF) clearance is essential for maintaining a healthy brain and cognition by removal of metabolic waste from the central nervous system. Physical exercise has been shown to improve human health; however, the effect of physical exercise on intrinsic CSF outflow in humans remains unexplored. The purpose of this study was to investigate intrinsic CSF outflow pathways and quantitative metrics of healthy individuals with active and sedentary lifestyles. In addition, the effect of exercise was investigated among the sedentary subjects before and after 3 weeks of physical activity. METHODS This study was performed on 18 healthy adults with informed consent, using a clinical 3-Tesla MRI scanner. We classified participants into two groups based on reported time spent sitting per day (active group: < 7 hours sitting per day and sedentary group: ≥ 7 hours sitting per day). To elucidate the effect of exercise, sedentary individuals increased their activity to 3.5 hours for 3 weeks. RESULTS We show that there are two intrinsic CSF egress pathways of the dura mater and lower parasagittal dura (PSD). The adults with an active lifestyle had greater intrinsic CSF outflow metrics than adults with a more sedentary lifestyle. However, after increased physical activity, the sedentary group showed improved CSF outflow metrics. This improvement was particularly notable at the lower PSD, where outflow metrics were highest among the active group. CONCLUSION Our findings describe the relationship between physical activity and intrinsic CSF outflow and show a potential selective outflow pathway with increasing physical activity in the lower PSD pathway, potentially from the perivascular space or cortical venous subpial space.
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Affiliation(s)
- Mitsue Miyazaki
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Vadim Malis
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Asako Yamamoto
- Department of Radiology, Teikyo University, Tokyo, Japan
| | - Jirach Kungsamutr
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Linda K. McEvoy
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Marin A. McDonald
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Won C Bae
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, Veterans Affairs Healthcare System, La Jolla, CA, USA
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Beschorner N, Nedergaard M. Glymphatic system dysfunction in neurodegenerative diseases. Curr Opin Neurol 2024; 37:182-188. [PMID: 38345416 DOI: 10.1097/wco.0000000000001252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW Purpose of this review is to update the ongoing work in the field of glymphatic and neurodegenerative research and to highlight focus areas that are particularly promising. RECENT FINDINGS Multiple reports have over the past decade documented that glymphatic fluid transport is broadly suppressed in neurodegenerative diseases. Most studies have focused on Alzheimer's disease using a variety of preclinical disease models, whereas the clinical work is based on various neuroimaging approaches. It has consistently been reported that brain fluid transport is impaired in patients suffering from Alzheimer's disease compared with age-matched control subjects. SUMMARY An open question in the field is to define the mechanistic underpinning of why glymphatic function is suppressed. Other questions include the opportunities for using glymphatic imaging for diagnostic purposes and in treatment intended to prevent or slow Alzheimer disease progression.
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Affiliation(s)
- Natalie Beschorner
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen N, Denmark
- Center for Translational Neuromedicine, University of Rochester Medical School, Rochester, New York, USA
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Evans PG, Sajic M, Yu Y, Harrison IF, Hosford PS, Smith KJ, Lythgoe MF, Stuckey DJ, Wells JA. Changes in cardiac-driven perivascular fluid movement around the MCA in a pharmacological model of acute hypertension detected with non-invasive MRI. J Cereb Blood Flow Metab 2024; 44:508-515. [PMID: 37873754 PMCID: PMC10981406 DOI: 10.1177/0271678x231209641] [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: 03/20/2023] [Revised: 07/31/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
Perivascular spaces mediate a complex interaction between cerebrospinal fluid and brain tissue that may be an important pathway for solute waste clearance. Their structural or functional derangement may contribute to the development of age-related neurogenerative conditions. Here, we employed a non-invasive low b-value diffusion-weighted ECG-gated MRI method to capture perivascular fluid movement around the middle cerebral artery of the anaesthetised rat brain. Using this method, we show that such MRI estimates of perivascular fluid movement directionality are highly sensitive to the cardiac cycle. We then show that these measures of fluid movement directionality are decreased in the angiotensin-II pharmacological model of acute hypertension, with an associated dampening of vessel pulsatility. This translational MRI method may, therefore, be useful to monitor derangement of perivascular fluid movement associated with cardiovascular pathologies, such as hypertension, in order to further our understanding of perivascular function in neurology.
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Affiliation(s)
- Phoebe G Evans
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Maria Sajic
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Yichao Yu
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Ian F Harrison
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Patrick S Hosford
- Centre for Cardiovascular and Metabolic Neuroscience, Department of Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - Ken J Smith
- Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Mark F Lythgoe
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Daniel J Stuckey
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
| | - Jack A Wells
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, UK
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Dong Y, Xu T, Yuan L, Wang Y, Yu S, Wang Z, Chen S, Chen C, He W, Stewart T, Zhang W, Yang X. Cerebrospinal fluid efflux through dynamic paracellular pores on venules as a missing piece of the brain drainage system. EXPLORATION (BEIJING, CHINA) 2024; 4:20230029. [PMID: 38855622 PMCID: PMC11022608 DOI: 10.1002/exp.20230029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/31/2023] [Indexed: 06/11/2024]
Abstract
The glymphatic system plays a key role in the clearance of waste from the parenchyma, and its dysfunction has been associated with the pathogenesis of Alzheimer's disease (AD). However, questions remain regarding its complete mechanisms. Here, we report that efflux of cerebrospinal fluid (CSF)/interstitial fluid (ISF) solutes occurs through a triphasic process that cannot be explained by the current model, but rather hints at the possibility of other, previously undiscovered routes from paravenous spaces to the blood. Using real-time, in vivo observation of efflux, a novel drainage pathway was discovered, in which CSF molecules enter the bloodstream directly through dynamically assembled, trumpet-shaped pores (basolateral ϕ<8 μm; apical ϕ < 2 μm) on the walls of brain venules. As Zn2+ could facilitate the brain clearance of macromolecular ISF solutes, Zn2+-induced reconstruction of the tight junctions (TJs) in vascular endothelial cells may participate in pore formation. Thus, an updated model for glymphatic clearance of brain metabolites and potential regulation is postulated. In addition, deficient clearance of Aβ through these asymmetric venule pores was observed in AD model mice, supporting the notion that impaired brain drainage function contributes to Aβ accumulation and pathogenic dilation of the perivascular space in AD.
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Affiliation(s)
- Yaqiong Dong
- Institute of Translational Medicine, The Affiliated Hospital of Qingdao University, College of MedicineQingdao UniversityQingdaoChina
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Ting Xu
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Lan Yuan
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Yahan Wang
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Siwang Yu
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Zhi Wang
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Shizhu Chen
- The National Institutes of Pharmaceutical R&D Co., Ltd.China Resources Pharmaceutical Group LimitedBeijingChina
| | - Chunhua Chen
- Department of Anatomy and HistologyPeking University Health Science CenterBeijingChina
| | - Weijiang He
- State Key Laboratory of Coordination Chemistry, Coordination Chemistry Institute, School of Chemistry and Chemical EngineeringNanjing UniversityNanjingChina
| | - Tessandra Stewart
- Department of PathologyUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Weiguang Zhang
- Department of Anatomy and HistologyPeking University Health Science CenterBeijingChina
| | - Xiaoda Yang
- The State Key Laboratories of Natural and Biomimetic Drugs and Department of Chemical Biology, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
- SATCM Key Laboratory of Compound Drug DetoxificationPeking University Health Science CenterBeijingChina
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37
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Cai J, Zeng X, Huang X, Dong H, Liu J, Lin J, Xie M, Wei X. Relationship of neutrophil/lymphocyte ratio with cerebral small vessel disease and its common imaging markers. Immun Inflamm Dis 2024; 12:e1228. [PMID: 38578037 PMCID: PMC10996379 DOI: 10.1002/iid3.1228] [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: 06/26/2023] [Revised: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND High neutrophil/lymphocyte ratio (NLR) is associated with poor prognosis in ischemic stroke. However, the role of NLR in cerebral small vessel disease (CSVD) is controversial. Herein, we evaluated the value of NLR in identifying CSVD and its relationship with the common imaging markers of CSVD. METHODS A total of 667 patients were enrolled in this study, including 368 in the CSVD group and 299 in the non-CSVD group. Clinical, laboratory, and imaging data were collected. The relationship of NLR with CSVD and common imaging markers of CSVD were analyzed with univariate and multivariate logistic regression analysis. The predictive value of NLR was assessed with the receiver operating characteristic curve. RESULTS NLR (odds ratio [OR] = 1.929, 95% confidence interval [CI] = 1.599-2.327, p < .001) was an independent risk factor for CSVD. NLR was also independently associated with moderate to severe white matter hyperintensity (WMH) (OR = 2.136, 95% CI = 1.768-2.580, p < .001), moderate to severe periventricular WMH (OR = 2.138, 95% CI = 1.771-2.579, p < .001), and moderate to severe deep WMH (OR = 1.654, 95% CI = 1.438-1.902, p < .001), moderately to severely enlarged perivascular spaces (EPVS) (OR = 1.248, 95% CI = 1.110-1.402, p < .001), moderately to severely EPVS in the basal ganglia (OR = 1.136, 95% CI = 1.012-1.275, p = .030), and moderately to severely EPVS in the centrum semiovale (OR = 1.140, 95% CI = 1.027-1.266, p = .014). However, NLR was not statistically significantly associated with lacune. The optimal cutoff point of NLR in predicting CSVD was 2.47, with sensitivity and specificity of 84.2% and 66.9%, respectively (p < .01). The diagnostic effect was maximized when NLR was combined with other risk factors. CONCLUSIONS NLR is an independent risk factor for CSVD and is independently associated with common imaging markers of CSVD. NLR may serve as a valid and convenient biomarker for assessing CSVD.
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Affiliation(s)
- Jiangping Cai
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Xiaoyi Zeng
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Xiaojin Huang
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Hansheng Dong
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Junyi Liu
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Jie Lin
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Meirong Xie
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
| | - Xiaolan Wei
- Department of NeurologyThe First Hospital of Quanzhou Affiliated to Fujian Medical UniversityFujianChina
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Cao X, Gan C, Zhang H, Yuan Y, Sun H, Zhang L, Wang L, Zhang L, Zhang K. Altered perivascular spaces in subcortical white matter in Parkinson's disease patients with levodopa-induced dyskinesia. NPJ Parkinsons Dis 2024; 10:71. [PMID: 38548788 PMCID: PMC10978930 DOI: 10.1038/s41531-024-00688-0] [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: 09/05/2023] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
Dilated perivascular spaces (PVS) have emerged as a pathological hallmark in various neurological conditions, including Parkinson's disease (PD). Levodopa-induced dyskinesia (LID), an intractable motor complication of PD, remains enigmatic regarding the distribution patterns of PVS. Our objective was to scrutinize the percent PVS (pPVS) changes within PD patients with LID (PD-LID). In total, 132 individuals were enrolled, including PD-LID (n = 42), PD patients without LID (PD-nLID, n = 45), and healthy controls (HCs, n = 45). Employing an automated approach for PVS quantification based on structural magnetic resonance imaging, we comprehensively evaluated total pPVS in subcortical white matter globally and regionally. A significant increase in global pPVS was observed in PD patients versus HCs, particularly evident in PD-LID relative to HCs. Within the PD-LID group, elevated pPVS was discerned in the right inferior frontal gyrus region (rIFG) (pars opercularis), contrasting with PD-nLID and HCs. Moreover, PD patients exhibited increased pPVS in bilateral superior temporal regions compared to HCs. Notably, pPVS in the rIFG positively correlated with dyskinetic symptoms and could well identify LID. Our findings unveiled PVS alternations in subcortical white matter in PD-LID at both global and regional levels, highlighting the increased pPVS in rIFG as a prospective imaging marker for LID.
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Affiliation(s)
- Xingyue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Caiting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yongsheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huimin Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Li Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lina Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lian Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
| | - Kezhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Abstract
The brain is a complex organ, fundamentally changing across the day to perform basic functions like sleep, thought, and regulating whole-body physiology. This requires a complex symphony of nutrients, hormones, ions, neurotransmitters and more to be properly distributed across the brain to maintain homeostasis throughout 24 hours. These solutes are distributed both by the blood and by cerebrospinal fluid. Cerebrospinal fluid contents are distinct from the general circulation because of regulation at brain barriers including the choroid plexus, glymphatic system, and blood-brain barrier. In this review, we discuss the overlapping circadian (≈24-hour) rhythms in brain fluid biology and at the brain barriers. Our goal is for the reader to gain both a fundamental understanding of brain barriers alongside an understanding of the interactions between these fluids and the circadian timing system. Ultimately, this review will provide new insight into how alterations in these finely tuned clocks may lead to pathology.
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Affiliation(s)
- Velia S Vizcarra
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Ryann M Fame
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lauren M Hablitz
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
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40
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Vittorini MG, Sahin A, Trojan A, Yusifli S, Alashvili T, Bonifácio GV, Paposhvili K, Tischler V, Lampl C, Sacco S. The glymphatic system in migraine and other headaches. J Headache Pain 2024; 25:34. [PMID: 38462633 PMCID: PMC10926631 DOI: 10.1186/s10194-024-01741-2] [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] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
Glymphatic system is an emerging pathway of removing metabolic waste products and toxic solutes from the brain tissue. It is made of a network of perivascular spaces, filled in cerebrospinal and interstitial fluid, encompassing penetrating and pial vessels and communicating with the subarachnoid space. It is separated from vessels by the blood brain barrier and from brain tissue by the endfeet of the astrocytes rich in aquaporin 4, a membrane protein which controls the water flow along the perivascular space. Animal models and magnetic resonance (MR) studies allowed to characterize the glymphatic system function and determine how its impairment could lead to numerous neurological disorders (e.g. Alzheimer's disease, stroke, sleep disturbances, migraine, idiopathic normal pressure hydrocephalus). This review aims to summarize the role of the glymphatic system in the pathophysiology of migraine in order to provide new ways of approaching to this disease and to its therapy.
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Affiliation(s)
- Maria Grazia Vittorini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aysenur Sahin
- Faculty of Medicine-Acibadem Mehmet, Ali Aydinlar University, Istanbul, Turkey
| | - Antonin Trojan
- Department of Neurology, Strakonice Hospital, Strakonice, Czechia
| | - Sevil Yusifli
- Faculty of Medicine-Istanbul University, Istanbul, Turkey
| | - Tamta Alashvili
- Department of Internal Medicine, New Vision University Hospital, Tbilisi, Georgia
| | | | - Ketevan Paposhvili
- Department of Neurology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Viktoria Tischler
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Christian Lampl
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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41
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Hong H, Tozer DJ, Markus HS. Relationship of Perivascular Space Markers With Incident Dementia in Cerebral Small Vessel Disease. Stroke 2024; 55:1032-1040. [PMID: 38465597 PMCID: PMC10962441 DOI: 10.1161/strokeaha.123.045857] [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: 11/14/2023] [Revised: 02/02/2024] [Accepted: 02/13/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Recent studies, using diffusion tensor image analysis along the perivascular space (DTI-ALPS), suggest impaired perivascular space (PVS) function in cerebral small vessel disease, but they were cross-sectional, making inferences on causality difficult. We determined associations between impaired PVS, measured using DTI-ALPS and PVS volume, and cognition and incident dementia. METHODS In patients with lacunar stroke and confluent white matter hyperintensities, without dementia at baseline, recruited prospectively in a single center, magnetic resonance imaging was performed annually for 3 years, and cognitive assessments, including global, memory, executive function, and processing speed, were performed annually for 5 years. We determined associations between DTI-ALPS and PVS volume with cerebral small vessel disease imaging markers (white matter hyperintensity volume, lacunes, and microbleeds) at baseline and with changes in imaging markers. We determined whether DTI-ALPS and PVS volume at baseline and change over 3 years predicted incident dementia. Analyses were controlled for conventional diffusion tensor image metrics using 2 markers (median mean diffusivity [MD] and peak width of skeletonized MD) and adjusted for age, sex, and vascular risk factors. RESULTS A total of 120 patients, mean age 70.0 years and 65.0% male, were included. DTI-ALPS declined over 3 years, while no change in PVS volume was found. Neither DTI-ALPS nor PVS volume was associated with cerebral small vessel disease imaging marker progression. Baseline DTI-ALPS was associated with changes in global cognition (β=0.142, P=0.032), executive function (β=0.287, P=0.027), and long-term memory (β=0.228, P=0.027). Higher DTI-ALPS at baseline predicted a lower risk of dementia (hazard ratio, 0.328 [0.183-0.588]; P<0.001), and this remained significant after including median MD as a covariate (hazard ratio, 0.290 [0.139-0.602]; P<0.001). Change in DTI-ALPS predicted dementia conversion (hazard ratio, 0.630 [0.428-0.964]; P=0.048), but when peak width of skeletonized MD and median MD were entered as covariates, the association was not significant. There was no association between baseline PVS volume, or PVS change over 3 years, and conversion to dementia. CONCLUSIONS DTI-ALPS predicts future dementia risk in patients with lacunar strokes and confluent white matter hyperintensities. However, the weakening of the association between change in DTI-ALPS and incident dementia after controlling for peak width of skeletonized MD and median MD suggests part of the signal may represent conventional diffusion tensor image metrics. PVS volume is not a predictor of future dementia risk.
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Affiliation(s)
- Hui Hong
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
- Department of Radiology, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (H.H.)
| | - Daniel J. Tozer
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, United Kingdom (H.H., D.J.T., H.S.M.)
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Lee BC, Tsai HH, Chen ZW, Chang CC, Huang JZ, Chang YY, Tsai CH, Chou CH, Liao CW, Pan CT, Wu VC, Hung CS, Tsai LK, Lin YH. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage. Hypertens Res 2024; 47:608-617. [PMID: 37993592 DOI: 10.1038/s41440-023-01458-w] [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: 01/24/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/24/2023]
Abstract
Primary aldosteronism is associated with various types of cardiovascular and cerebrovascular damage independently of hypertension. Although chronic hypertension and related cerebral arteriosclerosis are the main risk factors for intracerebral hemorrhage, the effects of aldosteronism remain poorly understood. We enrolled 90 survivors of hypertensive intracerebral hemorrhage, 21 of them with aldosteronism and 69 with essential hypertension as controls in this study. Clinical parameters and neuroimaging markers of cerebral small vessel disease were recorded, and its correlations with aldosteronism were investigated. Our results showed that the aldosteronism group (55.2 ± 9.7 years, male 47.6%) had similar hypertension severity but exhibited a higher cerebral microbleed count (interquartile range) (8.5 [2.0‒25.8] vs 3 [1.0‒6.0], P = 0.005) and higher severity of dilated perivascular space in the basal ganglia (severe perivascular space [number >20], 52.4% vs. 24.6%, P = 0.029; large perivascular space [>3 mm], 52.4% vs. 20.3%, P = 0.010), compared to those with essential hypertension (53.8 ± 11.7 years, male 73.9%). In multivariate models, aldosteronism remained an independent predictor of a higher (>10) microbleed count (odds ratio = 8.60, P = 0.004), severe perivascular space (odds ratio = 4.00, P = 0.038); the aldosterone-to-renin ratio was associated with dilated perivascular space (P = 0.043) and large perivascular space (P = 0.008). In conclusions, survivors of intracerebral hemorrhage with aldosteronism showed a tendency towards more severe hypertensive arteriopathy than the essential hypertension counterparts independently of blood pressure; aldosteronism may contribute to dilated perivascular space around the deep perforating arteries. Aldosteronism is associated with more severe cerebral small vessel disease in hypertensive intracerebral hemorrhage.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, ROC
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan, ROC
- National Taiwan University Cancer Center, Taipei, Taiwan, ROC
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan, ROC
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC.
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC.
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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Duarte Coello R, Valdés Hernández MDC, Zwanenburg JJM, van der Velden M, Kuijf HJ, De Luca A, Moyano JB, Ballerini L, Chappell FM, Brown R, Jan Biessels G, Wardlaw JM. Detectability and accuracy of computational measurements of in-silico and physical representations of enlarged perivascular spaces from magnetic resonance images. J Neurosci Methods 2024; 403:110039. [PMID: 38128784 DOI: 10.1016/j.jneumeth.2023.110039] [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: 07/25/2023] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) visible perivascular spaces (PVS) have been associated with age, decline in cognitive abilities, interrupted sleep, and markers of small vessel disease. But the limits of validity of their quantification have not been established. NEW METHOD We use a purpose-built digital reference object to construct an in-silico phantom for addressing this need, and validate it using a physical phantom. We use cylinders of different sizes as models for PVS. We also evaluate the influence of 'PVS' orientation, and different sets of parameters of the two vesselness filters that have been used for enhancing tubular structures, namely Frangi and RORPO filters, in the measurements' accuracy. RESULTS PVS measurements in MRI are only a proxy of their true dimensions, as the boundaries of their representation are consistently overestimated. The success in the use of the Frangi filter relies on a careful tuning of several parameters. Alpha= 0.5, beta= 0.5 and c= 500 yielded the best results. RORPO does not have these requirements and allows detecting smaller cylinders in their entirety more consistently in the absence of noise and confounding artefacts. The Frangi filter seems to be best suited for voxel sizes equal or larger than 0.4 mm-isotropic and cylinders larger than 1 mm diameter and 2 mm length. 'PVS' orientation did not affect measurements in data with isotropic voxels. COMPARISON WITH EXISTENT METHODS Does not apply. CONCLUSIONS The in-silico and physical phantoms presented are useful for establishing the validity of quantification methods of tubular small structures.
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Affiliation(s)
- Roberto Duarte Coello
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK.
| | | | | | - Hugo J Kuijf
- Image Sciences Institute, UMC Utrecht, Utrecht, Netherlands
| | | | - José Bernal Moyano
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; German Centre for Neurodegenerative Diseases, Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; University for Foreigner of Perugia, Perugia, Italy
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
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Valdés Hernández MDC, Duarte Coello R, Xu W, Bernal J, Cheng Y, Ballerini L, Wiseman SJ, Chappell FM, Clancy U, Jaime García D, Arteaga Reyes C, Zhang JF, Liu X, Hewins W, Stringer M, Doubal F, Thrippleton MJ, Jochems A, Brown R, Wardlaw JM. Influence of threshold selection and image sequence in in-vivo segmentation of enlarged perivascular spaces. J Neurosci Methods 2024; 403:110037. [PMID: 38154663 DOI: 10.1016/j.jneumeth.2023.110037] [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: 09/30/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Growing interest surrounds perivascular spaces (PVS) as a clinical biomarker of brain dysfunction given their association with cerebrovascular risk factors and disease. Neuroimaging techniques allowing quick and reliable quantification are being developed, but, in practice, they require optimisation as their limits of validity are usually unspecified. NEW METHOD We evaluate modifications and alternatives to a state-of-the-art (SOTA) PVS segmentation method that uses a vesselness filter to enhance PVS discrimination, followed by thresholding of its response, applied to brain magnetic resonance images (MRI) from patients with sporadic small vessel disease acquired at 3 T. RESULTS The method is robust against inter-observer differences in threshold selection, but separate thresholds for each region of interest (i.e., basal ganglia, centrum semiovale, and midbrain) are required. Noise needs to be assessed prior to selecting these thresholds, as effect of noise and imaging artefacts can be mitigated with a careful optimisation of these thresholds. PVS segmentation from T1-weighted images alone, misses small PVS, therefore, underestimates PVS count, may overestimate individual PVS volume especially in the basal ganglia, and is susceptible to the inclusion of calcified vessels and mineral deposits. Visual analyses indicated the incomplete and fragmented detection of long and thin PVS as the primary cause of errors, with the Frangi filter coping better than the Jerman filter. COMPARISON WITH EXISTING METHODS Limits of validity to a SOTA PVS segmentation method applied to 3 T MRI with confounding pathology are given. CONCLUSIONS Evidence presented reinforces the STRIVE-2 recommendation of using T2-weighted images for PVS assessment wherever possible. The Frangi filter is recommended for PVS segmentation from MRI, offering robust output against variations in threshold selection and pathology presentation.
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Affiliation(s)
- Maria Del C Valdés Hernández
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK.
| | - Roberto Duarte Coello
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - William Xu
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - José Bernal
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Yajun Cheng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Lucia Ballerini
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; University for Foreigner of Perugia, Perugia, Italy
| | - Stewart J Wiseman
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Francesca M Chappell
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Una Clancy
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Daniela Jaime García
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Carmen Arteaga Reyes
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Jun-Fang Zhang
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK; Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodi Liu
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Will Hewins
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael Stringer
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Angela Jochems
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, Department of Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
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Ang PS, Zhang DM, Azizi SA, Norton de Matos SA, Brorson JR. The glymphatic system and cerebral small vessel disease. J Stroke Cerebrovasc Dis 2024; 33:107557. [PMID: 38198946 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107557] [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: 08/01/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES Cerebral small vessel disease is a group of pathologies in which alterations of the brain's blood vessels contribute to stroke and neurocognitive changes. Recently, a neurotoxic waste clearance system composed of perivascular spaces abutting the brain's blood vessels, termed the glymphatic system, has been identified as a key player in brain homeostasis. Given that small vessel disease and the glymphatic system share anatomical structures, this review aims to reexamine small vessel disease in the context of the glymphatic system and highlight novel aspects of small vessel disease physiology. MATERIALS AND METHODS This review was conducted with an emphasis on studies that examined aspects of small vessel disease and on works characterizing the glymphatic system. We searched PubMed for relevant articles using the following keywords: glymphatics, cerebral small vessel disease, arterial pulsatility, hypertension, blood-brain barrier, endothelial dysfunction, stroke, diabetes. RESULTS Cerebral small vessel disease and glymphatic dysfunction are anatomically connected and significant risk factors are shared between the two. These include hypertension, type 2 diabetes, advanced age, poor sleep, obesity, and neuroinflammation. There is clear evidence that CSVD hinders the effective functioning of glymphatic system. CONCLUSION These shared risk factors, as well as the model of cerebral amyloid angiopathy pathogenesis, hint at the possibility that glymphatic dysfunction could independently contribute to the pathogenesis of cerebral small vessel disease. However, the current evidence supports a model of cascading dysfunction, wherein concurrent small vessel and glymphatic injury hinder glymphatic-mediated recovery and promote the progression of subclinical to clinical disease.
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Affiliation(s)
- Phillip S Ang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Douglas M Zhang
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | - Saara-Anne Azizi
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
| | | | - James R Brorson
- University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States; Department of Neurology, The University of Chicago, Chicago, IL 60637, United States.
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Tian Y, Wang M, Pan Y, Meng X, Zhao X, Liu L, Wang Y, Wang Y. In patients who had a stroke or TIA, enlarged perivascular spaces in basal ganglia may cause future haemorrhagic strokes. Stroke Vasc Neurol 2024; 9:8-17. [PMID: 37188388 PMCID: PMC10956113 DOI: 10.1136/svn-2022-002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION It remains unclear whether enlarged perivascular spaces (EPVS) predict poor clinical outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attack (TIA). METHOD Data were obtained from the Third China National Stroke Registry study. We estimated EPVS in basal ganglia (BG) and centrum semiovale (CSO) using a semiquantified scale (Grade from 0 to 4). Using Cox and logistic regression analyses, the associations of EPVS with 3-month and 1-year adverse outcomes (including recurrent stroke, ischaemic stroke, haemorrhagic stroke, combined vascular event, disability and mortality) were explored. Sensitivity analyses of any association of cerebral small vessel disease at baseline and development of a small arterial occlusion (SAO) were conducted. RESULT Among 12 603 patients with AIS/TIA, median age was 61.7±11.6 years, and 68.2% were men. After adjusting for all potential confounders, frequent-to-severe BG-EPVS was associated with a decreased risk of recurrent ischaemic stroke (HR 0.71, 95% CI 0.55 to 0.92, p=0.01) but an increased risk of haemorrhagic stroke (HR 1.99, 95% CI 1.11 to 3.58, p=0.02) at 1 year after AIS/TIA, compared with none-to-mild BG-EPVS. Patients with frequent-to-severe CSO-EPVS had a decreased risk of disability (OR 0.76, 95% CI 0.62 to 0.92, p=0.004) and all-cause death (HR 0.55, 95% CI 0.31 to 0.98, p=0.04) within 3-month but not 1-year follow-ups, compared with those with none-to-mild BG-EPVS. Sensitivity analyses showed that both BG-EPVS (HR 0.43, 95% CI 0.21 to 0.87, p=0.02) and CSO-EPVS (HR 0.58, 95% CI 0.35 to 0.95, p=0.03) were associated with a decreased risk of subsequent ischaemic stroke in patients with SAO during 1-year follow-up. CONCLUSION BG-EPVS increased the risk of haemorrhagic stroke in patients already with AIS/TIA within 1 year. Therefore, caution is recommended when selecting antithrombotic agents for secondary stroke prevention in patients with AIS/TIA and more severe BG-EPVS.
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Affiliation(s)
- Yu Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 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
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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Licastro E, Pignataro G, Iliff JJ, Xiang Y, Lo EH, Hayakawa K, Esposito E. Glymphatic and lymphatic communication with systemic responses during physiological and pathological conditions in the central nervous system. Commun Biol 2024; 7:229. [PMID: 38402351 PMCID: PMC10894274 DOI: 10.1038/s42003-024-05911-5] [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: 07/06/2023] [Accepted: 02/12/2024] [Indexed: 02/26/2024] Open
Abstract
Crosstalk between central nervous system (CNS) and systemic responses is important in many pathological conditions, including stroke, neurodegeneration, schizophrenia, epilepsy, etc. Accumulating evidence suggest that signals for central-systemic crosstalk may utilize glymphatic and lymphatic pathways. The glymphatic system is functionally connected to the meningeal lymphatic system, and together these pathways may be involved in the distribution of soluble proteins and clearance of metabolites and waste products from the CNS. Lymphatic vessels in the dura and meninges transport cerebrospinal fluid, in part collected from the glymphatic system, to the cervical lymph nodes, where solutes coming from the brain (i.e., VEGFC, oligomeric α-syn, β-amyloid) might activate a systemic inflammatory response. There is also an element of time since the immune system is strongly regulated by circadian rhythms, and both glymphatic and lymphatic dynamics have been shown to change during the day and night. Understanding the mechanisms regulating the brain-cervical lymph node (CLN) signaling and how it might be affected by diurnal or circadian rhythms is fundamental to find specific targets and timing for therapeutic interventions.
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Affiliation(s)
- Ester Licastro
- Neuroprotection Research Laboratories, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Division of Pharmacology, Department of Neuroscience, School of Medicine, University "Federico II", Naples, Italy
| | - Giuseppe Pignataro
- Division of Pharmacology, Department of Neuroscience, School of Medicine, University "Federico II", Naples, Italy
| | - Jeffrey J Iliff
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Yanxiao Xiang
- Neuroprotection Research Laboratories, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Department of Pharmacy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Eng H Lo
- Neuroprotection Research Laboratories, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA), Radcliffe Department of Medicine, University of Oxford, Headington, Oxford, UK
| | - Kazuhide Hayakawa
- Neuroprotection Research Laboratories, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Elga Esposito
- Neuroprotection Research Laboratories, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
- Consortium International pour la Recherche Circadienne sur l'AVC (CIRCA), Radcliffe Department of Medicine, University of Oxford, Headington, Oxford, UK.
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Cichońska D, Mazuś M, Kusiak A. Recent Aspects of Periodontitis and Alzheimer's Disease-A Narrative Review. Int J Mol Sci 2024; 25:2612. [PMID: 38473858 DOI: 10.3390/ijms25052612] [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: 01/16/2024] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Periodontitis is an inflammatory condition affecting the supporting structures of the teeth. Periodontal conditions may increase the susceptibility of individuals to various systemic illnesses, including Alzheimer's disease. Alzheimer's disease is a neurodegenerative condition characterized by a gradual onset and progressive deterioration, making it the primary cause of dementia, although the exact cause of the disease remains elusive. Both Alzheimer's disease and periodontitis share risk factors and clinical studies comparing the associations and occurrence of periodontitis among individuals with Alzheimer's disease have suggested a potential correlation between these conditions. Brains of individuals with Alzheimer's disease have substantiated the existence of microorganisms related to periodontitis, especially Porphyromonas gingivalis, which produces neurotoxic gingipains and may present the capability to breach the blood-brain barrier. Treponema denticola may induce tau hyperphosphorylation and lead to neuronal apoptosis. Lipopolysaccharides-components of bacterial cell membranes and mediators of inflammation-also have an impact on brain function. Further research could unveil therapeutic approaches targeting periodontal pathogens to potentially alleviate AD progression.
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Affiliation(s)
- Dominika Cichońska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, Orzeszkowej 18 St. 18, 80-208 Gdańsk, Poland
| | - Magda Mazuś
- Student Research Group of the Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, Orzeszkowej 18 St. 18, 80-208 Gdańsk, Poland
| | - Aida Kusiak
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Gdańsk, Orzeszkowej 18 St. 18, 80-208 Gdańsk, Poland
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Hong H, Hong L, Luo X, Zeng Q, Li K, Wang S, Jiaerken Y, Zhang R, Yu X, Zhang Y, Lei C, Liu Z, Chen Y, Huang P, Zhang M. The relationship between amyloid pathology, cerebral small vessel disease, glymphatic dysfunction, and cognition: a study based on Alzheimer's disease continuum participants. Alzheimers Res Ther 2024; 16:43. [PMID: 38378607 PMCID: PMC10877805 DOI: 10.1186/s13195-024-01407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Glymphatic dysfunction is a crucial pathway for dementia. Alzheimer's disease (AD) pathologies co-existing with cerebral small vessel disease (CSVD) is the most common pathogenesis for dementia. We hypothesize that AD pathologies and CSVD could be associated with glymphatic dysfunction, contributing to cognitive impairment. METHOD Participants completed with amyloid PET, diffusion tensor imaging (DTI), and T2 fluid-attenuated inversion-recovery (FLAIR) sequences were included from the Alzheimer's Disease Neuroimaging Initiative (ADNI). White matter hyperintensities (WMH), the most common CSVD marker, was evaluated from T2FLAIR images and represented the burden of CSVD. Amyloid PET was used to assess Aβ aggregation in the brain. We used diffusion tensor image analysis along the perivascular space (DTI-ALPS) index, the burden of enlarged perivascular spaces (PVS), and choroid plexus volume to reflect glymphatic function. The relationships between WMH burden/Aβ aggregation and these glymphatic markers as well as the correlations between glymphatic markers and cognitive function were investigated. Furthermore, we conducted mediation analyses to explore the potential mediating effects of glymphatic markers in the relationship between WMH burden/Aβ aggregation and cognition. RESULTS One hundred and thirty-three participants along the AD continuum were included, consisting of 40 CN - , 48 CN + , 26 MCI + , and 19 AD + participants. Our findings revealed that there were negative associations between whole-brain Aβ aggregation (r = - 0.249, p = 0.022) and WMH burden (r = - 0.458, p < 0.001) with DTI-ALPS. Additionally, Aβ aggregation (r = 0.223, p = 0.041) and WMH burden (r = 0.294, p = 0.006) were both positively associated with choroid plexus volume. However, we did not observe significant correlations with PVS enlargement severity. DTI-ALPS was positively associated with memory (r = 0.470, FDR-p < 0.001), executive function (r = 0.358, FDR-p = 0.001), visual-spatial (r = 0.223, FDR-p < 0.040), and language (r = 0.419, FDR-p < 0.001). Conversely, choroid plexus volume showed negative correlations with memory (r = - 0.315, FDR-p = 0.007), executive function (r = - 0.321, FDR-p = 0.007), visual-spatial (r = - 0.233, FDR-p = 0.031), and language (r = - 0.261, FDR-p = 0.021). There were no significant correlations between PVS enlargement severity and cognitive performance. In the mediation analysis, we found that DTI-ALPS acted as a mediator in the relationship between WMH burden/Aβ accumulation and memory and language performances. CONCLUSION Our study provided evidence that both AD pathology (Aβ) and CSVD were associated with glymphatic dysfunction, which is further related to cognitive impairment. These results may provide a theoretical basis for new targets for treating AD.
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Affiliation(s)
- Hui Hong
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Luwei Hong
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yeerfan Jiaerken
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ruiting Zhang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yao Zhang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Cui Lei
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhirong Liu
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yanxing Chen
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Minming Zhang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
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Zhong W, Xia Y, Ying Y, Wang Y, Yang L, Liang X, Zhao Q, Wu J, Liang Z, Wang X, Cheng X, Ding D, Dong Q. Cerebral pulsatility in relation with various imaging markers of cerebral small vessel disease: a longitudinal community-based study. Ther Adv Neurol Disord 2024; 17:17562864241227304. [PMID: 38371383 PMCID: PMC10874147 DOI: 10.1177/17562864241227304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/03/2024] [Indexed: 02/20/2024] Open
Abstract
Background Cerebral pulsatility is thought to reflect arterial stiffness and downstream microvascular resistance. Although previous studies indicated cerebral pulsatility might closely relate to development of cerebral small vessel disease (SVD), yet evidence remain controversial and longitudinal data are rare. Objective We aimed to explore relationships of cerebral pulsatility with severity and progression of various SVD imaging markers among the community-dwelling elderly. Design A longitudinal cohort study. Methods As part of the prospective community-based Shanghai Aging Study cohort, dementia- and stroke-free elderly were recruited for baseline assessment of cerebral pulsatility and SVD severity during 2010-2011 and traced for SVD progression during 2016-2017. Cerebral pulsatility was quantified for both anterior and posterior circulation with transcranial Doppler ultrasound. SVD imaging markers were measured with brain magnetic resonance imaging (MRI) including white matter hyperintensities (WMHs), enlarged perivascular spaces (ePVS), lacunes, and microbleeds. The cross-sectional and longitudinal relationships between cerebral pulsatility and SVD were analyzed by univariable and multivariable regression models. Results Totally, 188 eligible subjects were included at baseline and out of them, 100 (53.19%) returned for a 7-year follow-up. At baseline, increased pulsatility of posterior circulation was independently associated with more periventricular WMH (PWMH) and ePVS in basal ganglia (BG-ePVS) but not with other SVD markers. Longitudinally, higher posterior pulsatility predicted greater PWMH progression in participants with hypertension (β = 2.694, standard error [SE] = 1.112, p = 0.020), whereas pulsatility of anterior circulation was shown to prevent BG-ePVS progression among followed-up elderly (β = -6.737, SE = 2.685, p = 0.012). However, no significant relationship was found between cerebral pulsatility and burden of lacunes or cerebral microbleeds. Conclusion Higher pulsatility of posterior circulation could worsen PWMH progression, especially for participants with hypertension. But for development of ePVS, increased cerebral pulsatility could play a compensatory role among several healthy elderly. The distinct relationships between cerebral pulsatility and various SVD markers emphasized the importance of individualized SVD management.
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Affiliation(s)
- Weiyi Zhong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwei Xia
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunqing Ying
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lumeng Yang
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, National Clinical Research, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, National Clinical Research, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianjun Wu
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zonghui Liang
- Department of Radiology, Jing’an District Center Hospital, Shanghai, China
| | - Xiaoxiao Wang
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei, Anhui, China
| | - Xin Cheng
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, National Clinical Research, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Qiang Dong
- Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai 200040, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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