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Li W, Su C, Wang Z, Xu X, Zheng D. Cingulate sulcus sign: a descriptive analysis in a cerebral small vessel disease population. Front Aging Neurosci 2024; 16:1438796. [PMID: 39165838 PMCID: PMC11333361 DOI: 10.3389/fnagi.2024.1438796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
Objective The cingulate sulcus sign (CSS) has been observed in patients with idiopathic normal pressure hydrocephalus (iNPH), suggesting potential disruptions in cerebrospinal fluid circulation and compromised glymphatic system. Although there are similarities in the underlying mechanisms between cerebral small vessel disease (CSVD) and iNPH, the relationship between CSS and CSVD remains unclear. This study aimed to investigate the prevalence and potential mechanisms of CSS in patients with CSVD. Methods Data from patients diagnosed with CSVD at Shengjing Hospital of China Medical University between January 2020 and October 2022 were retrospectively collected, including general information, global cognitive function [assessed by measuring Mini-Mental State Examination (MMSE)], and four CSVD magnetic resonance imaging (MRI) markers [(white matter hyperintensity (WMH), cerebral microbleeds (CMBs), lacunes, and enlarged perivascular spaces (EPVS)], CSS and the Evan's index (EI). Results A total of 308 patients were included, and CSS was detected in 80 patients (26%). Univariate analysis revealed that MMSE scores in the CSS group were significantly lower compared to the non-CSS group (p < 0.001). Multivariable analysis showed an independent correlation between CSS and the presence of lacunes (odds ratio [OR] 0.358, 95% confidence interval [CI] 0.193-0.663, p = 0.001), presence of lobar dominant CMBs (OR 2.683, 95%CI 1.385-5.195, p = 0.003), periventricular WMH Fazekas score (OR 1.693, 95% CI 1.133-2.529, p = 0.01), and EI (OR 1.276, 95% CI 1.146-1.420, p < 0.001). Conclusion This preliminary study showed that CSS can be observed in some patients with CSVD. The presence of CSS may represent different mechanisms of CSVD pathogenesis and reflect differences in the degree of cerebrospinal fluid (CSF)/interstitial fluid (ISF) stasis.
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Affiliation(s)
| | | | | | | | - Dongming Zheng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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2
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Adaniya S, Matsuda H, Tomori M, Kaneko C, Tomura N. Enhancing Cerebral Amyloid Angiopathy-Related Inflammation Diagnosis With PET Using Pittsburgh Compound B. Clin Nucl Med 2024; 49:e281-e283. [PMID: 38619985 DOI: 10.1097/rlu.0000000000005173] [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: 04/17/2024]
Abstract
ABSTRACT Cerebral amyloid angiopathy-related inflammation is a rare encephalopathy characterized by inflammation against amyloid protein accumulated in cerebral small vessels. A 50-year-old man was presented with a subacute consciousness disorder. Brain MRI revealed high intensity lesions in the white matter of the right parietal and occipital lobes on fluid-attenuated inversion recovery sequences and cerebral microbleeds in the right parietal and occipital lobes on T2*-weighted images. Pittsburgh compound B-PET demonstrated accumulation in the right temporoparietal lobe, confirming a potential diagnosis of probable cerebral amyloid angiopathy-related inflammation without brain biopsy. Steroid pulse therapy was initiated, with good results.
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Affiliation(s)
- Shinobu Adaniya
- From the Department of Radiology and Neurology, Southern TOHOKU General Hospital
| | - Hiroshi Matsuda
- Drug Discovery and Cyclotron Research Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Masaki Tomori
- From the Department of Radiology and Neurology, Southern TOHOKU General Hospital
| | - Chikako Kaneko
- From the Department of Radiology and Neurology, Southern TOHOKU General Hospital
| | - Noriaki Tomura
- From the Department of Radiology and Neurology, Southern TOHOKU General Hospital
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Raposo N, Périole C, Planton M. In-vivo diagnosis of cerebral amyloid angiopathy: an updated review. Curr Opin Neurol 2024; 37:19-25. [PMID: 38038409 DOI: 10.1097/wco.0000000000001236] [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: 12/02/2023]
Abstract
PURPOSE OF REVIEW Sporadic cerebral amyloid angiopathy (CAA) is a highly prevalent small vessel disease in ageing population with potential severe complications including lobar intracerebral hemorrhage (ICH), cognitive impairment, and dementia. Although diagnosis of CAA was made only with postmortem neuropathological examination a few decades ago, diagnosing CAA without pathological proof is now allowed in living patients. This review focuses on recently identified biomarkers of CAA and current diagnostic criteria. RECENT FINDINGS Over the past few years, clinicians and researchers have shown increased interest for CAA, and important advances have been made. Thanks to recent insights into mechanisms involved in CAA and advances in structural and functional neuroimaging, PET amyloid tracers, cerebrospinal fluid and plasma biomarkers analysis, a growing number of biomarkers of CAA have been identified. Imaging-based diagnostic criteria including emerging biomarkers have been recently developed or updated, enabling accurate and earlier diagnosis of CAA in living patients. SUMMARY Recent advances in neuroimaging allow diagnosing CAA in the absence of pathological examination. Current imaging-based criteria have high diagnostic performance in patients presenting with ICH, but is more limited in other clinical context such as cognitively impaired patients or asymptomatic individuals. Further research is still needed to improve diagnostic accuracy.
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Affiliation(s)
- Nicolas Raposo
- Department of neurology, Toulouse University Hospital
- Clinical Investigation Center, CIC1436, Toulouse University Hospital, F-CRIN/Strokelink Network, Toulouse
- Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
| | - Charlotte Périole
- Department of neurology, Toulouse University Hospital
- Clinical Investigation Center, CIC1436, Toulouse University Hospital, F-CRIN/Strokelink Network, Toulouse
| | - Mélanie Planton
- Department of neurology, Toulouse University Hospital
- Toulouse NeuroImaging Center, University of Toulouse, Inserm, UPS, France
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Okine DN, Knopman DS, Mosley TH, Wong DF, Johansen MC, Walker KA, Jack CR, Kantarci K, Pike JR, Graff-Radford J, Gottesman RF. Cerebral Microbleed Patterns and Cortical Amyloid-β: The ARIC-PET Study. Stroke 2023; 54:2613-2620. [PMID: 37638398 PMCID: PMC10877560 DOI: 10.1161/strokeaha.123.042835] [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: 02/16/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) are associated with cognitive decline, but their importance outside of cerebral amyloid angiopathy and the mechanisms of their impact on cognition are poorly understood. We evaluated the cross-sectional association between CMB patterns and cerebral Aβ (amyloid-β) deposition, by florbetapir positron emission tomography. METHODS The longitudinal ARIC study (Atherosclerosis Risk in Communities) recruited individuals from 4 US communities from 1987 to 1989. From 2012 to 2014, the ARIC-PET (Atherosclerosis Risk in Communities - Positron Emission Tomography) ancillary recruited 322 nondemented ARIC participants who completed 3T brain magnetic resonance imaging with T2*GRE as part of ARIC visit 5 to undergo florbetapir positron emission tomography imaging. Magnetic resonance imaging images were read for CMBs and superficial siderosis; on positron emission tomography, global cortical standardized uptake value ratio >1.2 was considered a positive Aβ scan. Multivariable logistic regression models evaluated CMB characteristics in association with Aβ positivity. Effect modification by sex, race, APOE status, and cognition was evaluated. RESULTS CMBs were present in 24% of ARIC-PET participants. No significant associations were found between CMBs and Aβ positivity, but a pattern of isolated lobar CMBs or superficial siderosis was associated with over 4-fold higher odds of elevated Aβ when compared with those with no CMBs (odds ratio, 4.72 [95% CI, 1.16-19.16]). A similar elevated risk was not observed in those with isolated subcortical or mixed subcortical and either lobar CMBs or superficial siderosis. Although no significant interactions were found, effect estimates for elevated Aβ were nonsignificantly lower (P>0.10, odds ratio, 0.4-0.6) for a mixed CMB pattern, and odds ratios were nonsignificantly higher for lobar-only CMBs for 4 subgroups: women (versus men); Black participants (versus White participants), APOE ε4 noncarriers (versus carriers), and cognitively normal (versus mild cognitive impairment). CONCLUSIONS In this community-based cohort of nondemented adults, lobar-only pattern of CMBs or superficial siderosis is most strongly associated with brain Aβ, with no elevated risk for a mixed CMB pattern. Further studies are needed to understand differences in CMB patterns and their meaning across subgroups.
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Affiliation(s)
- Derrick N. Okine
- National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, MD
| | | | - Thomas H. Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Dean F. Wong
- Department of Radiology, Washington University, St. Louis, MO
| | - Michelle C. Johansen
- Department of Neurology, The John Hopkins University School of Medicine, Baltimore, MD
| | - Keenan A. Walker
- National Institute on Aging Intramural Program, NIH, Baltimore, MD
| | | | | | - James R. Pike
- Gillings School of Global Public Health, University of North Carolina
| | | | - Rebecca F. Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, MD
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Tsai Y, Tsai H, Liu C, Lin S, Chen Y, Jeng J, Tsai L, Yen R. Cerebral amyloid deposition predicts long-term cognitive decline in hemorrhagic small vessel disease. Brain Behav 2023; 13:e3189. [PMID: 37533346 PMCID: PMC10570474 DOI: 10.1002/brb3.3189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/03/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND To investigate the association between cerebral amyloid deposition and long-term cognitive outcomes in patients with hemorrhagic small vessel disease (SVD) and survivors of intracerebral hemorrhage (ICH). METHODS Patients experiencing an ICH without overt dementia were prospectively recruited (n = 68) for brain MRI and Pittsburgh compound B (PiB) positron emission tomography scans at baseline. Cognitive function was assessed using the mini-mental status examination (MMSE) and clinical dementia rating after an overall median follow-up of 3.8 years. A positive amyloid scan was defined as a global PiB standardized uptake value ratio >1.2. Associations between follow-up cognitive outcomes and neuroimaging markers were explored using multivariable Cox regression models. RESULTS PiB(+) patients were older (72.1 ± 7.8 vs. 59.9 ± 11.7, p = .002) and more frequently had cerebral amyloid angiopathy (CAA) (63.6% vs. 15.8%, p = .002) than PiB(-) patients. PiB(+) was associated with a higher risk of dementia conversion (32.9 vs. 4.0 per 100-person-years, hazard ratio [HR] = 15.7 [3.0-80.7], p = .001) and MMSE score decline (58.8 vs. 9.9 per 100-person-years, HR = 6.2 [1.9-20.0], p = .002). In the non-CAA subgroup (n = 52), PiB(+) remained an independent predictor of dementia conversion, p = .04). In the Cox models, PiB(+) was an independent predictor of dementia conversion (HR = 15.8 [2.6-95.4], p = .003) and MMSE score decline (HR = 5.7 [1.6-20.3], p = .008) after adjusting for confounders. CONCLUSIONS Cerebral amyloid deposition potentially contributes to long-term cognitive decline in SVD-related ICH.
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Affiliation(s)
- Ya‐Chin Tsai
- Department of Nuclear MedicineNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Hsin‐Hsi Tsai
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
- Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
| | - Chia‐Ju Liu
- Department of Nuclear MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Sheng‐Sian Lin
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
| | - Ya‐Fang Chen
- Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
| | - Jiann‐Shing Jeng
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
| | - Li‐Kai Tsai
- Department of NeurologyNational Taiwan University Hospital Bei‐Hu BranchTaipeiTaiwan
- Department of NeurologyNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Ruoh‐Fang Yen
- Department of Nuclear MedicineNational Taiwan University HospitalTaipeiTaiwan
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Goeldlin M, Stewart C, Radojewski P, Wiest R, Seiffge D, Werring DJ. Clinical neuroimaging in intracerebral haemorrhage related to cerebral small vessel disease: contemporary practice and emerging concepts. Expert Rev Neurother 2022; 22:579-594. [PMID: 35850578 DOI: 10.1080/14737175.2022.2104157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION About 80% of all non-traumatic intracerebral haemorrhage (ICH) are caused by the sporadic cerebral small vessel diseases deep perforator arteriopathy (DPA, also termed hypertensive arteriopathy or arteriolosclerosis) and cerebral amyloid angiopathy (CAA), though these frequently co-exist in older people. Contemporary neuroimaging (MRI and CT) detects an increasing spectrum of haemorrhagic and non-haemorrhagic imaging biomarkers of small vessel disease which may identify the underlying arteriopathies. AREAS COVERED We discuss biomarkers for cerebral small vessel disease subtypes in ICH, and explore their implications for clinical practice and research. EXPERT OPINION ICH is not a single disease, but results from a defined range of vascular pathologies with important implications for prognosis and treatment. The terms "primary" and "hypertensive" ICH are poorly defined and should be avoided, as they encourage incomplete investigation and classification. Imaging-based criteria for CAA will show improved diagnostic accuracy, but specific imaging biomarkers of DPA are needed. Ultra-high-field 7T-MRI using structural and quantitative MRI may provide further insights into mechanisms and pathophysiology of small vessel disease. We expect neuroimaging biomarkers and classifications to allow personalized treatments (e.g. antithrombotic drugs) in clinical practice and to improve patient selection and monitoring in trials of targeted therapies directed at the underlying arteriopathies.
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Affiliation(s)
- Martina Goeldlin
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Catriona Stewart
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Piotr Radojewski
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - Roland Wiest
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital Bern University Hospital and University of Bern, Bern, Switzerland
| | - David J Werring
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, United Kingdom
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7
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Beaman C, Kozii K, Hilal S, Liu M, Spagnolo-Allende AJ, Polanco-Serra G, Chen C, Cheng CY, Zambrano D, Arikan B, Del Brutto VJ, Wright C, Flowers XE, Leskinen SP, Rundek T, Mitchell A, Vonsattel JP, Cortes E, Teich AF, Sacco RL, Elkind MSV, Roh D, Gutierrez J. Cerebral Microbleeds, Cerebral Amyloid Angiopathy, and Their Relationships to Quantitative Markers of Neurodegeneration. Neurology 2022; 98:e1605-e1616. [PMID: 35228332 PMCID: PMC9052569 DOI: 10.1212/wnl.0000000000200142] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Age-related cognitive impairment is driven by the complex interplay of neurovascular and neurodegenerative disease. There is a strong relationship between cerebral microbleeds (CMBs), cerebral amyloid angiopathy (CAA), and the cognitive decline observed in conditions such as Alzheimer disease. However, in the early, preclinical phase of cognitive impairment, the extent to which CMBs and underlying CAA affect volumetric changes in the brain related to neurodegenerative disease remains unclear. METHODS We performed cross-sectional analyses from 3 large cohorts: The Northern Manhattan Study (NOMAS), Alzheimer's Disease Neuroimaging Initiative (ADNI), and the Epidemiology of Dementia in Singapore study (EDIS). We conducted a confirmatory analysis of 82 autopsied cases from the Brain Arterial Remodeling Study (BARS). We implemented multivariate regression analyses to study the association between 2 related markers of cerebrovascular disease-MRI-based CMBs and autopsy-based CAA-as independent variables and volumetric markers of neurodegeneration as dependent variables. NOMAS included mostly dementia-free participants age 55 years or older from northern Manhattan. ADNI included participants living in the United States age 55-90 years with a range of cognitive status. EDIS included community-based participants living in Singapore age 60 years and older with a range of cognitive status. BARS included postmortem pathologic samples. RESULTS We included 2,657 participants with available MRI data and 82 autopsy cases from BARS. In a meta-analysis of NOMAS, ADNI, and EDIS, superficial CMBs were associated with larger gray matter (β = 4.49 ± 1.13, p = 0.04) and white matter (β = 4.72 ± 2.1, p = 0.03) volumes. The association between superficial CMBs and larger white matter volume was more evident in participants with 1 CMB (β = 5.17 ± 2.47, p = 0.04) than in those with ≥2 CMBs (β = 1.97 ± 3.41, p = 0.56). In BARS, CAA was associated with increased cortical thickness (β = 6.5 ± 2.3, p = 0.016) but not with increased brain weight (β = 1.54 ± 1.29, p = 0.26). DISCUSSION Superficial CMBs are associated with larger morphometric brain measures, specifically white matter volume. This association is strongest in brains with fewer CMBs, suggesting that the CMB/CAA contribution to neurodegeneration may not relate to tissue loss, at least in early stages of disease.
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Affiliation(s)
- Charles Beaman
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Krystyna Kozii
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Saima Hilal
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Minghua Liu
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Anthony J Spagnolo-Allende
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Guillermo Polanco-Serra
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Christopher Chen
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ching-Yu Cheng
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Daniela Zambrano
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Burak Arikan
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Victor J Del Brutto
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Clinton Wright
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Xena E Flowers
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Sandra P Leskinen
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Amanda Mitchell
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jean Paul Vonsattel
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Etty Cortes
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Andrew F Teich
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - David Roh
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jose Gutierrez
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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Margraf NG, Jensen-Kondering U, Weiler C, Leypoldt F, Maetzler W, Philippen S, Bartsch T, Flüh C, Röcken C, Möller B, Royl G, Neumann A, Brüggemann N, Roeben B, Schulte C, Bender B, Berg D, Kuhlenbäumer G. Cerebrospinal Fluid Biomarkers in Cerebral Amyloid Angiopathy: New Data and Quantitative Meta-Analysis. Front Aging Neurosci 2022; 14:783996. [PMID: 35237145 PMCID: PMC8884145 DOI: 10.3389/fnagi.2022.783996] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/03/2022] [Indexed: 01/31/2023] Open
Abstract
Background To evaluate the diagnostic accuracy of cerebrospinal fluid (CSF) biomarkers in patients with probable cerebral amyloid angiopathy (CAA) according to the modified Boston criteria in a retrospective multicentric cohort. Methods Beta-amyloid 1-40 (Aβ40), beta-amyloid 1-42 (Aβ42), total tau (t-tau), and phosphorylated tau 181 (p-tau181) were measured in 31 patients with probable CAA, 28 patients with Alzheimer’s disease (AD), and 30 controls. Receiver-operating characteristics (ROC) analyses were performed for the measured parameters as well as the Aβ42/40 ratio to estimate diagnostic parameters. A meta-analysis of all amenable published studies was conducted. Results In our data Aβ42/40 (AUC 0.88) discriminated best between CAA and controls while Aβ40 did not perform well (AUC 0.63). Differentiating between CAA and AD, p-tau181 (AUC 0.75) discriminated best in this study while Aβ40 (AUC 0.58) and Aβ42 (AUC 0.54) provided no discrimination. In the meta-analysis, Aβ42/40 (AUC 0.90) showed the best discrimination between CAA and controls followed by t-tau (AUC 0.79), Aβ40 (AUC 0.76), and p-tau181 (AUC 0.71). P-tau181 (AUC 0.76), Aβ40 (AUC 0.73), and t-tau (AUC 0.71) differentiated comparably between AD and CAA while Aβ42 (AUC 0.54) did not. In agreement with studies examining AD biomarkers, Aβ42/40 discriminated excellently between AD and controls (AUC 0.92–0.96) in this study as well as the meta-analysis. Conclusion The analyzed parameters differentiate between controls and CAA with clinically useful accuracy (AUC > ∼0.85) but not between CAA and AD. Since there is a neuropathological, clinical and diagnostic continuum between CAA and AD, other diagnostic markers, e.g., novel CSF biomarkers or other parameters might be more successful.
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Affiliation(s)
- Nils G. Margraf
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- *Correspondence: Nils G. Margraf,
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Caroline Weiler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Institute of Clinical Chemistry, University Medical Center Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Walter Maetzler
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Sarah Philippen
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Christoph Röcken
- Department of Pathology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Bettina Möller
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
| | - Georg Royl
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University Medical Center Schleswig Holstein, Campus Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Benjamin Roeben
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Claudia Schulte
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Diagnostical and Interventional Neuroradiology, University Hospital of Tübingen, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel University, Kiel, Germany
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9
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Chang Y, Liu J, Wang L, Li X, Wang Z, Lin M, Jin W, Zhu M, Xu B. Diagnostic Utility of Integrated 11C-Pittsburgh Compound B Positron Emission Tomography/Magnetic Resonance for Cerebral Amyloid Angiopathy: A Pilot Study. Front Aging Neurosci 2021; 13:721780. [PMID: 34899265 PMCID: PMC8660657 DOI: 10.3389/fnagi.2021.721780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We aimed to compare amyloid deposition at the lobar cerebral microbleed (CMB) sites of cerebral amyloid angiopathy (CAA), Alzheimer’s disease (AD), and cognitively normal healthy controls (NC) and to propose a novel diagnostic method for differentiating CAA patients from AD patients with integrated 11C-Pittsburgh compound B (PIB) positron emission tomography (PET)/magnetic resonance (MR) and assess its diagnostic value. Methods: Nine CAA, 15 AD patients, and 15 NC subjects were enrolled in this study. Each subject underwent an 11C-PIB brain PET/MR examination. Susceptibility weighted imaging was assessed to detect CMB locations, and standardized uptake value ratios (SUVRs) were measured at these sites. Cortical PIB distributions were quantitatively evaluated. Patients with CAA, AD, and NC subjects were compared with global and regional cortical SUVRs at CMB cites. The diagnostic accuracy of MRI, PIB-PET, and PET/MR in differentiating CAA and AD was evaluated. Results: Lobar CMBs were detected in all the CAA patients, eight of the 15 AD patients (53.3%), and four of the 15 NC subjects (26.7%), respectively. The PIB deposition at CMB sites was significantly higher in CAA patients compared with AD patients and NC subjects in terms of SUVR (1.72 ± 0.10 vs. 1.42 ± 0.16 and 1.17 ± 0.08; p < 0.0001). The PIB deposition was associated with CMB locations and was greatest in the occipital and temporal regions of CAA patients. The global cortical PIB deposition was significantly higher in CAA than in NC subjects (1.66 ± 0.06 vs. 1.21 ± 0.06; p < 0.0001) and significantly lower than in AD patients (1.66 ± 0.06 vs. 1.86 ± 0.17; p < 0.0001). In contrast, the occipital/global PIB uptake ratio was significantly increased in CAA (occipital/global ratio, 1.05 ± 0.02) relative to AD patients (1.05 ± 0.02 vs. 0.99 ± 0.04; p < 0.001). PET/MR had a higher accuracy (sensitivity, 88.9%; specificity, 93.3%) than separate PET and MR. Conclusion: Our results indicate that the CMBs occur preferentially at loci with concentrated amyloid. By combining lobar CMBs with regional cortical amyloid deposition, the proposed workflow can further improve CAA diagnostic accuracy compared to each method alone. These findings improve our knowledge regarding the pathogenesis of CMBs and highlight the potential utility of PIB-PET/MR as a non-invasive tool for distinguishing CAA and AD patients.
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Affiliation(s)
- Yan Chang
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liang Wang
- PET/CT, Jixi Ji Mine Hospital, Jixi, China
| | - Xin Li
- Department of Interventional Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhenjun Wang
- Department of Radiology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mu Lin
- MR Collaboration, Diagnostic Imaging, Siemens Healthcare Ltd., Shanghai, China
| | - Wei Jin
- Department of Pathology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingwei Zhu
- Department of Neurology Medicine, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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10
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Tsai HH, Chen YF, Yen RF, Lo YL, Yang KC, Jeng JS, Tsai LK, Chang CF. Plasma soluble TREM2 is associated with white matter lesions independent of amyloid and tau. Brain 2021; 144:3371-3380. [PMID: 34515756 DOI: 10.1093/brain/awab332] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/21/2021] [Accepted: 08/08/2021] [Indexed: 12/20/2022] Open
Abstract
Cerebral small vessel disease is one of the most common causes of cognitive decline and stroke. While several lines of evidence have established a relationship between inflammation and cerebrovascular pathology, the mechanistic link has not yet been elucidated. Recent studies suggest activation of immune mediators, including the soluble form of triggering receptor expressed on myeloid cells 2 (TREM2), may be critical regulators. In this study, we compared the plasma levels of soluble TREM2 and its correlations with neuroimaging markers and cerebral amyloid load in ten patients with Alzheimer's disease and 66 survivors of spontaneous intracerebral haemorrhage with cerebral amyloid angiopathy or hypertensive small vessel disease, two of the most common types of sporadic small vessel disease. We performed brain MRI and 11C-Pittsburgh compound B PET for all participants to evaluate radiological small vessel disease markers and cerebral amyloid burden, and 18F-T807 PET in a subgroup of patients to evaluate cortical tau pathology. Plasma soluble TREM2 levels were comparable between patients with Alzheimer's disease and small vessel disease (P=0.690). In patients with small vessel disease, plasma soluble TREM2 was significantly associated with white matter hyperintensity volume (P<0.001), but not with cerebral amyloid load. Among patients with Alzheimer's disease and cerebral amyloid angiopathy, plasma soluble TREM2 was independently associated with a tau-positive scan (P=0.001) and white matter hyperintensity volume (P=0.013), but not amyloid load (P=0.221). Our results indicate plasma soluble TREM2 is associated with white matter hyperintensity independent of amyloid and tau pathology. These findings highlight the potential utility of plasma soluble TREM2 as a strong predictive marker for small vessel disease-related white matter injury and hold clinical implications for targeting the innate immune response when treating this disease.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan.,Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Fang Chen
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department and Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Ling Lo
- Department of Neurology, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - Kai-Chien Yang
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, 3Medical Imaging, and 4Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Che-Feng Chang
- Department and Graduate Institute of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
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11
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Park M, Baik K, Lee YG, Kang SW, Jung JH, Jeong SH, Lee PH, Sohn YH, Ye BS. Implication of Small Vessel Disease MRI Markers in Alzheimer's Disease and Lewy Body Disease. J Alzheimers Dis 2021; 83:545-556. [PMID: 34366356 DOI: 10.3233/jad-210669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Small vessel disease (SVD) magnetic resonance imaging (MRI) markers including deep and periventricular white matter hyperintensities (PWMH), lacunes, and microbleeds are frequently observed in Alzheimer's disease (AD) and Lewy body disease (LBD), but their implication has not been clearly elucidated. OBJECTIVE To investigate the implication of SVD MRI markers in cognitively impaired patients with AD and/or LBD. METHODS We consecutively recruited 57 patients with pure AD-related cognitive impairment (ADCI), 49 with pure LBD-related cognitive impairment (LBCI), 45 with mixed ADCI/LBCI, and 34 controls. All participants underwent neuropsychological tests, brain MRI, and amyloid positron emission tomography. SVD MRI markers including the severity of deep and PWMH and the number of lacunes and microbleeds were visually rated. The relationships among vascular risk factors, SVD MRI markers, ADCI, LBCI, and cognitive scores were investigated after controlling for appropriate covariates. RESULTS LBCI was associated with more severe PWMH, which was conversely associated with an increased risk of LBCI independently of vascular risk factors and ADCI. PWMH was associated with attention and visuospatial dysfunction independently of vascular risk factors, ADCI, and LBCI. Both ADCI and LBCI were associated with more lobar microbleeds, but not with deep microbleeds. CONCLUSION Our findings suggest that PWMH could reflect degenerative process related with LBD, and both AD and LBD independently increase lobar microbleeds.
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Affiliation(s)
- Mincheol Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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De Sciscio M, De Sciscio P, Vallat W, Kleinig T. Cerebral microbleed distribution following cardiac surgery can mimic cerebral amyloid angiopathy. BMJ Neurol Open 2021; 3:e000166. [PMID: 34337413 PMCID: PMC8278881 DOI: 10.1136/bmjno-2021-000166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/24/2021] [Indexed: 01/15/2023] Open
Abstract
Background and aims Having anecdotally noted a high frequency of lobar-restricted cerebral microbleeds (CMBs) mimicking cerebral amyloid angiopathy (CAA) in patients with previous cardiac surgery (especially valve replacement) presenting to our transient ischaemic attack (TIA) clinic, we set out to objectively determine the frequency and distribution of microbleeds in this population. Methods We performed a retrospective comparative cohort study in consecutive patients presenting to two TIA clinics with either: (1) previous coronary artery bypass grafting (CABG) (n=41); (2) previous valve replacement (n=41) or (3) probable CAA (n=41), as per the Modified Boston Criteria, without prior cardiac surgery. Microbleed number and distribution was determined and compared. Results At least one lobar-restricted microbleed was found in the majority of cardiac surgery patients (65%) and 32/82 (39%) met diagnostic criteria for CAA. Valve replacement patients had a higher microbleed prevalence (90 vs 51%, p<0.01) and lobar-restricted microbleed count (2.6±2.7 vs 1.0±1.4, p<0.01) than post-CABG patients; lobar-restricted microbleed count in both groups was substantially less than in CAA patients (15.5±20.4, p<0.01). In postcardiac surgery patients, subcortical white matter (SWM) microbleeds were proportionally more frequent compared with CAA patients. Receiver operator curve analysis of a 'location-based' ratio (calculated as SWM/SWM+strictly-cortical CMBs), revealed an optimal ratio of 0.45 in distinguishing cardiac surgery-associated microbleeds from CAA (sensitivity 0.56, specificity 0.93, area under the curve 0.71). Conclusion Lobar-restricted microbleeds are common in patients with past cardiac surgery, however a higher proportion of these CMBs involve the SWM than in patients with CAA.
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Affiliation(s)
- Michele De Sciscio
- Neurology & Stroke, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul De Sciscio
- Biomedical Engineering, Cambridge University, Cambridge, Cambridgeshire, UK
| | - Wilson Vallat
- Neurology & Stroke, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Timothy Kleinig
- Neurology & Stroke, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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13
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Tsai HH, Pasi M, Tsai LK, Huang CC, Chen YF, Lee BC, Yen RF, Gurol ME, Jeng JS. Centrum Semiovale Perivascular Space and Amyloid Deposition in Spontaneous Intracerebral Hemorrhage. Stroke 2021; 52:2356-2362. [PMID: 33874751 DOI: 10.1161/strokeaha.120.032139] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei (H.-H.T.).,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei (H.-H.T.).,Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P.)
| | - Li-Kai Tsai
- Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Chi-Ching Huang
- School of Medicine, College of Medicine, National Taiwan University, Taipei (C.-C.H.)
| | - Ya-Fang Chen
- Department of Medical Imaging (Y.-F.C., B.-C.L.), National Taiwan University Hospital, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging (Y.-F.C., B.-C.L.), National Taiwan University Hospital, Taipei
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.E.G.)
| | - Jiann-Shing Jeng
- Department of Neurology (H.-H.T., L.-K.T., J.-S.J.), National Taiwan University Hospital, Taipei
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14
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Rotta J, Perosa V, Yakupov R, Kuijf HJ, Schreiber F, Dobisch L, Oltmer J, Assmann A, Speck O, Heinze HJ, Acosta-Cabronero J, Duzel E, Schreiber S. Detection of Cerebral Microbleeds With Venous Connection at 7-Tesla MRI. Neurology 2021; 96:e2048-e2057. [PMID: 33653897 DOI: 10.1212/wnl.0000000000011790] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Cerebral microbleeds (MBs) are a common finding in patients with cerebral small vessel disease (CSVD) and Alzheimer disease as well as in healthy elderly people, but their pathophysiology remains unclear. To investigate a possible role of veins in the development of MBs, we performed an exploratory study, assessing in vivo presence of MBs with a direct connection to a vein. METHODS 7-Tesla (7T) MRI was conducted and MBs were counted on quantitative susceptibility mapping (QSM). A submillimeter resolution QSM-based venogram allowed identification of MBs with a direct spatial connection to a vein. RESULTS A total of 51 people (mean age [SD] 70.5 [8.6] years, 37% female) participated in the study: 20 had CSVD (cerebral amyloid angiopathy [CAA] with strictly lobar MBs [n = 8], hypertensive arteriopathy [HA] with strictly deep MBs [n = 5], or mixed lobar and deep MBs [n = 7], 72.4 [6.1] years, 30% female) and 31 were healthy controls (69.4 [9.9] years, 42% female). In our cohort, we counted a total of 96 MBs with a venous connection, representing 14% of all detected MBs on 7T QSM. Most venous MBs (86%, n = 83) were observed in lobar locations and all of these were cortical. Patients with CAA showed the highest ratio of venous to total MBs (19%) (HA = 9%, mixed = 18%, controls = 5%). CONCLUSION Our findings establish a link between cerebral MBs and the venous vasculature, pointing towards a possible contribution of veins to CSVD in general and to CAA in particular. Pathologic studies are needed to confirm our observations.
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Affiliation(s)
- Johanna Rotta
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Valentina Perosa
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK.
| | - Renat Yakupov
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Hugo J Kuijf
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Frank Schreiber
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Laura Dobisch
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Jan Oltmer
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Anne Assmann
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Oliver Speck
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Hans-Jochen Heinze
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Julio Acosta-Cabronero
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Emrah Duzel
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
| | - Stefanie Schreiber
- From the Department of Neurology (J.R., V.P., F.S., A.A., H.-J.H., S.S.) and Institute of Physics (O.S.), Otto-von-Guericke University; Institute of Cognitive Neurology and Dementia Research (IKND) (V.P., R.Y., J.O., H.-J.H., E.D.), Magdeburg, Germany; J. Philip Kistler Stroke Research Center (V.P.), Massachusetts General Hospital, Boston; German Center for Neurodegenerative Diseases (DZNE) (R.Y., F.S., L.D., O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Leibniz-Institute for Neurobiology (LIN) (O.S., H.-J.H., E.D.); Center for Behavioral Brain Sciences (CBBS) (O.S., H.-J.H., E.D., S.S.), Magdeburg, Germany; Tenoke Limited (J.A.-C.), Cambridge, UK; and Institute of Cognitive Neuroscience (E.D.), University College London, UK
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Xu M, Li B, Zhong D, Cheng Y, Wu Q, Zhang S, Zhang S, Wu B, Liu M. Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years. Front Aging Neurosci 2021; 13:628271. [PMID: 33679377 PMCID: PMC7933464 DOI: 10.3389/fnagi.2021.628271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH). Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome. Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038). Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.
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Affiliation(s)
- Mangmang Xu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Baojin Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Di Zhong
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Yajun Cheng
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shuting Zhang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Shihong Zhang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China
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Tsai HH, Chen SJ, Tsai LK, Pasi M, Lo YL, Chen YF, Tang SC, Jeng JS. Long-Term Vascular Outcomes in Patients With Mixed Location Intracerebral Hemorrhage and Microbleeds. Neurology 2020; 96:e995-e1004. [PMID: 33361256 DOI: 10.1212/wnl.0000000000011378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether mixed location intracerebral hemorrhages/microbleeds (mixed ICH) is a risk factor for vascular unfavorable outcome compared to cerebral amyloid angiopathy-related ICH (CAA-ICH) or strictly deep hypertensive ICH/microbleeds (HTN-ICH). METHODS A total of 300 patients with spontaneous ICH were included. Clinical data, neuroimaging markers, and follow-up outcomes (recurrent ICH, ischemic stroke, and vascular death) were compared among mixed ICH (n = 148), CAA-ICH (n = 32), and HTN-ICH (n = 120). The association between follow-up events and neuroimaging markers was explored using multivariable Cox regression models. RESULTS Patients with mixed ICH were older (65.6 ± 12.1 years vs 58.1 ± 13.3 years, p < 0.001) than patients with HTN-ICH, but younger than patients with CAA-ICH (73.3 ± 13.8 years, p = 0.001). Compared to CAA-ICH, mixed ICH had similar incidence of vascular events (all p > 0.05). Compared to HTN-ICH, mixed ICH is associated with higher ICH recurrence (hazard ratio [HR] 3.0, 95% confidence interval [CI] 1.2-7.7), more ischemic stroke (HR 8.2, 95% CI 1.0-65.8), and vascular composite outcome (HR 3.5, 95% CI 1.5-8.2) after adjustment for age and sex. In patients with mixed ICH, the presence of cortical superficial siderosis (cSS) is associated the development of ICH recurrence (HR 4.8, 95% CI 1.0-23.2), ischemic stroke (HR 8.8, 95% CI 1.7-45.5), and vascular composite outcome (HR 6.2, 95% CI 1.9-20.2). The association between cSS and ischemic stroke (p = 0.01) or vascular composite outcome (p = 0.003) remained significant after further adjustment for other radiologic markers. CONCLUSIONS Mixed ICH harbors higher risk of unfavorable vascular outcome than HTN-ICH. Presence of cSS in mixed ICH independently predicts vascular event, suggesting the contribution of detrimental effect due to coexisting CAA.
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Affiliation(s)
- Hsin-Hsi Tsai
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France.
| | - Szu-Ju Chen
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
| | - Li-Kai Tsai
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France.
| | - Marco Pasi
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
| | - Yen-Ling Lo
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
| | - Ya-Fang Chen
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
| | - Sung-Chun Tang
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
| | - Jiann-Shing Jeng
- From the Department of Neurology (H.-H.T., S.-J.C., Y.-L.L.), National Taiwan University Hospital Bei-Hu Branch; Departments of Neurology (H.-H.T., S.-J.C., L.-K.T., S.-C.T., J.-S.J.) and Medical Imaging (Y.-F.C.) and Graduate Institute of Clinical Medicine (H.-H.T.), National Taiwan University College of Medicine and Hospital, Taipei; and U1172-LilNCog-Lille Neuroscience & Cognition (M.P.), CHU Lille, Inserm, Univ Lille, France
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Scheumann V, Schreiber F, Perosa V, Assmann A, Mawrin C, Garz C, Heinze HJ, Görtler M, Düzel E, Vielhaber S, Charidimou A, Schreiber S. MRI phenotyping of underlying cerebral small vessel disease in mixed hemorrhage patients. J Neurol Sci 2020; 419:117173. [PMID: 33068905 DOI: 10.1016/j.jns.2020.117173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate underlying cerebral small vessel disease (CSVD) in patients with mixed cerebral hemorrhages patterns and phenotype them according to the contribution of the two most common sporadic CSVD subtypes: cerebral amyloid angiopathy (CAA) vs. hypertensive arteriopathy (HA). METHODS Brain MRIs of patients with intracerebral hemorrhages (ICHs) and/or cerebral microbleeds (CMBs) were assessed for the full spectrum of CSVD markers using validated scales: ICHs, CMBs, cortical superficial siderosis (cSS), white matter hyperintensities, MRI-visible perivascular spaces (PVS). PVS predominance pattern was grouped as centrum-semiovale (CSO)-PVS predominance, basal-ganglia (BG)-PVS predominance, CSO-PVS and BG-PVS equality. Patients with mixed cerebral hemorrhages were classified into mixed CAA-pattern or mixed HA-pattern according to the existence of cSS and/or a CSO-PVS predominance pattern and comparisons were performed. RESULTS We included 110 patients with CAA (strictly lobar ICHs/CMBs), 33 with HA (strictly deep ICHs/CMBs) and 97 with mixed lobar/deep ICHs/CMBs. Mixed patients were more similar to HA with respect to their MRI-CSVD markers, vascular risk profile and cerebrospinal fluid (CSF) measures. In the mixed patients, 33 (34%) had cSS, a CSO-PVS predominance pattern, or both, and were defined as mixed CAA-pattern cases. The mixed CAA-pattern patients were more alike CAA patients regarding their MRI-CSVD markers, CSF and genetic profile. CONCLUSION Our findings suggest that the heterogeneous group of patients with mixed cerebral hemorrhages distribution can be further phenotyped according to the predominant underlying CSVD. cSS presence and a CSO-PVS predominance pattern could serve as strongly suggestive markers of a contribution from CAA among patients with mixed hemorrhages.
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Affiliation(s)
- Vincent Scheumann
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Frank Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Valentina Perosa
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, 175 Cambridge Street, Boston, MA 02114, USA.
| | - Anne Assmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Cornelia Garz
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany.
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Michael Görtler
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Leibniz Institute for Neurobiology (LIN), Brenneckestraße, 39118 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke-University Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
| | - Andreas Charidimou
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University, Leipziger Straße 44, 39120 Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Leipziger Straße 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Universitätsplatz 2, 39106 Magdeburg, Germany.
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Papanastasiou G, Rodrigues MA, Wang C, Heurling K, Lucatelli C, Salman RAS, Wardlaw JM, van Beek EJR, Thompson G. Pharmacokinetic modelling for the simultaneous assessment of perfusion and 18F-flutemetamol uptake in cerebral amyloid angiopathy using a reduced PET-MR acquisition time: Proof of concept. Neuroimage 2020; 225:117482. [PMID: 33157265 DOI: 10.1016/j.neuroimage.2020.117482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Cerebral amyloid angiopathy (CAA) is a cerebral small vessel disease associated with perivascular β-amyloid deposition. CAA is also associated with strokes due to lobar intracerebral haemorrhage (ICH). 18F-flutemetamol amyloid ligand PET may improve the early detection of CAA. We performed pharmacokinetic modelling using both full (0-30, 90-120 min) and reduced (30 min) 18F-flutemetamol PET-MR acquisitions, to investigate regional cerebral perfusion and amyloid deposition in ICH patients. METHODS Dynamic18F-flutemetamol PET-MR was performed in a pilot cohort of sixteen ICH participants; eight lobar ICH cases with probable CAA and eight deep ICH patients. A model-based input function (mIF) method was developed for compartmental modelling. mIF 1-tissue (1-TC) and 2-tissue (2-TC) compartmental modelling, reference tissue models and standardized uptake value ratios were assessed in the setting of probable CAA detection. RESULTS The mIF 1-TC model detected perfusion deficits and 18F-flutemetamol uptake in cases with probable CAA versus deep ICH patients, in both full and reduced PET acquisition time (all P < 0.05). In the reduced PET acquisition, mIF 1-TC modelling reached the highest sensitivity and specificity in detecting perfusion deficits (0.87, 0.77) and 18F-flutemetamol uptake (0.83, 0.71) in cases with probable CAA. Overall, 52 and 48 out of the 64 brain areas with 18F-flutemetamol-determined amyloid deposition showed reduced perfusion for 1-TC and 2-TC models, respectively. CONCLUSION Pharmacokinetic (1-TC) modelling using a 30 min PET-MR time frame detected impaired haemodynamics and increased amyloid load in probable CAA. Perfusion deficits and amyloid burden co-existed within cases with CAA, demonstrating a distinct imaging pattern which may have merit in elucidating the pathophysiological process of CAA.
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Affiliation(s)
- Giorgos Papanastasiou
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Chengjia Wang
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Christophe Lucatelli
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | | | - Joanna M Wardlaw
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Gerard Thompson
- Edinburgh Imaging Facility, Queen's Medical Research Institute, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Asymptomatic Striatocapsular slit-like Hemorrhage as a Severity Marker in Patients with Hypertensive Angiopathy. J Stroke Cerebrovasc Dis 2020; 29:105153. [PMID: 32912549 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Concomitant asymptomatic striatocapsular slit-like hemorrhage (SSH) is occasionally found in patients of spontaneous intracerebral hemorrhage (ICH), but was seldomly described in the literature. In this study, we described the clinico-radiological features of asymptomatic SSH in ICH patients with hypertensive microangiopathy. METHODS AND RESULTS 246 patients with strictly deep or mixed deep and lobar ICH/microbleeds were included. SSH was defined as hypointense lesions involving the lateral aspect of lentiform nucleus or external capsule in slit shape (>1.5 cm) on susceptibility-weighted imaging without history of associated symptoms. Demographics and neuroimaging markers were compared between patients with SSH and those without. Patients with SSH (n=24, 10%) and without SSH had comparable age (62.0 ± 12.6 vs. 62.3 ± 13.5, p = 0.912) and vascular risk factor profiles including the diagnosis of chronic hypertension, diabetes, and dyslipidemia (all p>0.05). SSH was associated with more common lobar microbleeds (79.2% vs 48.2%, p = 0.005), lacunes (75% vs. 41.4%, p = 0.002) and higher white matter hyperintensity (WMH) volumes (24.1 [10.4-46.3] vs. 13.9 [7.0-24.8] mL, p = 0.012) on MRI, as well as more frequent left ventricular hypertrophy (LVH) (50.0% vs. 20.5%, p = 0.004) and albuminuria (41.7% vs. 19.4%, p = 0.018). In multivariable analyses, SSH remains independently associated with LVH (p = 0.017) and albuminuria (p = 0.032) after adjustment for age, sex, microbleed, lacune and WMH volume. CONCLUSIONS Asymptomatic SSH is associated with more severe cerebral small vessel disease-related change on brain MRI, and hypertensive cardiac and renal injury, suggesting a more advanced stage of chronic hypertension.
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Jensen-Kondering UR, Weiler C, Langguth P, Larsen N, Flüh C, Kuhlenbäumer G, Jansen O, Margraf NG. Clinical and radiological differences between patients with probable cerebral amyloid angiopathy and mixed cerebral microbleeds. J Neurol 2020; 267:3602-3608. [PMID: 32638111 PMCID: PMC7674181 DOI: 10.1007/s00415-020-10038-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The key imaging features of cerebral amyloid angiopathy (CAA) are lobar, cortical, or cortico-subcortical microbleeds, macrohaemorrhages and cortical superficial siderosis (cSS). In contrast, hypertensive angiopathy is characterized by (micro) haemorrhages in the basal ganglia, thalami, periventricular white matter or the brain stem. Another distinct form of haemorrhagic microangiopathy is mixed cerebral microbleeds (mixed CMB) with features of both CAA and hypertensive angiopathy. The distinction between the two entities (CAA and mixed CMB) is clinically relevant because the risk of haemorrhage and stroke should be well balanced if oral anticoagulation is indicated in CAA patients. We aimed to comprehensively compare these two entities. METHODS Patients with probable CAA according to the modified Boston criteria and mixed CMB without macrohaemorrhage were retrospectively identified from our database. Comprehensive comparison regarding clinical and radiological parameters was performed between the two cohorts. RESULTS Patients with CAA were older (78 ± 8 vs. 74 ± 9 years, p = 0.036) and had a higher prevalence of cSS (19% vs. 4%, p = 0.027) but a lower prevalence of lacunes (73% vs. 50%, p = 0.018) and deep lacunes (23% vs. 51%, p = 0.0003) compared to patients with mixed CMB. Logistic regression revealed an association between the presence of deep lacunes and mixed CMB. The other collected parameters did not reveal a significant difference between the two groups. CONCLUSIONS CAA and mixed CMB demonstrate radiological differences in the absence of macrohaemorrhages. However, more clinically available biomarkers are needed to elucidate the contribution of CAA and hypertensive angiopathy in mixed CMB patients.
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Affiliation(s)
- Ulf R Jensen-Kondering
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Caroline Weiler
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Patrick Langguth
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Nils G Margraf
- Department of Neurology, University of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
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21
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Chung CP, Chen JW, Chang FC, Li WC, Lee YC, Chen LF, Liao YC. Cerebral Microbleed Burdens in Specific Brain Regions Are Associated With Disease Severity of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. J Am Heart Assoc 2020; 9:e016233. [PMID: 32552418 PMCID: PMC7670534 DOI: 10.1161/jaha.120.016233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, caused by NOTCH3 mutations, is characterized by recurrent ischemic strokes and progressive cognitive decline. It remains unclear whether cerebral microbleeds (CMBs) can serve as a surrogate marker for disease progression in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. We aimed to investigate the CMB burdens in NOTCH3 mutation carriers at different disease stages and test their associations with cognitive performance. Methods and Results Forty‐nine individuals carrying NOTCH3 cysteine‐altering mutations received brain magnetic resonance imaging with T1‐weighted and susceptibility‐weighted images. Whole brain images were segmented into 14 regions using Statistical Parametric Mapping and FreeSurfer software, and semiautomatic methods were used to locate and quantify the number and volume of CMBs. In our study participants, the median of CMB counts was 13, with a wide individual variation (range, 0–286). CMBs were most frequently present in thalamus, followed by temporal lobe. In the whole brain, the CMB counts and CMB volume ratios (ie, CMB volume divided by the volume of corresponding brain region) gradually increased as the disease advanced. CMB counts in the thalamus and temporal and frontal lobes increased more rapidly than other brain regions as disease progressed. There were significant associations between Mini‐Mental State Examination scores and CMB counts in the frontal lobe, temporal lobe, and pons. Conclusions CMBs may have an influential role in the clinical manifestations of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. CMB burdens and their distribution in different brain regions may be capable to serve as a disease marker for monitoring the disease severity of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
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Affiliation(s)
- Chih-Ping Chung
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming University Taipei Taiwan.,Brain Research Center National Yang-Ming University Taipei Taiwan
| | - Jiun-Wei Chen
- Institute of Brain Science and Institute of Biomedical Informatics National Yang-Ming University Taipei Taiwan
| | - Feng-Chi Chang
- Department of Radiology Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming University Taipei Taiwan
| | - Wei-Chi Li
- Institute of Brain Science and Institute of Biomedical Informatics National Yang-Ming University Taipei Taiwan
| | - Yi-Chung Lee
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming University Taipei Taiwan.,Brain Research Center National Yang-Ming University Taipei Taiwan
| | - Li-Fen Chen
- Integrated Brain Research Laboratory Department of Medical Research Taipei Veterans General Hospital Taipei Taiwan.,Institute of Brain Science and Institute of Biomedical Informatics National Yang-Ming University Taipei Taiwan.,Brain Research Center National Yang-Ming University Taipei Taiwan
| | - Yi-Chu Liao
- Department of Neurology Neurological Institute Taipei Veterans General Hospital Taipei Taiwan.,School of Medicine National Yang-Ming University Taipei Taiwan.,Brain Research Center National Yang-Ming University Taipei Taiwan
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22
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Chiu WT, Lee TY, Chan L, Wu D, Huang LK, Chen DYT, Lee YT, Hu CJ, Hong CT. Deep cerebral microbleeds are associated with poor cholinesterase inhibitor treatment response in people with Alzheimer disease. Clin Neurol Neurosurg 2020; 195:105959. [PMID: 32480198 DOI: 10.1016/j.clineuro.2020.105959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cholinesterase inhibitors (ChEIs) are the most effective treatment for Alzheimer disease (AD), but the response to treatment varies. Vascular lesions are associated with the pathogenesis of AD, and cerebral microbleeds (CMBs) are an indicator of hemorrhagic vascular pathology, which can be detected through susceptibility-weighted magnetic resonance imaging (SWMRI). This study investigated the association between CMBs and ChEI treatment response in patients with AD. PATIENTS AND METHODS We reviewed the medical records of 112 Taiwanese people with mild to moderate AD and at least 2 years of ChEI treatment between 2009 and 2016. Their baseline CMBs were quantified using the Microbleed Anatomical Rating Scale on SWMRI. Cognitive function of the patients was assessed using the Mini-Mental State Examination (MMSE) and Cognitive Abilities Screening Instrument (CASI). Student t test and multivariable logistic regression were used to analyze the association between cognitive decline and CMBs. RESULTS The mean age of the study population was 76.0 ± 8.0 years. In total, 79 out of 112 patients were women. The presence of deep, but not lobar CMBs at baseline was associated with a significant cognitive decline according to the MMSE and CASI, particularly in long-term memory, attention, orientation, mental manipulation, and verbal fluency. Among deep CMBs, those in the basal ganglia and thalamus were significantly associated with cognitive decline. CONCLUSIONS Deep CMBs, particularly those in the basal ganglia and thalamus, but not lobar CMBs, are associated with poor response to ChEI treatment in people with AD. This can serve as a biomarker for predicting ChEI treatment response.
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Affiliation(s)
- Wei Ting Chiu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ting Yi Lee
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Dean Wu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li Kai Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - David Yen-Ting Chen
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao Tung Lee
- Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur Jong Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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23
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Planton M, Pariente J, Nemmi F, Albucher JF, Calviere L, Viguier A, Olivot JM, Salabert AS, Payoux P, Peran P, Raposo N. Interhemispheric distribution of amyloid and small vessel disease burden in cerebral amyloid angiopathy-related intracerebral hemorrhage. Eur J Neurol 2020; 27:1664-1671. [PMID: 32394598 DOI: 10.1111/ene.14301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) is a devastating presentation of cerebral amyloid angiopathy (CAA), but the mechanisms leading from vascular amyloid deposition to ICH are not well known. Whether amyloid burden and magnetic resonance imaging (MRI) markers of small vessel disease (SVD) are increased in the ICH-affected hemisphere compared to the ICH-free hemisphere in patients with a symptomatic CAA-related ICH was investigated. METHODS Eighteen patients with CAA-related ICH and 18 controls with deep ICH who underwent brain MRI and amyloid positron emission tomography using 18 F-florbetapir were prospectively enrolled. In each hemisphere amyloid uptake using the standardized uptake value ratio and the burden of MRI markers of SVD including cerebral microbleeds, chronic ICH, cortical superficial siderosis, white matter hyperintensities and lacunes were evaluated. Interhemispheric comparisons were assessed by non-parametric matched-pair tests within each patient group. RESULTS Amyloid burden was similarly distributed across the brain hemispheres in patients with CAA-related ICH (standardized uptake value ratio 1.11 vs. 1.12; P = 0.74). Cortical superficial siderosis tended to be more common in the ICH-affected hemisphere compared to the ICH-free hemisphere (61% vs. 33%; P = 0.063). Other MRI markers of SVD did not differ across brain hemispheres. In controls with deep ICH, no interhemispheric difference was observed either for amyloid burden or for MRI markers of SVD. CONCLUSIONS Brain hemorrhage does not appear to be directly linked to amyloid burden in patients with CAA-related ICH. These findings provide new insights into the mechanisms leading to hemorrhage in CAA.
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Affiliation(s)
- M Planton
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J Pariente
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - F Nemmi
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J-F Albucher
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - L Calviere
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - A Viguier
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - J-M Olivot
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - A-S Salabert
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Imaging Center, Toulouse University Hospital, Toulouse, France
| | - P Payoux
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Nuclear Medicine, Imaging Center, Toulouse University Hospital, Toulouse, France
| | - P Peran
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - N Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France.,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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24
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Hui L, Soliman ML, Geiger NH, Miller NM, Afghah Z, Lakpa KL, Chen X, Geiger JD. Acidifying Endolysosomes Prevented Low-Density Lipoprotein-Induced Amyloidogenesis. J Alzheimers Dis 2020; 67:393-410. [PMID: 30594929 DOI: 10.3233/jad-180941] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cholesterol dyshomeostasis has been linked to the pathogenesis of sporadic Alzheimer's disease (AD). In furthering the understanding of mechanisms by which increased levels of circulating cholesterol augments the risk of developing sporadic AD, others and we have reported that low-density lipoprotein (LDL) enters brain parenchyma by disrupting the blood-brain barrier and that endolysosome de-acidification plays a role in LDL-induced amyloidogenesis in neurons. Here, we tested the hypothesis that endolysosome de-acidification was central to amyloid-β (Aβ) generation and that acidifying endolysosomes protects against LDL-induced increases in Aβ levels in neurons. We demonstrated that LDL, but not HDL, de-acidified endolysosomes and increased intraneuronal and secreted levels of Aβ. ML-SA1, an agonist of endolysosome-resident TRPML1 channels, acidified endolysosomes, and TRPML1 knockdown attenuated ML-SA1-induced endolysosome acidification. ML-SA1 blocked LDL-induced increases in intraneuronal and secreted levels of Aβ as well as Aβ accumulation in endolysosomes, prevented BACE1 accumulation in endolysosomes, and decreased BACE1 activity levels. LDL downregulated TRPML1 protein levels, and TRPML1 knockdown worsens LDL-induced increases in Aβ. Our findings suggest that endolysosome acidification by activating TRPML1 may represent a protective strategy against sporadic AD.
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Affiliation(s)
- Liang Hui
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Mahmoud L Soliman
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Nicholas H Geiger
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Nicole M Miller
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Zahra Afghah
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Koffi L Lakpa
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Xuesong Chen
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Jonathan D Geiger
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
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25
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Tsai LK, Chen PL, Tsai HH, Chen YF, Wu PC, Jeng JS, Huang JW, Chu TS, Tze-Wah Kao J. Cerebral Microbleeds in Autosomal Dominant Polycystic Kidney Disease. J Stroke 2020; 22:153-156. [PMID: 32027801 PMCID: PMC7005356 DOI: 10.5853/jos.2019.02838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Lung Chen
- Department of Medical Genetics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Ya-Fang Chen
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Medical Imaging, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Ping-Chun Wu
- Graduate Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Wen Huang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzong-Shinn Chu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Juliana Tze-Wah Kao
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, FuJen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
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26
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Tsai HH, Pasi M, Tsai LK, Chen YF, Chen YW, Tang SC, Gurol ME, Yen RF, Jeng JS. Superficial Cerebellar Microbleeds and Cerebral Amyloid Angiopathy. Stroke 2020; 51:202-208. [PMID: 31726962 DOI: 10.1161/strokeaha.119.026235] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The differentiation between cerebral amyloid angiopathy (CAA) and hypertensive small vessel disease in primary intracerebral hemorrhage is mainly based on hemorrhagic neuroimaging markers in the supratentorial regions, and the cause for cerebellar microbleeds remains unknown. Our aim was to investigate whether superficial cerebellar microbleeds are more likely to be related to CAA rather than hypertensive small vessel disease.
Methods—
Two hundred seventy-five consecutive patients with intracerebral hemorrhage were retrospectively reviewed from a prospectively maintained hospital-based stroke registry. Eighty-five (33.1%) patients had cerebellar microbleeds and were categorized into superficial (gray matter, vermis), deep (white matter, deep nucleus, cerebellar peduncle), or mixed type based on the location of cerebellar hemorrhagic lesions. Amyloid imaging was obtained using 11C-Pittsburgh Compound B–positron emission tomography in a subgroup of patients. The associations between cerebellar microbleed locations and the type of small vessel disease (CAA versus hypertensive small vessel disease) based on distribution of supratentorial hemorrhagic lesions as well as other magnetic resonance imaging and positron emission tomography markers were analyzed.
Results—
The presence of cerebellar microbleed was independently associated with supratentorial microbleed and lacunar infarcts (both
P
<0.01). Strictly superficial cerebellar microbleeds were significantly related to CAA–intracerebral hemorrhage, cortical superficial siderosis and high-grade enlarged perivascular space in centrum semiovale (all
P
<0.05); deep or mixed cerebellar microbleeds were related to hypertension and deep microbleed (all
P
<0.05). In multivariable models, superficial cerebellar microbleeds were independently associated with CAA–intracerebral hemorrhage (
P
=0.03). Of 33 patients assessed by amyloid positron emission tomography, cerebral and cerebellar amyloid load (standardized uptake value ratio) was higher in patients with superficial cerebellar microbleeds compared with deep/mixed cerebellar microbleeds (cerebrum standardized uptake value ratio [reference: cerebellum] 1.33±0.24 versus 1.05±0.09,
P
<0.001; cerebellum standardized uptake value ratio [reference: pons] 0.58±0.08 versus 0.51±0.09,
P
=0.03).
Conclusions—
Patients with strictly superficial cerebellar microbleeds are associated with a clinicoradiological diagnosis of CAA as well as increased cerebral and cerebellar amyloid deposition on Pittsburgh Compound B–positron emission tomography, suggesting underlying CAA pathology.
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Affiliation(s)
- Hsin-Hsi Tsai
- From the Departments of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei (H.-H.T.)
- Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Marco Pasi
- Univ-Lille, Inserm U1171, CHU Lille (Department of Neurology, Stroke Unit), France (M.P.)
| | - Li-Kai Tsai
- Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Ya-Fang Chen
- Department of Medical Imaging (Y.-F.C.), National Taiwan University Hospital, Taipei
| | - Yu-Wei Chen
- Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
- Department of Neurology, Landseed International Hospital, Taoyuan (Y.-W.C.)
| | - Sung-Chun Tang
- Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - M. Edip Gurol
- Graduate institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei (H.-H.T.)
- Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (M.E.G.)
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei
| | - Jiann-Shing Jeng
- Departments of Neurology (H.-H.T., L.-K.T., Y.-W.C., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
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27
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Correlation between visual association memory test and structural changes in patients with Alzheimer's disease and amnestic mild cognitive impairment. J Formos Med Assoc 2019; 118:1325-1332. [DOI: 10.1016/j.jfma.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 11/09/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022] Open
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28
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Schelle J, Wegenast-Braun BM, Fritschi SK, Kaeser SA, Jährling N, Eicke D, Skodras A, Beschorner N, Obermueller U, Häsler LM, Wolfer DP, Mueggler T, Shimshek DR, Neumann U, Dodt HU, Staufenbiel M, Jucker M. Early Aβ reduction prevents progression of cerebral amyloid angiopathy. Ann Neurol 2019; 86:561-571. [PMID: 31359452 DOI: 10.1002/ana.25562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Clinical trials targeting β-amyloid peptides (Aβ) for Alzheimer disease (AD) failed for arguable reasons that include selecting the wrong stages of AD pathophysiology or Aβ being the wrong target. Targeting Aβ to prevent cerebral amyloid angiopathy (CAA) has not been rigorously followed, although the causal role of Aβ for CAA and related hemorrhages is undisputed. CAA occurs with normal aging and to various degrees in AD, where its impact and treatment is confounded by the presence of parenchymal Aβ deposition. METHODS APPDutch mice develop CAA in the absence of parenchymal amyloid, mimicking hereditary cerebral hemorrhage with amyloidosis Dutch type (HCHWA-D). Mice were treated with a β-site amyloid precursor protein cleaving enzyme 1 (BACE1) inhibitor. We used 3-dimensional ultramicroscopy and immunoassays for visualizing CAA and assessing Aβ in cerebrospinal fluid (CSF) and brain. RESULTS CAA onset in mice was at 22 to 24 months, first in frontal leptomeningeal and superficial cortical vessels followed by vessels penetrating the cortical layers. CSF Aβ increased with aging followed by a decrease of both Aβ40 and Aβ42 upon CAA onset, supporting the idea that combined reduction of CSF Aβ40 and Aβ42 is a specific biomarker for vascular amyloid. BACE1 inhibitor treatment starting at CAA onset and continuing for 4 months revealed a 90% Aβ reduction in CSF and largely prevented CAA progression and associated pathologies. INTERPRETATION This is the first study showing that Aβ reduction at early disease time points largely prevents CAA in the absence of parenchymal amyloid. Our observation provides a preclinical basis for Aβ-reducing treatments in patients at risk of CAA and in presymptomatic HCHWA-D. ANN NEUROL 2019;86:561-571.
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Affiliation(s)
- Juliane Schelle
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Bettina M Wegenast-Braun
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sarah K Fritschi
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Stephan A Kaeser
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nina Jährling
- TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Daniel Eicke
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Angelos Skodras
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Natalie Beschorner
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulrike Obermueller
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lisa M Häsler
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - David P Wolfer
- Institute of Anatomy, University of Zürich, Zürich, Switzerland
| | - Thomas Mueggler
- Institute for Biomedical Engineering, University and Swiss Federal Institute for Technology, Zürich, Switzerland
| | | | - Ulf Neumann
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Hans-Ulrich Dodt
- TU Wien, Vienna, Austria.,Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Matthias Staufenbiel
- Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Mathias Jucker
- German Center for Neurodegenerative Diseases, Tübingen, Germany.,Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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29
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Wang PN, Chou KH, Peng LN, Liu LK, Lee WJ, Chen LK, Lin CP, Chung CP. Strictly Lobar Cerebral Microbleeds Are Associated with Increased White Matter Volume. Transl Stroke Res 2019; 11:29-38. [DOI: 10.1007/s12975-019-00704-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/21/2019] [Accepted: 03/28/2019] [Indexed: 12/17/2022]
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30
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Sheikh-Bahaei N, Manavaki R, Sajjadi SA, Priest AN, O’Brien JT, Gillard JH. Correlation of Lobar Cerebral Microbleeds with Amyloid, Perfusion, and Metabolism in Alzheimer’s Disease. J Alzheimers Dis 2019; 68:1489-1497. [DOI: 10.3233/jad-180443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Nasim Sheikh-Bahaei
- Department of Radiology, Keck School of Medicine of USC, University of Southern California, USA
| | - Roido Manavaki
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S. Ahmad Sajjadi
- Department of Neurology, University of California Irvine, CA, USA
| | - Andrew N. Priest
- Department of Radiology, Cambridge University Hospitals, Cambridge, UK
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan H. Gillard
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge, UK
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31
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Tsai HH, Pasi M, Tsai LK, Chen YF, Lee BC, Tang SC, Fotiadis P, Huang CY, Yen RF, Jeng JS, Gurol ME. Microangiopathy underlying mixed-location intracerebral hemorrhages/microbleeds: A PiB-PET study. Neurology 2019; 92:e774-e781. [PMID: 30674594 PMCID: PMC6396971 DOI: 10.1212/wnl.0000000000006953] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 10/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that patients with concomitant lobar and deep intracerebral hemorrhages/microbleeds (mixed ICH) have predominantly hypertensive small vessel disease (HTN-SVD) rather than cerebral amyloid angiopathy (CAA), using in vivo amyloid imaging. METHODS Eighty Asian patients with primary ICH without dementia were included in this cross-sectional study. All patients underwent brain MRI and 11C-Pittsburgh compound B (PiB)-PET imaging. The mean cortical standardized uptake value ratio (SUVR) was calculated using cerebellum as reference. Forty-six patients (57.5%) had mixed ICH. Their demographic and clinical profile as well as amyloid deposition patterns were compared to those of 13 patients with CAA-ICH and 21 patients with strictly deep microbleeds and ICH (HTN-ICH). RESULTS Patients with mixed ICH were younger (62.8 ± 11.7 vs 73.3 ± 11.9 years in CAA, p = 0.006) and showed a higher rate of hypertension than patients with CAA-ICH (p < 0.001). Patients with mixed ICH had lower PiB SUVR than patients with CAA (1.06 [1.01-1.13] vs 1.43 [1.06-1.58], p = 0.003). In a multivariable logistic regression model, mixed ICH was associated with hypertension (odds ratio 8.9, 95% confidence interval 1.4-58.4, p = 0.02) and lower PiB SUVR (odds ratio 0.03, 95% confidence interval 0.001-0.87, p = 0.04) compared to CAA after adjustment for age. Compared to HTN-ICH, mixed ICH showed a similar mean age (62.8 ± 11.7 vs 60.1 ± 14.5 years in HTN-ICH) and risk factor profile (all p > 0.1). Furthermore, PiB SUVR did not differ between mixed ICH (values presented above) and HTN-ICH (1.10 [1.00-1.16], p = 0.45). CONCLUSIONS Patients with mixed ICH have much lower amyloid load than patients with CAA-ICH, while being similar to HTN-ICH. Overall, mixed ICH is probably caused by HTN-SVD, an important finding with clinical relevance.
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Affiliation(s)
- Hsin-Hsi Tsai
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
| | - Marco Pasi
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Li-Kai Tsai
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
| | - Ya-Fang Chen
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Bo-Ching Lee
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Sung-Chun Tang
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Panagiotis Fotiadis
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Chen-Yu Huang
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Ruoh-Fang Yen
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - Jiann-Shing Jeng
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei
| | - M Edip Gurol
- From the Department of Neurology (H.H.T.), National Taiwan University Hospital Bei-Hu Branch, Taipei; Departments of Neurology (H.H.T., L.-K.T., S.-C.T., J.-S.J.), Medical Imaging (Y.-F.C., B.-C.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; Department of Neurology (M.P., P.F., M.E.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA; Graduate Institute of Clinical Medicine (H.H.T.) and Division of Cardiology (C.-Y.H.), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei.
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Rostowsky KA, Maher AS, Irimia A. Macroscale White Matter Alterations Due to Traumatic Cerebral Microhemorrhages Are Revealed by Diffusion Tensor Imaging. Front Neurol 2018; 9:948. [PMID: 30483210 PMCID: PMC6243111 DOI: 10.3389/fneur.2018.00948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/23/2018] [Indexed: 12/02/2022] Open
Abstract
With the advent of susceptibility-weighted imaging (SWI), the ability to identify cerebral microbleeds (CMBs) associated with mild traumatic brain injury (mTBI) has become increasingly commonplace. Nevertheless, the clinical significance of post-traumatic CMBs remains controversial partly because it is unclear whether mTBI-related CMBs entail brain circuitry disruptions which, although structurally subtle, are functionally significant. This study combines magnetic resonance and diffusion tensor imaging (MRI and DTI) to map white matter (WM) circuitry differences across 6 months in 26 healthy control volunteers and in 26 older mTBI victims with acute CMBs of traumatic etiology. Six months post-mTBI, significant changes (p < 0.001) in the mean fractional anisotropy of perilesional WM bundles were identified in 21 volunteers, and an average of 47% (σ = 21%) of TBI-related CMBs were associated with such changes. These results suggest that CMBs can be associated with lasting changes in perilesional WM properties, even relatively far from CMB locations. Future strategies for mTBI care will likely rely on the ability to assess how subtle circuitry changes impact neural/cognitive function. Thus, assessing CMB effects upon the structural connectome can play a useful role when studying CMB sequelae and their potential impact upon the clinical outcome of individuals with concussion.
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Affiliation(s)
| | | | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, USC Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
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Wu BN, Wu J, Hao DL, Mao LL, Zhang J, Huang TT. High serum sICAM-1 is correlated with cerebral microbleeds and hemorrhagic transformation in ischemic stroke patients. Br J Neurosurg 2018; 32:631-636. [PMID: 30392400 DOI: 10.1080/02688697.2018.1518515] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Object: Intercellular adhesion molecule 1 (ICAM-1) is an adhesive protein involved in inflammatory responses and endothelial dysfunction. ICAM-1 expression is upregulated in cerebrovascular tissue affected by stroke. We investigated whether serum soluble ICAM-1 (sICAM-1) levels are associated with cerebral microbleeds (CMBs) and risk of hemorrhagic transformation (HT).Methods: 148 patients with acute ischemic stroke were enrolled. Serum sICAM-1 levels were measured and compared between patients and healthy controls. Multivariate logistic regression analysis was performed to estimate the relationship between serum sICAM-1 levels and the HT risk.Results: Serum sICAM-1 levels were significantly higher in ischemic stroke patients compared with healthy controls (p < .001), and higher in patients with CMBs (n = 81) compared with patients without CMBs (n = 67) (p < .001). Patients with high sICAM-1 levels (≥250.5 ng/mL) were more likely to have hypertension, diabetes mellitus, previous stroke, and CMBs compared with patients with low sICAM-1 levels. In stroke patients with CMBs, higher serum sICAM-1 levels were independently associated with increased HT risk.Conclusion: Serum sICAM-1 levels are associated with presence of CMBs and increased risk of HT in ischemic stroke patients.
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Affiliation(s)
- Bo-Na Wu
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
| | - Jing Wu
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
| | - Dong-Lin Hao
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
| | - Lun-Lin Mao
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
| | - Jin Zhang
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
| | - Ting-Ting Huang
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, People's Republic of China
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Cerebral small vessel disease burden and functional and radiographic outcomes in intracerebral hemorrhage. J Neurol 2018; 265:2803-2814. [PMID: 30242743 DOI: 10.1007/s00415-018-9059-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the effect of individual cerebral small vessel disease (CSVD) markers and cumulative CSVD burden on functional independence, ambulation and hematoma expansion in spontaneous intracerebral hemorrhage (ICH). METHODS Retrospective analysis of prospectively collected data from an observational study of consecutive patients with spontaneous ICH, brain MRI within 1 month from ictus, premorbid modified Rankin Scale (mRS) score ≤ 2, available imaging data and 90-day functional status in a tertiary academic center. Functional outcomes included 90-day functional independence (mRS ≤ 2) and independent ambulation; radiographic outcome was hematoma expansion (> 12.5 ml absolute or > 33% relative increase in ICH volume). We identified the presence and burden of individual CSVD markers (cerebral microbleeds (CMBs), enlarged perivascular spaces, lacunes, white matter hyperintensities) and composite CSVD burden score and explored their association with outcomes of interest in multivariable models adjusting for well-established confounders. RESULTS 111 patients were included, 65% lobar ICH, with a median volume 20.8 ml. 43 (38.7%) achieved functional independence and 71 (64%) independent ambulation. In multivariable adjusted models, there was higher total CSVD burden (OR 0.61, 95% CI 0.37-0.96, p = 0.03) and CMBs presence (OR 0.32, 95% CI 0.1-0.88, p = 0.04) remained independently inversely associated with functional independence. Individual CSVD markers or total CSVD score had no significant relation with ambulation and ICH expansion. Larger ICH volume and deep ICH location were the major determinants of lack of independent ambulation. CONCLUSIONS Our findings suggest that in ICH patients without previous functional dependence, total CSVD burden and particularly presence of CMBs significantly affect functional recovery. The latter is a novel finding and merits further exploration.
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Charidimou A, Farid K, Tsai HH, Tsai LK, Yen RF, Baron JC. Amyloid-PET burden and regional distribution in cerebral amyloid angiopathy: a systematic review and meta-analysis of biomarker performance. J Neurol Neurosurg Psychiatry 2018; 89:410-417. [PMID: 29070646 DOI: 10.1136/jnnp-2017-316851] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/28/2017] [Accepted: 10/02/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We performed a meta-analysis to synthesise current evidence on amyloid-positron emission tomography (PET) burden and presumed preferential occipital distribution in sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic search, we identified case-control studies with extractable data on global and occipital-to-global amyloid-PET uptake in symptomatic patients with CAA (per Boston criteria) versus control groups (healthy participants or patients with non-CAA deep intracerebral haemorrhage) and patients with Alzheimer's disease. To circumvent PET studies' methodological variation, we generated and used 'fold change', that is, ratio of mean amyloid uptake (global and occipital-to-global) of CAA relative to comparison groups. Amyloid-PET uptake biomarker performance was then quantified by random-effects meta-analysis on the ratios of the means. A ratio >1 indicates that amyloid-PET uptake (global or occipital/global) is higher in CAA than comparison groups, and a ratio <1 indicates the reverse. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 138 controls (96 healthy elderly, 42 deep intracerebral haemorrhage controls) and 72 patients with Alzheimer's disease, were included. Global amyloid-PET ratio between patients with CAA and controls was above 1, with an average effect size of 1.18 (95% CI 1.08 to 1.28; p<0.0001). Occipital-to-global amyloid-PET uptake ratio did not differ between patients with CAA versus patients with deep intracerebral haemorrhage or healthy controls. By contrast, occipital-to-global amyloid-PET uptake ratio was above 1 in patients with CAA versus those with Alzheimer's disease, with an average ratio of 1.10 (95% CI 1.03 to 1.19; p=0.009) and high statistical heterogeneity. CONCLUSIONS Our analysis provides exploratory actionable data on the overall effect sizes and strength of amyloid-PET burden and distribution in patients with CAA, useful for future larger studies.
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Group, Department of Neurology, J Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karim Farid
- Department of Nuclear Medicine, Martinique University Hospital, Fort-de-France, French West Indies
| | - Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Rouh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
| | - Jean-Claude Baron
- Department of Neurology, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
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Ni R, Chu L, Xu D, Li Y, Li Y, Zhang Y, You M, Zhu Y, Ouyang F, Zhang J, Cai G, Lin X, Yang Z, Gao Z. Risk factors of cerebral microbleeds in young and middle-aged patients with hypertension. Neurol Res 2018; 40:413-418. [PMID: 29569524 DOI: 10.1080/01616412.2018.1451268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective This study aimed to investigate the incidence and related risk factors of cerebral microbleeds (CMBs) in young and middle-aged patients with hypertension. Methods The study included 232 young and middle-aged (18-59 years-old) patients with hypertension from September 2014 to December 2016 in the Department of Neurology, Affiliated Hospital of Guizhou Medical University, China. The data were recorded which included demographics, vascular risk factors, medication history, and imaging data of patients. CMBs were evaluated based on the microbleeds anatomical rating scale. Results Of the enrolled participants, 115 were CMB positive, accounting for 49.6%. CMBs were more prone to occur in deep regions than in others (39.13%). Multiple cerebral microbleeds were associated with white matter hyperintensities(WMH), dyslipidemia, hyperhomocysteine, and uric acid. Moreover, WMH, dyslipidemia, ever smoker, antiplatelets use, and hyperhomocysteine were found to be risk factors for deep or infratentorial CMBs in young and middle-aged patients with hypertension. However, the lobar CMBs only had an independent correlation with dyslipidemia in these participants. Conclusions The incidence of CMBs in patients with hypertension was relatively high. It mostly occurred in a deep or infratentorial area with more vascular-associated risk factors. However, in patients with lobar CMBs, factors associated with lipid metabolism, such as amyloid deposition and unidentified genotype variation, may be crucial. Screening and regular follow-ups of CMBs by Susceptibility Weighted Imaging and active prevention in young and middle-aged patients with hypertension have clinical significance for timely understanding and predicting the occurrence and development of related cerebrovascular disease events.
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Affiliation(s)
- Ruihan Ni
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Lan Chu
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Dafei Xu
- b Department of Neurology , Tiankang Hospital of Tianchang , Anhui , China
| | - Ya Li
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Yuan Li
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Yifan Zhang
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Mingyao You
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Yingwu Zhu
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Fu Ouyang
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Jiayan Zhang
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Gang Cai
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Xiang Lin
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Zhang Yang
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
| | - Zidan Gao
- a Department of Neurology , The Affiliated Hospital of GuiZhou Medical University , Guizhou , China
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Greenberg SM, Charidimou A. Diagnosis of Cerebral Amyloid Angiopathy: Evolution of the Boston Criteria. Stroke 2018; 49:491-497. [PMID: 29335334 PMCID: PMC5892842 DOI: 10.1161/strokeaha.117.016990] [Citation(s) in RCA: 275] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/30/2017] [Accepted: 12/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Steven M Greenberg
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston.
| | - Andreas Charidimou
- From the Department of Neurology, Massachusetts General Hospital Stroke Research Center, Boston
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Charidimou A, Farid K, Baron JC. Amyloid-PET in sporadic cerebral amyloid angiopathy: A diagnostic accuracy meta-analysis. Neurology 2017; 89:1490-1498. [PMID: 28855406 DOI: 10.1212/wnl.0000000000004539] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/02/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To perform a meta-analysis synthesizing evidence of the value and accuracy of amyloid-PET in diagnosing patients with sporadic cerebral amyloid angiopathy (CAA). METHODS In a PubMed systematic literature search, we identified all case-control studies with extractable data relevant for the sensitivity and specificity of amyloid-PET positivity in symptomatic patients with CAA (cases) vs healthy participants or patients with spontaneous deep intracerebral hemorrhage (ICH) (control groups). Using a hierarchical (multilevel) logistic regression model, we calculated pooled diagnostic test accuracy. RESULTS Seven studies, including 106 patients with CAA (>90% with probable CAA) and 151 controls, were eligible and included in the meta-analysis. The studies were of moderate to high quality and varied in several methodological aspects, including definition of PET-positive and PET-negative cases and relevant cutoffs. The sensitivity of amyloid-PET for CAA diagnosis ranged from 60% to 91% and the specificity from 56% to 90%. The overall pooled sensitivity was 79% (95% confidence interval [CI] 62-89) and specificity was 78% (95% CI 67-86) for CAA diagnosis. A predefined subgroup analysis of studies restricted to symptomatic patients presenting with lobar ICH CAA (n = 58 vs 86 controls) resulted in 79% sensitivity (95% CI 61-90%) and 84% specificity (95% CI 65-93%). In prespecified bivariate diagnostic accuracy meta-analysis of 2 studies using 18F-florbetapir-PET, the sensitivity for CAA-ICH diagnosis was 90% (95% CI 76-100%) and specificity was 88% (95% CI 74-100%). CONCLUSIONS Amyloid-PET appears to have moderate to good diagnostic accuracy in differentiating patients with probable CAA from cognitively normal healthy controls or patients with deep ICH. Given that amyloid-PET labels both cerebrovascular and parenchymal amyloid, a negative scan might be useful to rule out CAA in the appropriate clinical setting.
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Affiliation(s)
- Andreas Charidimou
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France.
| | - Karim Farid
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
| | - Jean-Claude Baron
- From the Massachusetts General Hospital (A.C.), Stroke Research Center, Harvard Medical School, Boston; Department of Nuclear Medicine (K.F.), Martinique University Hospital, Fort-de-France, French West Indies; and Department of Neurology (J.-C.B.), Centre Hospitalier Sainte Anne, Inserm U894, Sorbonne Paris Cité, France
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