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Seshadri S, Caunca MR, Rundek T. Vascular Dementia and Cognitive Impairment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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2
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Santos PP, Silveira PSD, Souza-Duran FL, Tamashiro-Duran JH, Scazufca M, Menezes PR, Leite CDC, Lotufo PA, Vallada H, Wajngarten M, De Toledo Ferraz Alves TC, Rzezak P, Busatto GF. Prefrontal-Parietal White Matter Volumes in Healthy Elderlies Are Decreased in Proportion to the Degree of Cardiovascular Risk and Related to Inhibitory Control Deficits. Front Psychol 2017; 8:57. [PMID: 28184203 PMCID: PMC5266720 DOI: 10.3389/fpsyg.2017.00057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/10/2017] [Indexed: 01/05/2023] Open
Abstract
Cardiovascular risk (CVR) factors may be associated with poor cognitive functioning in elderlies and impairments in brain structure. Using MRI and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of individuals aged 65–75 years (n = 156), subdivided in three CVR subgroups using the Framingham Risk Score. Cognition was assessed using the Short Cognitive Performance Test. In high-risk subjects, we detected significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low and intermediate CVR subgroups. Findings remained significant after accounting for the presence of the APOEε4 allele. Inhibitory control performance was negatively related to right prefrontal WM volume, proportionally to the degree of CVR. Significantly reduced deep parietal WM was also detected bilaterally in the high CVR subgroup. This is the first large study documenting the topography of CVR-related WM brain volume deficits. The significant association regarding poor response inhibition indicates that prefrontal WM deficits related to CVR are clinically meaningful, since inhibitory control is known to rely on prefrontal integrity.
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Affiliation(s)
- Pedro P Santos
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
| | - Paula S Da Silveira
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
| | - Fabio L Souza-Duran
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
| | - Jaqueline H Tamashiro-Duran
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
| | - Márcia Scazufca
- Department and Institute of Psychiatry, University of São Paulo São Paulo, Brazil
| | - Paulo R Menezes
- Department of Preventive Medicine, Faculty of Medicine, University of São PauloSão Paulo, Brazil; Center of Research in Mental Health Population, University of São PauloSão Paulo, Brazil
| | - Claudia Da Costa Leite
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil; Laboratory of Magnetic Resonance in Neuroradiology, Institute and Department of Radiology, University of São PauloSão Paulo, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Center for Clinical and Epidemiologic Research, University of São Paulo São Paulo, Brazil
| | - Homero Vallada
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil; Department and Institute of Psychiatry, University of São PauloSão Paulo, Brazil
| | - Maurício Wajngarten
- Department of Cardiopneumology, Heart Institute, General Hospital of University of São Paulo Medical School São Paulo, Brazil
| | - Tânia C De Toledo Ferraz Alves
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
| | - Patricia Rzezak
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil; Laboratory of Clinical Neurophysiology, Institute of Psychiatry, University of São Paulo Medical School (IPq-HC-FMUSP)São Paulo, Brazil
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging, Institute and Department of Psychiatry, Universidade de São PauloSão Paulo, Brazil; Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), University of São PauloSão Paulo, Brazil
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Mitchell CC, Stein JH, Cook TD, Salamat S, Wang X, Varghese T, Jackson DC, Sandoval Garcia C, Wilbrand SM, Dempsey RJ. Histopathologic Validation of Grayscale Carotid Plaque Characteristics Related to Plaque Vulnerability. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:129-137. [PMID: 27720278 PMCID: PMC5327497 DOI: 10.1016/j.ultrasmedbio.2016.08.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 05/03/2023]
Abstract
Inflammation and angiogenesis play major roles in carotid plaque vulnerability. The purpose of this study was to determine whether gray-scale features of carotid plaques are associated with histologic markers for inflammation. Thirty-eight individuals completed a dedicated research carotid ultrasound exam before carotid endarterectomy. Gray-scale analysis was performed on plaque images to measure plaque echogenicity (gray-scale median [GSM] pixel brightness), plaque area, presence of discrete white areas (DWAs) and the percent of black area near the lumen on any one component of the plaque. Plaques with higher ultrasound GSM had greater percent calcification (p = 0.013) on histopathology. Presence of an ultrasound DWA was associated with more plaque hemosiderin (p = 0.0005) and inflammation (p = 0.019) on histopathology examination. The percent of plaque black area in any one component was associated with a higher score for macroscopic ulceration (p = 0.028). Ultrasound plaque characteristics (GSM, DWAs and black areas) represent histopathologic markers associated with plaque vulnerability. ClinicalTrials.gov identifier: NCT02476396.
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Affiliation(s)
- Carol C Mitchell
- Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - James H Stein
- Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Thomas D Cook
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shahriar Salamat
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Xiao Wang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daren C Jackson
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carolina Sandoval Garcia
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stephanie M Wilbrand
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Vascular Dementia and Cognitive Impairment. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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5
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Rondina JM, Squarzoni P, Souza-Duran FL, Tamashiro-Duran JH, Scazufca M, Menezes PR, Vallada H, Lotufo PA, de Toledo Ferraz Alves TC, Busatto Filho G. Framingham Coronary Heart Disease Risk Score Can be Predicted from Structural Brain Images in Elderly Subjects. Front Aging Neurosci 2014; 6:300. [PMID: 25520654 PMCID: PMC4249461 DOI: 10.3389/fnagi.2014.00300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 10/16/2014] [Indexed: 12/28/2022] Open
Abstract
Recent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer's disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: (i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). (ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. (iii) We found important gender differences, and the possible causes of that finding are discussed.
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Affiliation(s)
- Jane Maryam Rondina
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Centre for Computational Statistics and Machine Learning, Department of Computer Science, University College London , London , UK
| | - Paula Squarzoni
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil
| | - Fabio Luis Souza-Duran
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil
| | - Jaqueline Hatsuko Tamashiro-Duran
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil
| | - Marcia Scazufca
- Department and Institute of Psychiatry, University of São Paulo , São Paulo , Brazil
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, University of São Paulo , São Paulo , Brazil
| | - Homero Vallada
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil ; Department and Institute of Psychiatry, University of São Paulo , São Paulo , Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of São Paulo , São Paulo , Brazil
| | - Tania Correa de Toledo Ferraz Alves
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil ; Department and Institute of Psychiatry, University of São Paulo , São Paulo , Brazil
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Faculty of Medicine, University of São Paulo , São Paulo , Brazil ; Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo , São Paulo , Brazil ; Department and Institute of Psychiatry, University of São Paulo , São Paulo , Brazil
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Rajan KB, Aggarwal NT, Wilson RS, Everson-Rose SA, Evans DA. Association of cognitive functioning, incident stroke, and mortality in older adults. Stroke 2014; 45:2563-7. [PMID: 25104848 DOI: 10.1161/strokeaha.114.005143] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke increases the risk of dementia; however, bidirectional association of incident stroke and cognitive decline below dementia threshold is not well established. Also, both cognitive decline and stroke increase mortality risk. METHODS A longitudinal population-based cohort of 7217 older adults without a history of stroke from a biracial community was interviewed at 3-year intervals. Cognitive function was assessed using a standardized global cognitive score. Stroke was determined by linkage with Medicare claims, and mortality was ascertained via the National Death Index. We used a Cox model to assess the risk of incident stroke, a joint model with a piecewise linear mixed model with incident stroke as a change point for cognitive decline process, and a time-dependent relative risk regression model for mortality risk. RESULTS During follow-up, 1187 (16%) subjects had incident stroke. After adjusting for known confounders, lower baseline cognitive function was associated with a higher risk of incident stroke (hazard ratio, 1.61; 95% confidence interval, 1.46-1.77). Cognitive function declined by 0.064 U per year before incident stroke occurrence and 0.122 U per year after stroke, a nearly 1.9-fold increase in cognitive decline (95% confidence interval, 1.78-2.03). Both stroke (hazard ratio, 1.17; 95% confidence interval, 1.08-1.26) and cognitive decline (hazard ratio, 1.90; 95% confidence interval, 1.81-1.98) increased mortality risk. CONCLUSIONS Baseline cognitive function was associated with incident stroke. Cognitive decline increased significantly after stroke relative to before stroke. Cognitive decline increased mortality risk independent of the risk attributable to stroke and should be followed as a marker for both stroke and mortality.
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Affiliation(s)
- Kumar B Rajan
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.).
| | - Neelum T Aggarwal
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Robert S Wilson
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Susan A Everson-Rose
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Denis A Evans
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
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Ferreira LK, Tamashiro-Duran JH, Squarzoni P, Duran FL, Alves TC, Buchpiguel CA, Busatto GF. The link between cardiovascular risk, Alzheimer's disease, and mild cognitive impairment: support from recent functional neuroimaging studies. ACTA ACUST UNITED AC 2014; 36:344-57. [PMID: 24918525 DOI: 10.1590/1516-4446-2013-1275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review functional neuroimaging studies about the relationship between cardiovascular risk factors (CVRFs), Alzheimer's disease (AD), and mild cognitive impairment (MCI). METHODS We performed a comprehensive literature search to identify articles in the neuroimaging field addressing CVRF in AD and MCI. We included studies that used positron emission tomography (PET), single photon emission computerized tomography (SPECT), or functional magnetic resonance imaging (fMRI). RESULTS CVRFs have been considered risk factors for cognitive decline, MCI, and AD. Patterns of AD-like changes in brain function have been found in association with several CVRFs (both regarding individual risk factors and also composite CVRF measures). In vivo assessment of AD-related pathology with amyloid imaging techniques provided further evidence linking CVRFs and AD, but there is still limited information resulting from this new technology. CONCLUSION There is a large body of evidence from functional neuroimaging studies supporting the hypothesis that CVRFs may play a causal role in the pathophysiology of AD. A major limitation of most studies is their cross-sectional design; future longitudinal studies using multiple imaging modalities are expected to better document changes in CVRF-related brain function patterns and provide a clearer picture of the complex relationship between aging, CVRFs, and AD.
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Affiliation(s)
- Luiz K Ferreira
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Jaqueline H Tamashiro-Duran
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Paula Squarzoni
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Fabio L Duran
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Tania C Alves
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Carlos A Buchpiguel
- Center for Interdisciplinary Research on Applied Neurosciences (NAPNA), USP, São Paulo, SP, Brazil
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Clerici F, Caracciolo B, Cova I, Fusari Imperatori S, Maggiore L, Galimberti D, Scarpini E, Mariani C, Fratiglioni L. Does vascular burden contribute to the progression of mild cognitive impairment to dementia? Dement Geriatr Cogn Disord 2013; 34:235-43. [PMID: 23147614 DOI: 10.1159/000343776] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 11/19/2022] Open
Abstract
AIMS To investigate the contribution of vascular risk factors (VRFs), vascular diseases (VDs) and white matter lesions (WMLs) to the progression of mild cognitive impairment (MCI) to dementia and Alzheimer's disease (AD). METHODS Two hundred forty-five consecutive subjects with MCI (age 74.09 ± 6.92 years) were followed for an average of 2.4 years. The Hachinski Ischemic Score and the Framingham Stroke Risk Profile were used to summarize VRFs and VDs. WMLs were graded using the Age-Related White Matter Changes Scale. RESULTS One hundred twenty-nine (52.6%) out of 245 subjects at risk converted to dementia, including 87 cases of AD. When hypertension occurred in MCI with deep WMLs, a 1.8-fold increased risk of dementia was observed (95% CI = 1.0-3.4). When deep WMLs occurred in MCI with high scores (≥4) on the Hachinski scale, a 3.5-fold (95% CI = 1.6-7.4) and 3.8-fold (95% CI = 1.2-11.5) risk of progression to dementia and AD was observed, respectively. Analogously, the joint effect of WMLs and high scores (≥14) on the Framingham scale nearly doubled the risk of dementia (hazard ratio = 1.9, 95% CI = 1.1-3.3). CONCLUSIONS Accelerated progression of MCI to dementia and AD is to be expected when VRFs and VDs occur together with WMLs.
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Affiliation(s)
- Francesca Clerici
- Center for Research and Treatment of Cognitive Dysfunctions, Institute of Clinical Neurology, Department of Biomedical and Clinical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
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Tamashiro-Duran JH, Squarzoni P, de Souza Duran FL, Curiati PK, Vallada HP, Buchpiguel CA, Lotufo PA, Wajngarten M, Menezes PR, Scazufca M, de Toledo Ferraz Alves TC, Busatto GF. Cardiovascular risk in cognitively preserved elderlies is associated with glucose hypometabolism in the posterior cingulate cortex and precuneus regardless of brain atrophy and apolipoprotein gene variations. AGE (DORDRECHT, NETHERLANDS) 2013; 35:777-792. [PMID: 22544617 PMCID: PMC3636408 DOI: 10.1007/s11357-012-9413-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/17/2012] [Indexed: 05/31/2023]
Abstract
Cardiovascular risk factors (CVRF) possibly contribute to the emergence of Alzheimer's disease (AD). Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been widely used to demonstrate specific patterns of reduced cerebral metabolic rates of glucose (CMRgl) in subjects with AD and in non-demented carriers of the apolipoprotein ε4 (APOE ε4) allele, the major genetic risk factor for AD. However, functional neuroimaging studies investigating the impact of CVRF on cerebral metabolism have been scarce to date. The present FDG-PET study investigated 59 cognitively preserved elderlies divided into three groups according to their cardiovascular risk based on the Framingham 10-year risk Coronary Heart Disease Risk Profile (low-, medium-, and high-risk) to examine whether different levels of CVRF would be associated with reduced CMRgl, involving the same brain regions affected in early stages of AD. Functional imaging data were corrected for partial volume effects to avoid confounding effects due to regional brain atrophy, and all analyses included the presence of the APOE ε4 allele as a confounding covariate. Significant cerebral metabolism reductions were detected in the high-risk group when compared to the low-risk group in the left precuneus and posterior cingulate gyrus. This suggests that findings of brain hypometabolism similar to those seen in subjects with AD can be detected in association with the severity of cardiovascular risk in cognitively preserved individuals. Thus, a greater knowledge about how such factors influence brain functioning in healthy subjects over time may provide important insigths for the future development of strategies aimed at delaying or preventing the vascular-related triggering of pathologic brain changes in the AD.
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Affiliation(s)
- Jaqueline Hatsuko Tamashiro-Duran
- Laboratory of Neuroimaging in Psychiatry (LIM-21), Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
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Wiberg B, Kilander L, Sundström J, Byberg L, Lind L. The relationship between executive dysfunction and post-stroke mortality: a population-based cohort study. BMJ Open 2012; 2:bmjopen-2011-000458. [PMID: 22573701 PMCID: PMC3353124 DOI: 10.1136/bmjopen-2011-000458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To study the associations of pre-stroke cognitive performance with mortality after first-ever stroke or transient ischaemic attack (TIA). DESIGN A prospective cohort study. SETTING AND PARTICIPANTS In participants having first-ever stroke or TIA during up to 14 years of post-test follow-up (n=155), we investigated the associations of pre-stroke variables and cognitive test results with post-stroke survival. The study is based on those participants of the Uppsala Longitudinal Study of Adult Men who performed cognitive function tests at approximately age 70 (n=919). PRIMARY OUTCOME MEASURES Mortality after first-ever stroke or TIA related to pre-stroke executive performance. RESULTS Eighty-four (54%) of the first-ever stroke/TIA patients died under a median follow-up of 2.5 years after the event. In Cox proportional hazard analyses adjusting for age, education, social group and traditional stroke risk factors, poor performance in Trail Making Test (TMT)-A was related to mortality (HR 1.88 per SD, 95% CI 1.31 to 2.71, p=0.001). The risk of mortality was approximately threefold higher in the highest tertile compared with the lowest tertile (HR TMT-A= 2.90 per SD, 95% CI 1.24 to 6.77, p=0.014). A similar pattern was seen for TMT-B, but Mini-Mental State Examination results were not related to risk of post-stroke mortality. CONCLUSION Executive performance measured by TMT-A and -B before stroke was independently associated with long-term risk of mortality, after first-ever stroke or TIA in a population-based study of older men.
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Affiliation(s)
- Bernice Wiberg
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences/Orthopedics, Uppsala University, Uppsala, Sweden
- UCR-Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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11
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Seshadri S. Vascular Dementia and Vascular Cognitive Decline. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Llewellyn DJ, Lang IA, Xie J, Huppert FA, Melzer D, Langa KM. Framingham Stroke Risk Profile and poor cognitive function: a population-based study. BMC Neurol 2008; 8:12. [PMID: 18430227 PMCID: PMC2386808 DOI: 10.1186/1471-2377-8-12] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 04/22/2008] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between stroke risk and cognitive function has not previously been examined in a large community living sample other than the Framingham cohort. The objective of this study was to examine the relationship between 10-year risk for incident stroke and cognitive function in a large population-based sample. Methods Participants were 7377 adults aged 50 years and over of the 2002 wave of the English Longitudinal Study of Ageing, a prospective cohort study. A modified version of the Framingham Stroke Risk Profile (incorporating age, sex, systolic blood pressure, antihypertensive medication, diabetes, smoking status, cardiovascular disease, and atrial fibrillation) was used to assess 10-year risk of stroke. Linear regression models were used to determine the cross-sectional relationship of stroke risk to global cognitive function and performance in multiple cognitive domains. Results In unadjusted models 10 percentage point increments of 10-year stroke risk were associated with poor global cognitive function (-0.40 SD units, 95% CI -0.43 – -0.38), and lowered performance in all cognitive domains. After statistical adjustment for age, sex, testing interval and other correlates of cognitive function the association with stroke risk was attenuated though remained significant for global cognitive function (-0.06 SD units, 95% CI -0.09 – -0.03), immediate and delayed verbal memory, semantic verbal fluency and processing speed. Conclusion In individuals free from a history of stroke or dementia, high subclinical cerebrovascular disease burden was associated with worse cognitive function in multiple domains.
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Affiliation(s)
- David J Llewellyn
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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