1
|
Meng P, Liu T, Zhong Z, Fang R, Qiu F, Luo Y, Yang K, Cai H, Mei Z, Zhang X, Ge J. A novel rat model of cerebral small vessel disease based on vascular risk factors of hypertension, aging, and cerebral hypoperfusion. Hypertens Res 2024:10.1038/s41440-024-01741-4. [PMID: 38872026 DOI: 10.1038/s41440-024-01741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
Cerebral small vessel disease (CSVD) is a major cause of vascular cognitive impairment and functional loss in elderly patients. Progressive remodeling of cerebral microvessels due to arterial hypertension or other vascular risk factors, such as aging, can cause dementia or stroke. Typical imaging characteristics of CSVD include cerebral microbleeds (CMB), brain atrophy, small subcortical infarctions, white matter hyperintensities (WMH), and enlarged perivascular spaces (EPVS). Nevertheless, no animal models that reflect all the different aspects of CSVD have been identified. Here, we generated a new CSVD animal model using D-galactose (D-gal) combined with cerebral hypoperfusion in spontaneously hypertensive rats (SHR), which showed all the hallmark pathological features of CSVD and was based on vascular risk factors. SHR were hypodermically injected with D-gal (400 mg/kg/d) and underwent modified microcoil bilateral common carotid artery stenosis surgery. Subsequently, neurological assessments and behavioral tests were performed, followed by vascular ultrasonography, electron microscopy, flow cytometry, and histological analyses. Our rat model showed multiple cerebrovascular pathologies, such as CMB, brain atrophy, subcortical small infarction, WMH, and EPVS, as well as the underlying causes of CSVD pathology, including oxidative stress injury, decreased cerebral blood flow, structural and functional damage to endothelial cells, increased blood-brain barrier permeability, and inflammation. The use of this animal model will help identify new therapeutic targets and subsequently aid the development and testing of novel therapeutic interventions. Main process of the study: Firstly, we screened for optimal conditions for mimicking aging by injecting D-gal into rats for 4 and 8 weeks. Subsequently, we performed modified microcoil BCAS intervention for 4 and 8 weeks in rats to screen for optimal hypoperfusion conditions. Finally, based on these results, we combined D-gal for 8 weeks and modified microcoil BCAS for 4 weeks to explore the changes in SHR.
Collapse
Affiliation(s)
- Pan Meng
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Tongtong Liu
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ziyan Zhong
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Rui Fang
- Hunan Academy of Chinese Medicine, Changsha, Hunan, China
| | - Feng Qiu
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yan Luo
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Kailin Yang
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Huzhi Cai
- First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhigang Mei
- Science and Technology Innovation Center, Hunan University of Chinese Medicine, Changsha, Hunan, China.
| | - Xi Zhang
- The Second People's Hospital of Hunan Province, Changsha, Hunan, China.
| | - Jinwen Ge
- Hunan Academy of Chinese Medicine, Changsha, Hunan, China.
| |
Collapse
|
2
|
Nagayama T, Yamaguchi S, Nakayama T, Yang S, Inagaki S, Nagayama M. Effects of white matter hyperintensities on isolated executive function assessed by the Trail Making Test. F1000Res 2023; 12:1021. [PMID: 38434635 PMCID: PMC10905008 DOI: 10.12688/f1000research.139557.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND White matter hyperintensities (WMHs) on MRI are associated with cognitive dysfunction, particularly slow processing speed and executive dysfunction. However, it is not clear whether WMHs burden affects isolated executive function independent of aging when WMHs are assessed separately in periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH). PURPOSE To assess the relationship between the degree of WMHs and the performance on the Trail Making Test (TMT), which can evaluate isolated ability of set-shifting and working memory. METHODS 74 participants who visited our memory clinic and underwent the TMT subtests (TMT-A and TMT-B) and the Mini-Mental State Examination (MMSE). All subjects performed the TMT within the time limits and their MMSE scores were 24 or higher, and they were diagnosed as having normal cognition or mild cognitive impairment. The extent of PVH and DSWMH was graded from 0 to 3 using the Fazekas scale. We obtained testing time to complete the TMT-A and TMT-B, and calculated TMT-B minus TMT-A. We performed correlation analyses between the degree of WMHs and the time measures of the TMT subtests with adjustment of age. RESULTS Average scores of the MMSE were not different among the groups either by PVH grade or by DSWMH grade. In contrast, average time required for the TMT-A, TMT-B, and TMT-B minus TMT-A increased along with exacerbation of PVH and DSWMH grade. After the adjustment of age we found significant association between only DSWMH grade and the time difference of TMT-B minus TMT-A. CONCLUSIONS Exacerbation of PVH and DSWMH differentially affected isolated executive functions assessed by the TMT subtests independent of age and general cognitive function.
Collapse
Affiliation(s)
- Tomiko Nagayama
- Neurology, International University of Health and Welfare,Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Shuhei Yamaguchi
- Shimane Prefecture Bureau of Hospital Administration, Shimane Prefectural Center Hospital, Izumo, Shimane, 693-8555, Japan
| | - Takuya Nakayama
- Rehabilitation, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Sunghoon Yang
- Neurology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Seiichi Inagaki
- Graduate School of Public Health, International University of Health and Welfare, Narita, Tiba, 286-8686, Japan
| | - Masao Nagayama
- Neurology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| |
Collapse
|
3
|
Zhao S, Li Y, Shi Y, Li X. Cognitive Aging: How the Brain Ages? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1419:9-21. [PMID: 37418203 DOI: 10.1007/978-981-99-1627-6_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Cognitive aging refers to the cognitive changes or functional decline that comes with age. The relation between aging and functional declines involves various aspects of cognition, including memory, attention, processing speed, and executive function. In this chapter, we have introduced several dimensions about cognitive aging trajectories. Meanwhile, we have reviewed the history of the study of cognitive aging and expatiated two trends that are particularly noteworthy in the effort to elucidate the process of aging. One is that the differences between components of mental abilities have become gradually specified. The other one is a growing interest in the neural process, which relates changes in the brain structure to age-related changes in cognition. Lastly, as the basis of cognitive function, brain structures and functions change during aging, and these changes are reflected in a corresponding decline in cognitive function. We have discussed the patterns of reorganization of various structural and functional aging processes of the brain and their relationship with cognitive function.
Collapse
Affiliation(s)
- Shaokun Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Yumeng Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Yuqing Shi
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Faculty of Psychology, Beijing Normal University, Beijing, China.
- Beijing Aging Brain Rejuvenation Initiative (BABRI) Centre, Beijing Normal University, Beijing, China.
| |
Collapse
|
4
|
Wang J, Zhou Y, He Y, Li Q, Zhang W, Luo Z, Xue R, Lou M. Impact of different white matter hyperintensities patterns on cognition: A cross-sectional and longitudinal study. Neuroimage Clin 2022; 34:102978. [PMID: 35255417 PMCID: PMC8897653 DOI: 10.1016/j.nicl.2022.102978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES White matter hyperintensities (WMH) are highly prevalent in older adults and considered to be a contributor to cognition impairment. However, the strategic WMH lesion distribution related to cognitive impairment is still debated. The aim of this study was to characterize the spatial patterns of WMH associated with cognitive impairment and explore its risk factors. METHODS We retrospectively analyzed patients who underwent T2 fluid attenuated inversion recovery (FLAIR) and mini-mental state examination (MMSE) in two centers. WHM was classified into four patterns based on T2 FLAIR as follows: (1) multiple subcortical spots (multi-spots); (2) peri-basal ganglia (peri-BG); (3) anterior subcortical patches (anterior SC patches); and (4) posterior subcortical patches (posterior SC patches). We cross-sectionally and longitudinally estimated associations between different WMH patterns and all-cause dementia and cognitive decline. Multivariable logistic regression analysis was followed to identify risk factors of WMH patterns related to cognitive impairment. RESULTS A total of 442 patients with WMH were enrolled, with average age of 71.6 ± 11.3 years, and MMSE score of 24.1 ± 5.4. Among them, 281 (63.6%), 66 (14.9%), 163 (36.9%) and 197 (44.6%) patients presented multi-spots, peri-BG, anterior SC patches and posterior SC patches, respectively. Patients with anterior SC patches were more likely to have all-cause dementia in cross-sectional study (OR 2.002; 95% CI 1.098-3.649; p = 0.024), and have cognitive decline in longitudinal analysis (OR 3.029; 95% CI 1.270-7.223; p = 0.012). Four patterns of WMH referred to different cognitive domains, and anterior SC patches had the most significant and extensive impact on cognition after Bonferroni multiple comparison correction (all p < 0.0125). In addition, older age (OR 1.054; 95% CI 1.027-1.082; p < 0.001), hypertension (OR 1.956; 95% CI 1.145-3.341; p = 0.014), higher percentage of neutrophils (OR 1.046; 95% CI 1.014-1.080; p = 0.005) and lower concentration of hemoglobin (OR 0.983; 95% CI 0.967-1.000; p = 0.044) were risk factors for the presence of anterior SC patches. CONCLUSIONS Different patterns of subcortical leukoaraiosis visually identified on MRI might have different impacts on cognitive impairment. Further studies should be undertaken to validate this simple visual classification of WMH in different population.
Collapse
Affiliation(s)
- Junjun Wang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China; Department of Neurology, Zhejiang Hospital, #12 Lingyin Road, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Yaode He
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Qingqing Li
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Wenhua Zhang
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Zhongyu Luo
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Rui Xue
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China
| | - Min Lou
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University, School of Medicine. 88# Jiefang Road, Hangzhou, China.
| |
Collapse
|
5
|
Xiang K, Liu Y, Sun L. Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery. Front Aging Neurosci 2022; 13:728799. [PMID: 35185512 PMCID: PMC8847709 DOI: 10.3389/fnagi.2021.728799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
The motoric cognitive risk (MCR) syndrome is a pre-dementia condition, marked by the enhanced risk for Alzheimer's disease (AD) and vascular dementia, together with falls, disability, and abnormal movements. The research studies revealed the distinct neurological and non-neurological clinical gait irregularities during dementia and accelerated functional decline, such as postural and balance impairments, memory loss, cognitive failure, and metabolic dysfunctions. The disabling characteristics of MCR comprise altered afferent sensory and efferent motor responses, together with disrupted visual, vestibular, and proprioceptive components. The pathological basis of MCR relates with the frontal lacunar infarcts, white matter hyperintensity (WMH), gray matter atrophy in the pre-motor and pre-frontal cortex, abnormal cholinergic functioning, inflammatory responses, and genetic factors. Further, cerebrovascular lesions and cardiovascular disorders exacerbate the disease pathology. The diagnosis of MCR is carried out through neuropsychological tests, biomarker assays, imaging studies, questionnaire-based evaluation, and motor function tests, including walking speed, dual-task gait tests, and ambulation ability. Recovery from MCR may include cognitive, physical, and social activities, exercise, diet, nutritional supplements, symptomatic drug treatment, and lifestyle habits that restrict the disease progression. Psychotherapeutic counseling, anti-depressants, and vitamins may support motor and cognitive improvement, primarily through the restorative pathways. However, an in-depth understanding of the association of immobility, dementia, and cognitive stress with MCR requires additional clinical and pre-clinical studies. They may have a significant contribution in reducing MCR syndrome and the risk for dementia. Overall, the current review informs the vital connection between gait performance and cognition in MCR and highlights the usefulness of future research in the discernment and treatment of dementiating illness.
Collapse
|
6
|
Fan Y, Xu Y, Shen M, Guo H, Zhang Z. Total Cerebral Small Vessel Disease Burden on MRI Correlates With Cognitive Impairment in Outpatients With Amnestic Disorders. Front Neurol 2021; 12:747115. [PMID: 34925212 PMCID: PMC8675386 DOI: 10.3389/fneur.2021.747115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives: The main markers of cerebral small vessel disease (cSVD) on MRI may be entered into a scoring system, with the total score representing the overall burden of cSVD. An association between total cSVD score and cognitive dysfunction has been reported in several cohorts. The present study aimed to investigate this association in outpatients with amnestic disorders. Materials and Methods: Outpatients with amnestic complaints in a memory clinic (n = 289) were recruited retrospectively. All the patients had undergone clinical and cognitive evaluation at first presentation. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) scale. The total cSVD score was based on the following markers on MRI: lacune; white matter hyperintensities, microbleed, and enlarged perivascular spaces. The association between total cSVD score and MoCA score was tested via Spearman's analysis and a linear regression model. Results: Among the 289 patients, rates for 0–4 cSVD markers respectively ranged from 30.4 to 2.8%. A multiple linear regression model revealed an inverse correlation between the total cSVD score and MoCA score. The association remained significant after adjusting for gender, age, education, levels of medial temporal lobe atrophy, and classical vascular risk factors [β = −0.729, 95% CI (−1.244, −0.213); P = 0.006]. When individual markers were individually analyzed after adjusting for the same factors, only microbleed associated with MoCA score [β = −3.007, 95% CI (−4.533, −1.480), P < 0.001]. Conclusions: A significant association was demonstrated between total cSVD score and cognitive performance in the outpatients with amnestic disorders.
Collapse
Affiliation(s)
- Yangyi Fan
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Ming Shen
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Huailian Guo
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Zhaoxu Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, China
| |
Collapse
|
7
|
Sanderson-Cimino M, Panizzon MS, Elman JA, Tu X, Gustavson DE, Puckett O, Cross K, Notestine R, Hatton SN, Eyler LT, McEvoy LK, Hagler DJ, Neale MC, Gillespie NA, Lyons MJ, Franz CE, Fennema-Notestine C, Kremen WS. Periventricular and deep abnormal white matter differ in associations with cognitive performance at midlife. Neuropsychology 2021; 35:252-264. [PMID: 33970659 PMCID: PMC8500190 DOI: 10.1037/neu0000718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Abnormal white matter (AWM) on magnetic resonance imaging is associated with cognitive performance in older adults. We explored cognitive associations with AWM during late-midlife. Method: Participants were community-dwelling men (n = 242; M = 61.90 years; range = 56-66). Linear-mixed effects regression models examined associations of total, periventricular, and deep AWM with cognitive performance, controlling for multiple comparisons. Models considering specific cognitive domains controlled for current general cognitive ability (GCA). We hypothesized that total AWM would be associated with worse processing speed, executive function, and current GCA; deep AWM would correlate with GCA and periventricular AWM would relate to specific cognitive abilities. We also assessed the potential influence of cognitive reserve by examining a moderation effect of early life (mean age of 20) cognition. Results: Greater total and deep AWM were associated with poorer current GCA. Periventricular AWM was associated with worse executive function, working memory, and episodic memory. When periventricular and deep AWM were modeled simultaneously, both retained their respective significant associations with cognitive performance. Cognitive reserve did not moderate associations. Conclusions: Our findings suggest that AWM contributes to poorer cognitive function in late-midlife. Examining only total AWM may obscure the potential differential impact of regional AWM. Separating total AWM into subtypes while controlling for current GCA revealed a dissociation in relationships with cognitive performance; deep AWM was associated with nonspecific cognitive ability whereas periventricular AWM was associated with specific frontal-related abilities and memory. Management of vascular or other risk factors that may increase the risk of AWM should begin during or before early late-midlife. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Mark Sanderson-Cimino
- Joint Doctoral Program in Clinical Psychology, San Diego State/University of California
- Center for Behavior Genetics of Aging, University of California
| | - Matthew S. Panizzon
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
| | - Jeremy A. Elman
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
| | - Xin Tu
- Family Medicine and Public Health, University of California
| | - Daniel E. Gustavson
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
- Department of Medicine, Vanderbilt University Medical Center
| | - Olivia Puckett
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
| | | | - Randy Notestine
- Department of Psychiatry University of California
- Computational and Applied Statistics Laboratory (CASL) at the San Diego Supercomputer Center
| | - Sean N Hatton
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
- Department of Neurosciences, University of California
| | - Lisa T. Eyler
- Department of Psychiatry University of California
- Mental Illness Research, Education, And Clinical Center, Veterans Affairs San Diego Healthcare System
| | - Linda K. McEvoy
- Department of Radiology, University of California, San Diego
| | | | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University
| | - Carol E. Franz
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
| | - Christine Fennema-Notestine
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
- Department of Radiology, University of California, San Diego
| | - William S. Kremen
- Center for Behavior Genetics of Aging, University of California
- Department of Psychiatry University of California
- Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System
| |
Collapse
|
8
|
Toppala S, Ekblad LL, Lötjönen J, Helin S, Hurme S, Johansson J, Jula A, Karrasch M, Koikkalainen J, Laine H, Parkkola R, Viitanen M, Rinne JO. Midlife Insulin Resistance as a Predictor for Late-Life Cognitive Function and Cerebrovascular Lesions. J Alzheimers Dis 2020; 72:215-228. [PMID: 31561373 PMCID: PMC6839606 DOI: 10.3233/jad-190691] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Type 2 diabetes (T2DM) increases the risk for Alzheimer’s disease (AD) but not for AD neuropathology. The association between T2DM and AD is assumed to be mediated through vascular mechanisms. However, insulin resistance (IR), the hallmark of T2DM, has been shown to associate with AD neuropathology and cognitive decline. Objective: To evaluate if midlife IR predicts late-life cognitive performance and cerebrovascular lesions (white matter hyperintensities and total vascular burden), and whether cerebrovascular lesions and brain amyloid load are associated with cognitive functioning. Methods: This exposure-to-control follow-up study examined 60 volunteers without dementia (mean age 70.9 years) with neurocognitive testing, brain 3T-MRI and amyloid-PET imaging. The volunteers were recruited from the Finnish Health 2000 survey (n = 6062) to attend follow-up examinations in 2014–2016 according to their insulin sensitivity in 2000 and their APOE genotype. The exposure group (n = 30) had IR in 2000 and the 30 controls had normal insulin sensitivity. There were 15 APOEɛ4 carriers per group. Statistical analyses were performed with multivariable linear models. Results: At follow-up the IR+group performed worse on executive functions (p = 0.02) and processing speed (p = 0.007) than the IR- group. The groups did not differ in cerebrovascular lesions. No associations were found between cerebrovascular lesions and neurocognitive test scores. Brain amyloid deposition associated with slower processing speed. Conclusion: Midlife IR predicted poorer executive functions and slower processing speed, but not cerebrovascular lesions. Brain amyloid deposition was associated with slower processing speed. The association between midlife IR and late-life cognition might not be mediated through cerebrovascular lesions measured here.
Collapse
Affiliation(s)
- Sini Toppala
- Turku PET Centre, University of Turku, Finland.,Turku City Hospital, University of Turku, Finland
| | | | | | - Semi Helin
- Turku PET Centre, University of Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Finland
| | - Jarkko Johansson
- Turku PET Centre, University of Turku, Finland.,Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | | | - Hanna Laine
- Turku City Hospital, University of Turku, Finland.,Department of Medicine, University of Turku, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University and Turku University Hospital, Turku, Finland
| | - Matti Viitanen
- Turku City Hospital, University of Turku, Finland.,Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| | - Juha O Rinne
- Turku PET Centre, University of Turku, Finland.,Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| |
Collapse
|
9
|
Jayakody O, Breslin M, Srikanth V, Callisaya M. Medical, Sensorimotor and Cognitive Factors Associated With Gait Variability: A Longitudinal Population-Based Study. Front Aging Neurosci 2018; 10:419. [PMID: 30618725 PMCID: PMC6305368 DOI: 10.3389/fnagi.2018.00419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Greater gait variability increases the risk of falls. However, little is known about changes in gait variability in older age. The aims of this study were to examine: (1) change in gait variability across time and (2) factors that predict overall mean gait variability and its change over time. Methods: Participants (n = 410; mean age 72 years) were assessed at baseline and during follow up visits at an average of 30 and 54 months. Step time, step length, step width and double support time (DST) were measured using a GAITRite walkway. Variability was calculated as the standard deviation of all steps for each individual. Covariates included demographic, medical, sensorimotor and cognitive factors. Mixed models were used to determine (1) change in gait variability over time (2) factors that predicted or modified any change. Results: Over 4.6 years the presence of cardiovascular disease at baseline increased the rate of change for step length variability (p = 0.04 for interaction), lower education increased the rate of change for DST variability (p = 0.04) and weaker quadriceps strength increased the rate of change for step width variability (p = 0.01). Greater postural sway predicted greater variability on average across the three phases (p < 0.05). Arthritis, a higher body mass index (BMI), slower processing speed and lower quadriceps strength predicted greater mean step time variability (p < 0.05). Arthritis and a higher BMI predicted greater mean step length variability, while slower processing speed and BMI predicted greater mean DST variability (p < 0.05). Conclusion: Over a nearly 5-year period, variability in different gait measures do not show uniform changes over time. Furthermore, each variability measure appears to be modified and predicted by different factors. These results provide information on potential targets for future trials to maintain mobility and independence in older age.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Velandai Srikanth
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Department of Medicine, Peninsula Health, Monash University, Melbourne, VIC, Australia
| | - Michele Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,Department of Medicine, Peninsula Health, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
10
|
Jiang J, Liu T, Zhu W, Koncz R, Liu H, Lee T, Sachdev PS, Wen W. UBO Detector – A cluster-based, fully automated pipeline for extracting white matter hyperintensities. Neuroimage 2018; 174:539-549. [DOI: 10.1016/j.neuroimage.2018.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 11/27/2022] Open
|
11
|
Molad J, Kliper E, Korczyn AD, Ben Assayag E, Ben Bashat D, Shenhar-Tsarfaty S, Aizenstein O, Shopin L, Bornstein NM, Auriel E. Only White Matter Hyperintensities Predicts Post-Stroke Cognitive Performances Among Cerebral Small Vessel Disease Markers: Results from the TABASCO Study. J Alzheimers Dis 2018; 56:1293-1299. [PMID: 28157096 DOI: 10.3233/jad-160939] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND White matter hyperintensities (WMH) were shown to predict cognitive decline following stroke or transient ischemic attack (TIA). However, WMH are only one among other radiological markers of cerebral small vessel disease (SVD). OBJECTIVE The aim of this study was to determine whether adding other SVD markers to WMH improves prediction of post-stroke cognitive performances. METHODS Consecutive first-ever stroke or TIA patients (n = 266) from the Tel Aviv Acute Brain Stroke Cohort (TABASCO) study were enrolled. MRI scans were performed within seven days of stroke onset. We evaluated the relationship between cognitive performances one year following stroke, and previously suggested total SVD burden score including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS). RESULTS Significant negative associations were found between WMH and cognition (p < 0.05). Adding other SVD markers (lacunes, CMB, PVS) to WMH did not improve predication of post-stroke cognitive performances. Negative correlations between SVD burden score and cognitive scores were observed for global cognitive, memory, and visual spatial scores (all p < 0.05). However, following an adjustment for confounders, no associations remained significant. CONCLUSION WMH score was associated with poor post-stroke cognitive performance. Adding other SVD markers or SVD burden score, however, did not improve prediction.
Collapse
Affiliation(s)
- Jeremy Molad
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Efrat Kliper
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Functional Brain Center, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Einor Ben Assayag
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Dafna Ben Bashat
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Functional Brain Center, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sagol School of Neurosciense, Tel Aviv University, Tel-Aviv, Israel
| | | | - Orna Aizenstein
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ludmila Shopin
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Natan M Bornstein
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Eitan Auriel
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
David JP, Ferrat E, Parisot J, Naga H, Lakroun S, Menasria F, Saddedine S, Natella PA, Paillaud E, Fromentin I, Bastuji-Garin S. White Matter Lesions: Prevalence and Clinical Phenotype in Asymptomatic Individuals Aged ≥50 Years. Dement Geriatr Cogn Disord 2018; 42:159-168. [PMID: 27649085 DOI: 10.1159/000448991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To assess the prevalence of early confluent/confluent white matter lesions (ec/cWMLs) in asymptomatic individuals aged ≥50 years and to identify associated clinical phenotypes. METHODS Cross-sectional analysis of 141 asymptomatic individuals aged ≥50 years assessed at an outpatient department in France. Brain magnetic resonance imaging was rated using the Fazekas scale. Age-adjusted odds ratios (ORs) and 95% confidence intervals were estimated using logistic models to investigate factors associated with ec/cWMLs; independent risk factors were identified by multivariate analysis. RESULTS Median age was 63 years; 53.9% were women, 32.6% had hypertension, and 76.6% had ≥1 cardiovascular risk factors. The prevalence of ec/cWMLs was 26.2%. Apart from age, independent risk factors were family history of cardiovascular event (OR = 5.55; 1.13-27.32) and hypertension (2.47; 1.05-5.81). Patients with ec/cWMLs had lower cognitive dual-task walking speed (1.15; 0.98-1.40), MMSE (1.41; 1.06-1.89), and FAB scores (5.21; 1.49-19.84). The Scheltens score was independently associated with the WML severity score. CONCLUSION ec/cWMLs are common in asymptomatic community-dwelling individuals aged ≥50 years. They are associated with cardiovascular risk factors, impairments in global and executive cognitive function, and Scheltens score elevation.
Collapse
Affiliation(s)
- Jean-Philippe David
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Wang Y, Meng R, Song H, Liu G, Hua Y, Cui D, Zheng L, Feng W, Liebeskind DS, Fisher M, Ji X. Remote Ischemic Conditioning May Improve Outcomes of Patients With Cerebral Small-Vessel Disease. Stroke 2017; 48:3064-3072. [PMID: 29042490 DOI: 10.1161/strokeaha.117.017691] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/29/2017] [Accepted: 09/08/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the efficacy of remote ischemic conditioning (RIC) in patients with cerebral small-vessel disease. METHODS Thirty patients with cerebral small-vessel disease-related mild cognitive impairment were enrolled in this prospective, randomized controlled study for 1 year. Besides routine medical treatment, participants were randomized into the experimental group (n=14) undergoing 5 cycles consisting of ischemia followed by reperfusion for 5 minutes on both upper limbs twice daily for 1 year or the control group (n=16) who were treated with sham ischemia-reperfusion cycles. The primary outcome was the change of brain lesions, and secondary outcomes were changes of cognitive function, plasma biomarkers, and cerebral hemodynamic parameters both at baseline and at the end of 1-year follow-up. RESULTS Compared with pretreatment, the post-treatment white matter hyperintensities volume in the RIC group was significantly reduced (9.10±7.42 versus 6.46±6.05 cm3; P=0.020), whereas no significant difference was observed in the sham-RIC group (8.99±6.81 versus 8.07±6.56 cm3; P=0.085). The reduction of white matter hyperintensities volume in the RIC group was more substantial than that in sham group (-2.632 versus -0.935 cm3; P=0.049). No significant difference was found in the change of the number of lacunes between 2 groups (0 versus 0; P=0.694). A significant treatment difference at 1 year on visuospatial and executive ability was found between the 2 groups (0.639 versus 0.191; P=0.048). RIC showed greater effects compared with sham-RIC on plasma triglyceride (-0.433 versus 0.236 mmol/L; P=0.005), total cholesterol (-0.975 versus 0.134 mmol/L; P<0.001), low-density lipoprotein (-0.645 versus -0.029 mmol/L; P=0.034), and homocysteine (-4.737 versus -1.679 µmol/L; P=0.044). Changes of the pulsation indices of middle cerebral arteries from the baseline to 1 year were different between the 2 groups (right: -0.075 versus 0.043; P=0.030; left: -0.085 versus 0.043; P=0.010). CONCLUSIONS RIC seems to be potentially effective in patients with cerebral small-vessel disease in slowing cognition decline and reducing white matter hyperintensities. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01658306.
Collapse
Affiliation(s)
- Yuan Wang
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Ran Meng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Haiqing Song
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Gang Liu
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Yang Hua
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Dehua Cui
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Lemin Zheng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Wuwei Feng
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - David S Liebeskind
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Marc Fisher
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Xunming Ji
- From the Department of Neurology (Y.W., R.M., H.S., G.L.), Department of Neurosurgery (X.J.), Department of Vascular Ultrasound (Y.H.), Beijing Key Laboratory of Hypoxia Conditioning Translational Medicine (D.C., L.Z.), Xuanwu Hospital, Capital Medicine University, Beijing, China; Peking University Health Science Center, Beijing, China (D.C., L.Z.); Department of Neurology, Medical University of South Carolina, Charleston (W.F.); Neurovascular Imaging Research Core and Department of Neurology, University of California in Los Angeles (D.S.L.); and Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.).
| |
Collapse
|
14
|
Williams OA, Zeestraten EA, Benjamin P, Lambert C, Lawrence AJ, Mackinnon AD, Morris RG, Markus HS, Charlton RA, Barrick TR. Diffusion tensor image segmentation of the cerebrum provides a single measure of cerebral small vessel disease severity related to cognitive change. Neuroimage Clin 2017; 16:330-342. [PMID: 28861335 PMCID: PMC5568143 DOI: 10.1016/j.nicl.2017.08.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/05/2017] [Accepted: 08/12/2017] [Indexed: 02/02/2023]
Abstract
Cerebral small vessel disease (SVD) is the primary cause of vascular cognitive impairment and is associated with decline in executive function (EF) and information processing speed (IPS). Imaging biomarkers are needed that can monitor and identify individuals at risk of severe cognitive decline. Recently there has been interest in combining several magnetic resonance imaging (MRI) markers of SVD into a unitary score to describe disease severity. Here we apply a diffusion tensor image (DTI) segmentation technique (DSEG) to describe SVD related changes in a single unitary score across the whole cerebrum, to investigate its relationship with cognitive change over a three-year period. 98 patients (aged 43-89) with SVD underwent annual MRI scanning and cognitive testing for up to three years. DSEG provides a vector of 16 discrete segments describing brain microstructure of healthy and/or damaged tissue. By calculating the scalar product of each DSEG vector in reference to that of a healthy ageing control we generate an angular measure (DSEG θ) describing the patients' brain tissue microstructural similarity to a disease free model of a healthy ageing brain. Conventional MRI markers of SVD brain change were also assessed including white matter hyperintensities, cerebral atrophy, incident lacunes, cerebral-microbleeds, and white matter microstructural damage measured by DTI histogram parameters. The impact of brain change on cognition was explored using linear mixed-effects models. Post-hoc sample size analysis was used to assess the viability of DSEG θ as a tool for clinical trials. Changes in brain structure described by DSEG θ were related to change in EF and IPS (p < 0.001) and remained significant in multivariate models including other MRI markers of SVD as well as age, gender and premorbid IQ. Of the conventional markers, presence of new lacunes was the only marker to remain a significant predictor of change in EF and IPS in the multivariate models (p = 0.002). Change in DSEG θ was also related to change in all other MRI markers (p < 0.017), suggesting it may be used as a surrogate marker of SVD damage across the cerebrum. Sample size estimates indicated that fewer patients would be required to detect treatment effects using DSEG θ compared to conventional MRI and DTI markers of SVD severity. DSEG θ is a powerful tool for characterising subtle brain change in SVD that has a negative impact on cognition and remains a significant predictor of cognitive change when other MRI markers of brain change are accounted for. DSEG provides an automatic segmentation of the whole cerebrum that is sensitive to a range of SVD related structural changes and successfully predicts cognitive change. Power analysis shows DSEG θ has potential as a monitoring tool in clinical trials. As such it may provide a marker of SVD severity from a single imaging modality (i.e. DTIs).
Collapse
Affiliation(s)
- Owen A. Williams
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Eva A. Zeestraten
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Philip Benjamin
- Department of Radiology, Charing Cross Hospital Campus, Imperial College NHS Trust, London, UK
| | - Christian Lambert
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Andrew J. Lawrence
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Andrew D. Mackinnon
- Atkinson Morley Regional Neuroscience Centre, St George's NHS Healthcare Trust, London, UK
| | - Robin G. Morris
- Department of Psychology, King's College Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hugh S. Markus
- Stroke Research Group, Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Thomas R. Barrick
- Neuroscience Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
15
|
Uiterwijk R, van Oostenbrugge RJ, Huijts M, De Leeuw PW, Kroon AA, Staals J. Total Cerebral Small Vessel Disease MRI Score Is Associated with Cognitive Decline in Executive Function in Patients with Hypertension. Front Aging Neurosci 2016; 8:301. [PMID: 28018214 PMCID: PMC5149514 DOI: 10.3389/fnagi.2016.00301] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives: Hypertension is a major risk factor for white matter hyperintensities (WMH), lacunes, cerebral microbleeds, and perivascular spaces, which are MRI markers of cerebral small vessel disease (SVD). Studies have shown associations between these individual MRI markers and cognitive functioning and decline. Recently, a “total SVD score” was proposed in which the different MRI markers were combined into one measure of SVD, to capture total SVD-related brain damage. We investigated if this SVD score was associated with cognitive decline over 4 years in patients with hypertension. Methods: In this longitudinal cohort study, 130 hypertensive patients (91 patients with uncomplicated hypertension and 39 hypertensive patients with a lacunar stroke) were included. They underwent a neuropsychological assessment at baseline and after 4 years. The presence of WMH, lacunes, cerebral microbleeds, and perivascular spaces were rated on baseline MRI. Presence of each individual marker was added to calculate the total SVD score (range 0–4) in each patient. Results: Uncorrected linear regression analyses showed associations between SVD score and decline in overall cognition (p = 0.017), executive functioning (p < 0.001) and information processing speed (p = 0.037), but not with memory (p = 0.911). The association between SVD score and decline in overall cognition and executive function remained significant after adjustment for age, sex, education, anxiety and depression score, potential vascular risk factors, patient group, and baseline cognitive performance. Conclusion: Our study shows that a total SVD score can predict cognitive decline, specifically in executive function, over 4 years in hypertensive patients. This emphasizes the importance of considering total brain damage due to SVD.
Collapse
Affiliation(s)
- Renske Uiterwijk
- Department of Neurology, Maastricht University Medical CentreMaastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht UniversityMaastricht, Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical CentreMaastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht UniversityMaastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht UniversityMaastricht, Netherlands
| | - Marjolein Huijts
- Department of Psychiatry and Psychology, Maastricht University Medical Centre Maastricht, Netherlands
| | - Peter W De Leeuw
- Cardiovascular Research Institute Maastricht, Maastricht UniversityMaastricht, Netherlands; Department of Internal Medicine, Maastricht University Medical CentreMaastricht, Netherlands
| | - Abraham A Kroon
- Cardiovascular Research Institute Maastricht, Maastricht UniversityMaastricht, Netherlands; Department of Internal Medicine, Maastricht University Medical CentreMaastricht, Netherlands
| | - Julie Staals
- Department of Neurology, Maastricht University Medical CentreMaastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht UniversityMaastricht, Netherlands
| |
Collapse
|
16
|
Wang N, Allali G, Kesavadas C, Noone ML, Pradeep VG, Blumen HM, Verghese J. Cerebral Small Vessel Disease and Motoric Cognitive Risk Syndrome: Results from the Kerala-Einstein Study. J Alzheimers Dis 2016; 50:699-707. [PMID: 26757037 DOI: 10.3233/jad-150523] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The contribution of cerebral small vessel disease to cognitive decline, especially in non-Caucasian populations, is not well established. OBJECTIVE We examined the relationship between cerebral small vessel disease and motoric cognitive risk syndrome (MCR), a recently described pre-dementia syndrome, in Indian seniors. METHODS 139 participants (mean age 66.6 ± 5.4 y, 33.1% female) participating in the Kerala-Einstein study in Southern India were examined in a cross-sectional study. The presence of cerebral small vessel disease (lacunar infarcts and cerebral microbleeds (CMB)) and white matter hyperintensities on MRI was ascertained by raters blinded to clinical information. MCR was defined by the presence of cognitive complaints and slow gait in older adults without dementia or mobility disability. RESULTS Thirty-eight (27.3%) participants met MCR criteria. The overall prevalence of lacunar infarcts and CMB was 49.6% and 9.4% , respectively. Lacunar infarcts in the frontal lobe, but no other brain regions, were associated with MCR even after adjusting for vascular risk factors and presence of white matter hyperintensities (adjusted Odds Ratio (aOR): 4.67, 95% CI: 1.69-12.94). Frontal lacunar infarcts were associated with slow gait (aOR: 3.98, 95% CI: 1.46-10.79) and poor performance on memory test (β: -1.24, 95% CI: -2.42 to -0.05), but not with cognitive complaints or non-memory tests. No association of CMB was found with MCR, individual MCR criterion or cognitive tests. CONCLUSIONS Frontal lacunar infarcts are associated with MCR in Indian seniors, perhaps, by contributing to slow gait and poor memory function.
Collapse
Affiliation(s)
- Nan Wang
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gilles Allali
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chandrasekharan Kesavadas
- Department of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mohan L Noone
- Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Vayyattu G Pradeep
- Department of Neurology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Helena M Blumen
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
17
|
Coca A, Monteagudo E, Doménech M, Camafort M, Sierra C. Can the Treatment of Hypertension in the Middle-Aged Prevent Dementia in the Elderly? High Blood Press Cardiovasc Prev 2016; 23:97-104. [PMID: 27075454 DOI: 10.1007/s40292-016-0144-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022] Open
Abstract
Hypertension, one of the main risk factors for cardiovascular disease, is thought to play a crucial role in the pathophysiology of cognitive impairment. Studies have associated hypertension with subjective cognitive failures and objective cognitive decline. Subjective cognitive failures may reflect the early phase of a long pathological process leading to cognitive decline and dementia that has been associated with hypertension and other cardiovascular risk factors. The underlying cerebral structural change associated with cognitive decline may be a consequence of the cerebral small-vessel disease induced by high blood pressure and may be detected on magnetic resonance imaging as white matter hyperintensities, cerebral microbleeds, lacunar infarcts or enlarged perivascular spaces. The increasing interest in the relationship between hypertension and cognitive decline is based on the fact that blood pressure control in middle-aged subjects may delay or stop the progression of cognitive decline and reduce the risk of dementia in the elderly. Although more evidence is required, several studies on hypertension have shown a beneficial effect on the incidence of dementia.
Collapse
Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Eila Monteagudo
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Mónica Doménech
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| |
Collapse
|
18
|
MR imaging of the brain in large cohort studies: feasibility report of the population- and patient-based BiDirect study. Eur Radiol 2016; 27:231-238. [PMID: 27059857 DOI: 10.1007/s00330-016-4303-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/02/2016] [Accepted: 02/23/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To describe the implementation and protocol of cerebral magnetic resonance imaging (MRI) in the longitudinal BiDirect study and to report rates of study participation as well as management of incidental findings. METHODS Data came from the BiDirect study that investigates the relationship between depression and arteriosclerosis and comprises 2258 participants in three cohorts: 999 patients with depression, 347 patients with manifest cardiovascular disease (CVD) and 912 population-based controls. The study program includes MRI of the brain. Reasons for non-participation were systematically collected. Incidental findings were categorized and disclosed according to clinical relevance. RESULTS At baseline 2176 participants were offered MRI, of whom 1453 (67 %) completed it. Reasons for non-participation differed according to cohort, age and gender with controls showing the highest participation rate of 79 %. Patient cohorts had higher refusal rates and CVD patients a high prevalence of contraindications. In the first follow-up examination 69 % of participating subjects completed MRI. Incidental findings were disclosed to 246 participants (17 %). The majority of incidental findings were extensive white matter hyperintensities requiring further diagnostic work-up. CONCLUSIONS Knowledge about subjects and sensible definition of incidental findings are crucial for large-scale imaging projects. Our data offer practical and concrete information for the design of future studies. KEY POINTS • Willingness to participate in MRI is generally high, also in follow-up examinations. • Rates of refusal and prevalence of contraindications differ according to subject characteristics. • Extensive white matter hyperintensities considerably increase the disclosure rates of incidental findings. • MRI workflow requires continuous case-by-case handling by an interdisciplinary team.
Collapse
|
19
|
Okazaki S, Hornberger E, Griebe M, Gass A, Hennerici MG, Szabo K. MRI Characteristics of the Evolution of Supratentorial Recent Small Subcortical Infarcts. Front Neurol 2015; 6:118. [PMID: 26074870 PMCID: PMC4443727 DOI: 10.3389/fneur.2015.00118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/09/2015] [Indexed: 11/13/2022] Open
Abstract
Objective Morphological changes of recent small subcortical infarcts are not well defined. The purpose of the present study was to describe the MRI characteristics of the evolution for this stroke subtype. Methods We conducted a retrospective review of patients diagnosed with definite supratentorial recent small subcortical infarcts according to the ASCO classification with baseline and follow-up MRI (≥90 days of stroke onset). We investigated the incidence of cavity formation, the infarct volume change, and the positional relationship between infarct lesions and preexisting white matter hyperintensities (WMHs) of presumed vascular origin. Results We identified 62 patients with a median age of 71 years (range: 30–87). Median follow-up period was 26 months (range: 3–99). Cavity formation was observed in 38 infarct lesions (61%). Eighteen lesions (29%) were partially adjacent to WMHs and 7 (11%) were fused into WMHs. In a multiple logistic regression analysis, age [odds ratio per 5-year increase: 1.34; 95% confidence interval (CI): 1.03–1.80; p = 0.03] and baseline infarct volume (odds ratio per 1-ml increase: 4.7; 95% CI: 1.6–19.7; p = 0.003) were independent predictors of cavity formation. There was a significant volume reduction between baseline and follow-up infarct lesions (median volume reduction rate: 44%). Conclusion More than one-third of recent small subcortical infarcts do not lead to cavity formation and 40% of infarct lesions overlap with WMHs. Our data indicate the continuity between recent small subcortical infarcts and WMHs.
Collapse
Affiliation(s)
- Shuhei Okazaki
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| | - Eva Hornberger
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| | - Martin Griebe
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| | - Achim Gass
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| | - Michael G Hennerici
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| | - Kristina Szabo
- Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany
| |
Collapse
|
20
|
Alteraciones neuropsicológicas asociadas en pacientes con infarto lacunar. ACTA COLOMBIANA DE PSICOLOGIA 2014. [DOI: 10.14718/acp.2014.17.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Existe poca evidencia del deterioro cognoscitivo que defina el perfil del paciente con Infarto Lacunar (IL). El propósito de este estudio fue identificar las alteraciones neuropsicológicas en este tipo de pacientes. La muestra estuvo compuesta por 16 pacientes con IL y 16 participantes sanos con una edad promedio de 63 ± 9.41 y 64.75 ± 9.06 años y una escolaridad de 7.55 ± 4.34 y 7.94 ± 3.51, respectivamente. Se valoró la función cognoscitiva mediante un instrumento de tamizaje y una batería neuropsicológica. El análisis estadístico se llevó a cabo a través de la prueba Kruskal-Wallis y la U de Man-Whitney. Los pacientes con IL se caracterizan por la alteración de dominios como planeación, fluidez verbal, cambio atencional, habilidad visoconstructiva y velocidad de procesamiento de la información (p < 0.050). El IL se relaciona con el deterioro del funcionamiento ejecutivo y de velocidad de procesamiento, debido a la interrupción de circuitos frontocortico-subcorticales asociados con su correcto desempeño.
Collapse
|
21
|
Overdorp EJ, Kessels RPC, Claassen JA, Oosterman JM. Cognitive impairments associated with medial temporal atrophy and white matter hyperintensities: an MRI study in memory clinic patients. Front Aging Neurosci 2014; 6:98. [PMID: 24904411 PMCID: PMC4034495 DOI: 10.3389/fnagi.2014.00098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/06/2014] [Indexed: 11/13/2022] Open
Abstract
In this retrospective study, we investigated the independent effects of white matter hyperintensities (WMH) and hippocampal atrophy on cognitive functions in a broad sample of patients seen in a memory clinic. To ensure generalizability, these associations were examined irrespective of diagnosis and with minimal exclusion criteria. Next to these independent effects, interactions between WMH and hippocampal atrophy were examined. Between January 2006 and September 2011 a total of 500 patients visited the memory clinic, 397 of whom were included. Magnetic resonance images of 397 patients were visually analyzed for WMH, medial temporal atrophy (MTA), and global atrophy. We evaluated the association of WMH and MTA with the following cognitive domains: global cognition, episodic memory, working memory, executive function and psychomotor speed. Main effects and interaction effects were examined by means of correlation and regression analyses. In the regression analyses, we controlled for potential confounding effects of global atrophy. The correlational results revealed that WMH were associated with global cognition, executive function and psychomotor speed, whereas a trend was found for episodic memory. MTA was associated with all these four cognitive domains; an additional trend was observed for working memory. Hierarchical regression analyses revealed main independent effects of MTA for episodic memory, executive function, psychomotor speed and global cognition; WMH were only associated with global cognition. The interaction between MTA and WMH was significant for episodic memory only. This study demonstrates that predominantly MTA is an independent predictor not only for memory function, with which is it classically associated, but also for global cognition and executive function. Taken together, MTA may be an important correlate of cognitive deficits found in people attending the memory clinic.
Collapse
Affiliation(s)
- Eduard J Overdorp
- Department of Psychiatry, Gelre Medical Centre Zutphen, Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands ; Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Jurgen A Claassen
- Department of Medical Psychology, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands ; Department of Geriatric Medicine, Radboud University Medical Center-Radboud Alzheimer Center Nijmegen, Netherlands
| | - Joukje M Oosterman
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Nijmegen, Netherlands
| |
Collapse
|
22
|
Huijts M, Duits A, van Oostenbrugge RJ, Kroon AA, de Leeuw PW, Staals J. Accumulation of MRI Markers of Cerebral Small Vessel Disease is Associated with Decreased Cognitive Function. A Study in First-Ever Lacunar Stroke and Hypertensive Patients. Front Aging Neurosci 2013; 5:72. [PMID: 24223555 PMCID: PMC3818574 DOI: 10.3389/fnagi.2013.00072] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/21/2013] [Indexed: 12/04/2022] Open
Abstract
Background: White matter lesions (WMLs), asymptomatic lacunar infarcts, brain microbleeds (BMBs), and enlarged perivascular spaces (EPVS) have been identified as silent lesions due to cerebral small vessel disease (cSVD). All these markers have been individually linked to cognitive functioning, but are also strongly correlated with each other. The combined effect of these markers on cognitive function has never been studied and would possibly provide more useful information on the effect on cognitive function. Methods: Brain MRI and extensive neuropsychological assessment were performed in 189 patients at risk for cSVD (112 hypertensive patients and 77 first-ever lacunar stroke patients). We rated the presence of any asymptomatic lacunar infarct, extensive WMLs, any deep BMB, and moderate to extensive EPVS in the basal ganglia. The presence of each marker was summed to an ordinal score between 0 and 4. Associations with domains of cognitive function (memory, executive function, information processing speed, and overall cognition) were analyzed with correlation analyses. Results: Correlation analyses revealed significant associations between accumulating cSVD burden and decreased performance on all cognitive domains (all p ≤ 0.001). Results remained significant for information processing speed (r = −0.181, p = 0.013) and overall cognition (r = −0.178, p = 0.017), after correction for age and sex. Testing of trend using linear regression analyses revealed the same results. Discussion: We tested a new approach to capture total brain damage resulting from cSVD and found that accumulation of MRI burden of cSVD is associated with decreased performance on tests of information processing speed and overall cognition, implying that accumulating brain damage is accompanied by worse cognitive functioning.
Collapse
Affiliation(s)
- Marjolein Huijts
- Department of Neurology, Maastricht University , Maastricht , Netherlands ; School for Mental Health and Neuroscience (MHeNS), Maastricht University , Maastricht , Netherlands ; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , Netherlands
| | | | | | | | | | | |
Collapse
|
23
|
Gawron N, Łojek E, Kijanowska-Haładyna B, Nestorowicz J, Harasim A, Pluta A, Sobańska M. Cognitive patterns of normal elderly subjects are consistent with frontal cortico-subcortical and fronto-parietal neuropsychological models of brain aging. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:195-209. [PMID: 25084844 DOI: 10.1080/09084282.2013.789965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Three neuropsychological theories have been developed according to a possible existence of a similar pattern of cognitive decline in elderly individuals and patients with brain damage. The respective neuropsychological theories attribute age-related deficits to: (a) dysfunction of the frontal lobes, (b) temporo-parietal dysfunction, or (c) decline of right-hemisphere functions. In the present study, we examined which of these theories best explains the cognitive patterns of normal elderly subjects older than 80 years of age (old elderly). Thirty normal old elderly subjects, 14 patients with subcortical vascular dementia, 14 with mild Alzheimer's disease, 15 with damage of the right hemisphere of the brain, and 20 young elderly controls participated. A test battery covering the main cognitive domains was administered to all participants. A hierarchical cluster analysis revealed five groups of individuals with different cognitive patterns across the whole sample. Old elderly subjects were assigned to four groups according to: (a) preserved overall cognitive performance, (b) processing speed decline, (c) attention decline, or (d) executive impairment. The results of the study are most congruent with models emphasizing frontal-lobe cortical-subcortical and fronto-parietal changes in old age. The results also indicate considerable heterogeneity in the cognitive patterns of normal old elderly adults.
Collapse
Affiliation(s)
- Natalia Gawron
- a Faculty of Psychology , University of Warsaw , Warsaw , Poland
| | | | | | | | | | | | | |
Collapse
|
24
|
Bolandzadeh N, Davis JC, Tam R, Handy TC, Liu-Ambrose T. The association between cognitive function and white matter lesion location in older adults: a systematic review. BMC Neurol 2012; 12:126. [PMID: 23110387 PMCID: PMC3522005 DOI: 10.1186/1471-2377-12-126] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 10/12/2012] [Indexed: 11/16/2022] Open
Abstract
Background Maintaining cognitive function is essential for healthy aging and to function autonomously within society. White matter lesions (WMLs) are associated with reduced cognitive function in older adults. However, whether their anatomical location moderates these associations is not well-established. This review systematically evaluates peer-reviewed evidence on the role of anatomical location in the association between WMLs and cognitive function. Methods In accordance with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement, databases of EMBASE, PUBMED, MEDLINE, and CINAHL, and reference lists of selected papers were searched. We limited our search results to adults aged 60 years and older, and studies published in the English language from 2000 to 2011. Studies that investigated the association between cognitive function and WML location were included. Two independent reviewers extracted: 1) study characteristics including sample size, sample characteristic, and study design; 2) WML outcomes including WML location, WML quantification method (scoring or volume measurement), strength of the MRI magnet in Tesla, and MRI sequence used for WML detection; and 3) cognitive function outcomes including cognitive tests for two cognitive domains of memory and executive function/processing speed. Results Of the 14 studies included, seven compared the association of subcortical versus periventricular WMLs with cognitive function. Seven other studies investigated the association between WMLs in specific brain regions (e.g., frontal, parietal lobes) and cognitive function. Overall, the results show that a greater number of studies have found an association between periventricular WMLs and executive function/processing speed, than subcortical WMLs. However, whether WMLs in different brain regions have a differential effect on cognitive function remains unclear. Conclusions Evidence suggests that periventricular WMLs may have a significant negative impact on cognitive abilities of older adults. This finding may be influenced by study heterogeneity in: 1) MRI sequences, WML quantification methods, and neuropsychological batteries; 2) modifying effect of cardiovascular risk factors; and 3) quality of studies and lack of sample size calculation.
Collapse
Affiliation(s)
- Niousha Bolandzadeh
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | | | | | | | | |
Collapse
|
25
|
He L, Parikh NA. Automated detection of white matter signal abnormality using T2 relaxometry: application to brain segmentation on term MRI in very preterm infants. Neuroimage 2012; 64:328-40. [PMID: 22974556 DOI: 10.1016/j.neuroimage.2012.08.081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022] Open
Abstract
Hyperintense white matter signal abnormalities, also called diffuse excessive high signal intensity (DEHSI), are observed in up to 80% of very preterm infants on T2-weighted MRI scans at term-equivalent age. DEHSI may represent a developmental stage or diffuse microstructural white matter abnormalities. Automated quantitative assessment of DEHSI severity may help resolve this debate and improve neonatal brain tissue segmentation. For T2-weighted sequence without fluid attenuation, the signal intensity distribution of DEHSI greatly overlaps with that of cerebrospinal fluid (CSF) making its detection difficult. Furthermore, signal intensities of T2-weighted images are susceptible to magnetic field inhomogeneity. Increased signal intensities caused by field inhomogeneity may be confused with DEHSI. To overcome these challenges, we propose an algorithm to detect DEHSI using T2 relaxometry, whose reflection of the rapid changes in free water content provides improved distinction between CSF and DEHSI over that of conventional T2-weighted imaging. Moreover, the parametric transverse relaxation time T2 is invulnerable to magnetic field inhomogeneity. We conducted computer simulations to select an optimal detection parameter and to validate the proposed method. We also demonstrated that brain tissue segmentation is further enhanced by incorporating DEHSI detection for both simulated preterm infant brain images and in vivo in very preterm infants imaged at term-equivalent age.
Collapse
Affiliation(s)
- Lili He
- Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43215, USA.
| | | |
Collapse
|
26
|
Elnimr EM, Kondo T, Suzukamo Y, Satoh M, Oouchida Y, Hara A, Ohkubo T, Kikuya M, Hirano M, Hosokawa A, Hosokawa T, Imai Y, Izumi SI. Association between white matter hyperintensity and lacunar infarction on MRI and subitem scores of the Japanese version of mini-mental state examination for testing cognitive decline: the Ohasama study. Clin Exp Hypertens 2012; 34:541-7. [PMID: 22564143 DOI: 10.3109/10641963.2012.681723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We assessed whether subitem scores on the Mini-Mental State Examination (MMSE) associated independently with cerebral white matter hyperintensity (WMH) and lacunar infarction (LI). Magnetic resonance imaging (MRI) and neuropsychological evaluation (MMSE) were performed in 1008 elderly individuals from the Ohasama Study (348 men, 660 women [65.5%]; age 68.0 ± 6.0 [mean ± SD] years; MMSE score, 26.5 ± 2.9). The relationships between MRI findings and MMSE subitem scores were analyzed by logistic regression. Significant associations were observed between the MMSE subitems "Orientation to place" and WMH, and "Copy a figure" and LI. Pathological changes were detected by brain MRI associated with a decrease in cognitive function in healthy elderly individuals.
Collapse
Affiliation(s)
- Eman M Elnimr
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Solesio-Jofre E, Lorenzo-López L, Gutiérrez R, López-Frutos JM, Ruiz-Vargas JM, Maestú F. Age-related effects in working memory recognition modulated by retroactive interference. J Gerontol A Biol Sci Med Sci 2011; 67:565-72. [PMID: 22080502 DOI: 10.1093/gerona/glr199] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
One of the main causes for age-related declines in working memory is a higher vulnerability to retroactive interference due to a reduced ability to suppress irrelevant information. However, the underlying neural correlates remain to be established. Magnetoencephalography was used to investigate differential neural patterns in young and older adults performing an interference-based memory task with two experimental conditions, interrupting and distracting, during successful recognition. Behaviorally, both types of retroactive interference significantly impaired accuracy at recognition more in older adults than in young adults with the latter exhibiting greater disruptions by interrupters. Magnetoencephalography revealed the presence of differential age-related neural patterns. Specifically, time-modulated activations in temporo-occipital and superior parietal regions were higher in young adults compared with older adults for the interrupting condition. These results suggest that age-related deficits in inhibitory mechanisms that increase vulnerability to retroactive interference may be associated with neural under-recruitments in a high-interference task.
Collapse
Affiliation(s)
- Elena Solesio-Jofre
- Laboratory for Cognitive and Computational Neuroscience, Centre for Biomedical Technology, Madrid University of Technology/Complutense University of Madrid, Campus de Montegancedo, Pozuelo de Alarcón, Madrid 28660, Spain.
| | | | | | | | | | | |
Collapse
|
28
|
MRI-detected white matter lesions: do they really matter? J Neural Transm (Vienna) 2011; 118:673-81. [DOI: 10.1007/s00702-011-0594-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
|
29
|
Pham TD. Brain lesion detection in MRI with fuzzy and geostatistical models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2010:3150-3. [PMID: 21096593 DOI: 10.1109/iembs.2010.5627188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Automated image detection of white matter changes of the brain is essentially helpful in providing a quantitative measure for studying the association of white matter lesions with other types of biomedical data. Such study allows the possibility of several medical hypothesis validations which lead to therapeutic treatment and prevention. This paper presents a new clustering-based segmentation approach for detecting white matter changes in magnetic resonance imaging with particular reference to cognitive decline in the elderly. The proposed method is formulated using the principles of fuzzy c-means algorithm and geostatistics.
Collapse
Affiliation(s)
- Tuan D Pham
- School of Engineering and Information Technology, University of New South Wales, Canberra ACT 2600, Australia.
| |
Collapse
|
30
|
Pham TD, Berger K. Automated detection of white matter changes in elderly people using fuzzy, geostatistical, and information combining models. ACTA ACUST UNITED AC 2010; 15:242-50. [PMID: 20889435 DOI: 10.1109/titb.2010.2081996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detection of white matter changes of the brain using magnetic resonance imaging (MRI) has increasingly been an active and challenging research area in computational neuroscience. There have rarely been any single image analysis methods that can effectively address the issue of automated quantification of neuroimages, which are subject to different interests of various medical hypotheses. This paper presents new image segmentation models for automated detection of white matter changes of the brain in an elderly population. The methods are based on the computational models of fuzzy clustering, possibilistic clustering, geostatistics, and knowledge combination. Experimental results on MRI data have shown that the proposed image analysis methodology can be applied as a very useful computerized tool for the validation of our particular medical question, where white matter changes of the brain are thought to be the most important social medical evidence.
Collapse
Affiliation(s)
- Tuan D Pham
- School of Engineering and Information Technology, University of New South Wales, Canberra, ACT 2600, Australia.
| | | |
Collapse
|
31
|
Pham TD, Elfiqi HZ, Knecht S, Wersching H, Baune BT, Berger K. Structural simplexity of the brain. J Neurosci Methods 2010; 188:113-26. [PMID: 20132839 DOI: 10.1016/j.jneumeth.2010.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Tuan D Pham
- School of Engineering and Information Technology, University of New South Wales, Canberra, ACT, Australia.
| | | | | | | | | | | |
Collapse
|
32
|
Baune BT. The puzzle of predicting the impact of brain infarcts on cognitive impairment in the aging brain. Stroke 2009; 40:667-9. [PMID: 19131649 DOI: 10.1161/strokeaha.108.534230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|