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Brain Reserve in a Case of Cognitive Resilience to Severe Leukoaraiosis. J Int Neuropsychol Soc 2021; 27:99-108. [PMID: 32539895 PMCID: PMC7738360 DOI: 10.1017/s1355617720000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Leukoaraiosis, or white matter rarefaction, is a common imaging finding in aging and is presumed to reflect vascular disease. When severe in presentation, potential congenital or acquired etiologies are investigated, prompting referral for neuropsychological evaluation in addition to neuroimaging. T2-weighted imaging is the most common magnetic resonance imaging (MRI) approach to identifying white matter disease. However, more advanced diffusion MRI techniques may provide additional insight into mechanisms that influence the abnormal T2 signal, especially when clinical presentations are discrepant with imaging findings. METHOD We present a case of a 74-year-old woman with severe leukoaraoisis. She was examined by a neurologist, neuropsychologist, and rheumatologist, and completed conventional (T1, T2-FLAIR) MRI, diffusion tensor imaging (DTI), and advanced single-shell, high b-value diffusion MRI (i.e., fiber ball imaging [FBI]). RESULTS The patient was found to have few neurological signs, no significant cognitive impairment, a negative workup for leukoencephalopathy, and a positive antibody for Sjogren's disease for which her degree of leukoaraiosis would be highly atypical. Tractography results indicate intact axonal architecture that was better resolved using FBI rather than DTI. CONCLUSIONS This case illustrates exceptional cognitive resilience in the face of severe leukoaraiosis and the potential for advanced diffusion MRI to identify brain reserve.
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Zhu Y, Lu T, Xie C, Wang Q, Wang Y, Cao X, Su Y, Wang Z, Zhang Z. Functional Disorganization of Small-World Brain Networks in Patients With Ischemic Leukoaraiosis. Front Aging Neurosci 2020; 12:203. [PMID: 32719596 PMCID: PMC7348592 DOI: 10.3389/fnagi.2020.00203] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/11/2020] [Indexed: 01/15/2023] Open
Abstract
Cognitive impairment is a key clinical feature of ischemic leukoaraiosis (ILA); however, the underlying neurobiological mechanism is still unclear. ILA has been associated with widespread gray and white matter (WM) damage mainly located in cortical-cortical and cortico-subcortical pathways. A total of 36 patients with ILA (Fazekas rating score ≥2) and 31 healthy controls (HCs) underwent comprehensive neuropsychological assessments (covering four cognitive domains, i.e., information processing speed, episodic memory, executive and visuospatial function) and resting-state functional MRI scans. Graph theory-based analyses were employed to explore the topological organization of the brain connectome in ILA patients, and we further sought to explore the associations of connectome-based metrics and neuropsychological performances. An efficient small-world architecture in the functional brain connectome was observed in the ILA and control groups. Moreover, compared with the HCs, the ILA patients showed increased path length and decreased network efficiency (i.e., global and local efficiency) in their functional brain networks. Further network-based statistic (NBS) analysis revealed a functional-disconnected network in ILA, which is comprised of functional connections linking different brain modules (i.e., default mode, frontoparietal, ventral attention and limbic systems) and connections within single modules (i.e., ventral attention and limbic systems). Intriguingly, the abnormal network metrics correlated with cognitive deficits in ILA patients. Therefore, our findings provide further evidence to support the concept that ILA pathologies could disrupt brain connections, impairing network functioning, and cognition via a “disconnection syndrome.”
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Affiliation(s)
- Yixin Zhu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tong Lu
- Department of Radiology, ZhongDa Hospital Affiliated to Southeast University, Nanjing, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Qing Wang
- Department of Radiology, ZhongDa Hospital Affiliated to Southeast University, Nanjing, China
| | - Yanjuan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xuejin Cao
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuting Su
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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Shi J, Hao K, Qi P, Xie X, Yang X, Dong M, Shang Y, Zhang S. Confirmation of the abnormal lipid metabolism as a risk factor for the disease of leukoaraiosis. Saudi J Biol Sci 2017; 24:508-513. [PMID: 28386174 PMCID: PMC5372372 DOI: 10.1016/j.sjbs.2017.01.020] [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: 12/07/2016] [Revised: 12/28/2016] [Accepted: 01/06/2017] [Indexed: 11/05/2022] Open
Abstract
Our purpose is to screen out medical history indicators and test indicators linked to lipid metabolism which is closely correlated to leukoaraiosis (LA), and to build assistant diagnosis model based on support vector machine (SVM), which provided theoretical evidence for genesis and development of LA. One thousand LA patients who underwent magnetic resonance imaging (MRI) examination in Imaging Department was retrospectively analyzed and divided into LA group and non-LA group in accordance with examination results. Detailed clinical statistics of the two groups were collected, including test indicators related to lipid metabolism, such as total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), medical history indicators, age, sex, diabetes, hypertension, hyperlipidemia, history of intracranial infection, history of cerebral hemorrhage, cerebral infarction, lacunar infarction and relevant biochemical indexes. The study shows that patients’ incidence of LA was 31.10%; in accordance with Logistic analysis, the incidence of LA is significantly correlated to factors like age, hypertension, history of cerebral hemorrhage, cerebral infarction, lacunar infarction and triglyceride elevation; two SVMs, one including all variables and the other containing all screened variables were successfully established, and the former’s accuracy, specificity and sensitivity respectively were 85.0%, 85.0% and 85.0% while the latter’s 90.0%, 100.0% and 80.0%. Test indicators and medical history indicators of lipid metabolism correlated to LA were screened out successfully. Meanwhile, an effective SVM model also was built successfully, which is able to predict LA relatively accurately and can be used as assistant diagnostic tool for clinicians.
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Affiliation(s)
- Junying Shi
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Kai Hao
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Peihong Qi
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Xiaogang Xie
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Xinhuan Yang
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Mei Dong
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Yingjie Shang
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
| | - Sijia Zhang
- Imaging Department, People's Hospital of Zhengzhou, Zhengzhou 450003, China
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Chen Y, Wang C, Liang H, Chen H, Bi Y, Sun H, Shi Q, Deng Y, Li J, Wang Y, Zhang Y. Resting-state functional magnetic resonance imaging in patients with leukoaraiosis-associated subcortical vascular cognitive impairment: a cross-sectional study. Neurol Res 2016; 38:510-7. [DOI: 10.1080/01616412.2016.1177929] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lin Q, Huang WQ, Tzeng CM. Genetic associations of leukoaraiosis indicate pathophysiological mechanisms in white matter lesions etiology. Rev Neurosci 2015; 26:343-58. [PMID: 25781674 DOI: 10.1515/revneuro-2014-0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 12/18/2014] [Indexed: 11/15/2022]
Abstract
Leukoaraiosis (LA), also called white matter lesions (WMLs) and white matter hyperintensities (WMHs), is a frequent neuroimaging finding commonly seen on magnetic resonance imaging brain scans of elderly people with prevalence ranging from 50% to 100%. Although it remains asymptomatic, LA is not considered to be benign, and it is showed to be related to a host of poor clinical outcomes and increases the risk of disability, dementia, depression, stroke, and the overall morbidity and mortality. Pathologically, LA is characterized by loss of myelin and axons, patchy demyelination, and denudation of ependyma in regions of WMH. Age and hypertension are the most importantly established risk factors for LA. However, the precise pathogenic mechanisms remain unclear. Together with the previous findings, our recent genetic results strongly supported that LA is associated with immune response and neuroinflammation. Therefore, we confidently hypothesized that LA was not only a common neuroimaging phenomenon in the elderly but also an emerging neuroinflammatory disorder in the central nervous system. This article focusing on neuroimaging classification, genetics basis, and putative molecular mechanism introduced the basic knowledge and current status of LA and put forward some of our research ideas and results from our molecular genetics research, which may pave the way for deciphering the putative pathogenic mechanism, risk factor, epigenetic index, and its application in diagnostic agents or drug target for prevention and treatment. Thus, it could provide clinicians and researchers with a specific and modern overview of LA to enable the understanding of recent progress and future directions in this illness.
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Te M, Zhao E, Xingyue Z, Qinjian S, Chuanqiang Q. Leukoaraiosis with mild cognitive impairment. Neurol Res 2015; 37:410-4. [DOI: 10.1179/1743132815y.0000000028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Education modulates the impact of white matter lesions on the risk of mild cognitive impairment and dementia. Am J Geriatr Psychiatry 2014; 22:1336-45. [PMID: 24021219 PMCID: PMC4143478 DOI: 10.1016/j.jagp.2013.06.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/24/2013] [Accepted: 06/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Conflicting results have been reported regarding the association between white matter lesions (WML) and cognitive impairment. We hypothesized that education, a marker of cognitive reserve (CR), could modulate the effects of WML on the risk of mild cognitive impairment (MCI) or dementia. METHODS We followed 500 healthy subjects from a cohort of community-dwelling persons aged 65 years and over (ESPRIT Project). At baseline, WML volume was measured using a semi-automatic method on T2-weighted MRI. Standardized cognitive and neurological evaluations were repeated after 2, 4, and 7 years. The sample was dichotomized according to education level into low (≤8 years) and high (>8 years) education groups. Cox proportional hazard models were constructed to study the association between WML and risk of MCI/dementia. RESULTS The interaction between education level and WML volume reached significance (p = 0.017). After adjustment for potential confounders, the association between severe WML and increased MCI/dementia risk was significant in the low education group (≤8 years) (p = 0.02, hazard ratio [HR]: 3.77 [1.29-10.99]), but not in the high education group (>8 years) (p = 0.82, HR: 1.07 [0.61-1.87]). CONCLUSIONS Severe WML significantly increases the risk of developing MCI/dementia over a 7-year period in low educated participants. Subjects with higher education levels were seen to be more likely to be resilient to the deleterious effects of severe WML. The CR hypothesis suggests several avenues for dementia prevention.
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Mortamais M, Reynes C, Brickman AM, Provenzano FA, Muraskin J, Portet F, Berr C, Touchon J, Bonafé A, le Bars E, Maller JJ, Meslin C, Sabatier R, Ritchie K, Artero S. Spatial distribution of cerebral white matter lesions predicts progression to mild cognitive impairment and dementia. PLoS One 2013; 8:e56972. [PMID: 23457645 PMCID: PMC3572965 DOI: 10.1371/journal.pone.0056972] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 01/17/2013] [Indexed: 11/18/2022] Open
Abstract
CONTEXT White matter lesions (WML) increase the risk of dementia. The relevance of WML location is less clear. We sought to determine whether a particular WML profile, based on the density and location of lesions, could be associated with an increased risk of mild cognitive impairment (MCI) or dementia over the following 7 years. METHODS In 426 healthy subjects from a cohort of community-dwelling people aged 65 years and over (ESPRIT Project), standardized cognitive and neurological evaluations were repeated after 2, 4 and 7 years. Patterns of WML were computed with a supervised data mining approach (decision trees) using the regional WML volumes (frontal, parietal, temporal, and occipital regions) and the total WML volume estimated at baseline. Cox proportional hazard models were then constructed to study the association between WML patterns and risk of MCI/dementia. RESULTS Total WML volume and percentage of WML in the temporal region proved to be the best predictors of progression to MCI and dementia. Specifically, severe total WML load with a high proportion of lesions in the temporal region was significantly associated with the risk of developing MCI or dementia. CONCLUSIONS Above a certain threshold of damage, a pattern of WML clustering in the temporal region identifies individuals at increased risk of MCI or dementia. As this WML pattern is observed before the onset of clinical symptoms, it may facilitate the detection of patients at risk of MCI/dementia.
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Affiliation(s)
- Marion Mortamais
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Christelle Reynes
- University of Montpellier 1, Montpellier, France
- EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Adam M. Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Frank A. Provenzano
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Jordan Muraskin
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University, College of Physicians and Surgeons, New York, New York, United States of America
| | - Florence Portet
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- Unité Transversale des Troubles Neurologiques du Sujet Âgé, CHU Caremeau, Centre Ruffi, Pôle de Gériatrie, CHU Nîmes, Nîmes, France
- Montpellier University Hospital, University Department of Adult Psychiatry, La Colombière Hospital, CHU de Montpellier, Montpellier, France
| | - Claudine Berr
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Jacques Touchon
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
| | - Alain Bonafé
- University of Montpellier 1, Montpellier, France
- CHRU Montpellier, Montpellier, France
| | - Emmanuelle le Bars
- University of Montpellier 1, Montpellier, France
- CHRU Montpellier, Montpellier, France
| | - Jerome J. Maller
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - Chantal Meslin
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Robert Sabatier
- University of Montpellier 1, Montpellier, France
- EA 2415, Faculté de Pharmacie, Montpellier, France
| | - Karen Ritchie
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
- Faculty of Medicine, Imperial College, London, United Kingdom
| | - Sylvaine Artero
- Inserm, U1061, La Colombière Hospital, Montpellier, France
- University of Montpellier 1, Montpellier, France
- * E-mail:
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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]
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Lu H, Xu F, Rodrigue KM, Kennedy KM, Cheng Y, Flicker B, Hebrank AC, Uh J, Park DC. Alterations in cerebral metabolic rate and blood supply across the adult lifespan. ACTA ACUST UNITED AC 2010; 21:1426-34. [PMID: 21051551 DOI: 10.1093/cercor/bhq224] [Citation(s) in RCA: 283] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
With age, the brain undergoes comprehensive changes in its function and physiology. Cerebral metabolism and blood supply are among the key physiologic processes supporting the daily function of the brain and may play an important role in age-related cognitive decline. Using MRI, it is now possible to make quantitative assessment of these parameters in a noninvasive manner. In the present study, we concurrently measured cerebral metabolic rate of oxygen (CMRO(2)), cerebral blood flow (CBF), and venous blood oxygenation in a well-characterized healthy adult cohort from 20 to 89 years old (N = 232). Our data showed that CMRO(2) increased significantly with age, while CBF decreased with age. This combination of higher demand and diminished supply resulted in a reduction of venous blood oxygenation with age. Regional CBF was also determined, and it was found that the spatial pattern of CBF decline was heterogeneous across the brain with prefrontal cortex, insular cortex, and caudate being the most affected regions. Aside from the resting state parameters, the blood vessels' ability to dilate, measured by cerebrovascular reactivity to 5% CO(2) inhalation, was assessed and was reduced with age, the extent of which was more prominent than that of the resting state CBF.
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Affiliation(s)
- Hanzhang Lu
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Sorocco KH, Monnot M, Vincent AS, Ross ED, Lovallo WR. Deficits in affective prosody comprehension: family history of alcoholism versus alcohol exposure. Alcohol Alcohol 2009; 45:25-9. [PMID: 19820001 DOI: 10.1093/alcalc/agp064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abstinent alcoholics have deficits in comprehending the affective intonation in speech. Prior work suggests that these deficits are due to alcohol exposure rather than preexisting risk factors for alcoholism. The present paper examines whether family history of alcoholism is a contributor to affective prosody deficits in alcoholics. METHODS Fifty-eight healthy, nonabusing young adults with and without a family history of alcoholism or other substance abuse (29 FH+ and 29 FH-) were compared on affective prosody comprehension using the Aprosodia Battery. A secondary analysis was done comparing affective prosody comprehension in FH+ and FH- detoxified alcoholics from an earlier study (17 FH+ and 14 FH-). RESULTS Performance on the Aprosodia Battery was not related to FH status in either the healthy, nonabusing sample or in the detoxified alcoholic group. CONCLUSIONS The present study lends support to previous research suggesting that deficits in affective prosody comprehension observed in detoxified alcoholics are associated with a history of heavy drinking rather than with a family history of alcoholism.
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Affiliation(s)
- Kristen H Sorocco
- Behavioral Sciences Laboratories, Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA.
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Rypma B, Prabhakaran V. When less is more and when more is more: The mediating roles of capacity and speed in brain-behavior efficiency. INTELLIGENCE 2009; 37:207-222. [PMID: 20161012 PMCID: PMC2758693 DOI: 10.1016/j.intell.2008.12.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An enduring enterprise of experimental psychology has been to account for individual differences in human performance. Recent advances in neuroimaging have permitted testing of hypotheses regarding the neural bases of individual differences but this burgeoning literature has been characterized by inconsistent results. We argue that careful design and analysis of neuroimaging studies is required to separate individual differences in processing capacity from individual differences in processing speed to account for these differences in the literature. We utilized task designs which permitted separation of processing capacity influences on brain-behavior relationships from those related to processing speed. In one set of studies, participants performed verbal delayed-recognition tasks during blocked and event-related fMRI scanning. The results indicated that those participants with greater working memory (WM) capacity showed greater prefrontal cortical activity, strategically capitalized on the additional processing time available in the delay period, and evinced faster WM-retrieval rates than low-capacity participants. In another study, participants performed a digit-symbol substitution task (DSST) designed to minimize WM storage capacity requirements and maximize processing speed requirements during fMRI scanning. In some prefrontal cortical (PFC) brain regions, participants with faster processing speed showed less PFC activity than slower performers while in other PFC and parietal regions they showed greater activity. Regional-causality analysis indicated that PFC exerted more influence over other brain regions for slower than for faster individuals. These results support a model of neural efficiency in which individuals differ in the extent of direct processing links between neural nodes. One benefit of direct processing links may be a surplus of resources that maximize available capacity permitting fast and accurate performance.
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Affiliation(s)
- Bart Rypma
- School of Behavioral and Brain Sciences and Center for Brain Health, University of Texas at Dallas
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Alves GS, Alves CEDO, Lanna ME, Moreira DM, Engelhardt E, Laks J. Subcortical ischemic vascular disease and cognition: A systematic review. Dement Neuropsychol 2008; 2:82-90. [PMID: 29213548 PMCID: PMC5619575 DOI: 10.1590/s1980-57642009dn20200002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 05/06/2008] [Indexed: 11/22/2022] Open
Abstract
Subcortical Ischemic Vascular Disease (SIVD) is underdiagnosed. This review investigates the relationship among SIVD severity, cognitive status and neuroimaging markers. METHODS Cohort, cross-sectional and case control studies were searched on ISI, Medline, Scielo, PsychoInfo and LILACS databases published between 1995 and 2006. RESULTS The most impaired cognitive domains were executive, attentional and memory retrieval mechanisms. These cognitive features were frequently associated to White Matter Lesions (WML). CONCLUSIONS WML is an independent factor in cognitive decline. However, the threshold for this impact is not yet clearly established.
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Affiliation(s)
| | | | - Maria Elisa Lanna
- Institute of Psychiatry, Federal University of Rio de
Janeiro, Brazil
| | - Denise Madeira Moreira
- Institute of Neurology, Federal University of Rio de
Janeiro, Brazil
- Radiology Service of the Procardíaco Hospital,
Brazil
| | - Eliasz Engelhardt
- Institute of Neurology, Federal University of Rio de
Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de
Janeiro, Brazil
- State University of Rio de Janeiro, Brazil
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Ross ED, Monnot M. Neurology of affective prosody and its functional-anatomic organization in right hemisphere. BRAIN AND LANGUAGE 2008; 104:51-74. [PMID: 17537499 DOI: 10.1016/j.bandl.2007.04.007] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 04/17/2007] [Accepted: 04/26/2007] [Indexed: 05/15/2023]
Abstract
Unlike the aphasic syndromes, the organization of affective prosody in brain has remained controversial because affective-prosodic deficits may occur after left or right brain damage. However, different patterns of deficits are observed following left and right brain damage that suggest affective prosody is a dominant and lateralized function of the right hemisphere. Using the Aprosodia Battery, which was developed to differentiate left and right hemisphere patterns of affective-prosodic deficits, functional-anatomic evidence is presented in patients with focal ischemic strokes to support the concepts that (1) affective prosody is a dominant and lateralized function of the right hemisphere, (2) the intrahemispheric organization of affective prosody in the right hemisphere, with the partial exception of Repetition, is analogous to the organization of propositional language in the left hemisphere and (3) the aprosodic syndromes are cortically based as part of evolutionary adaptations underlying human language and communication.
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Affiliation(s)
- Elliott D Ross
- Department of Neurology, University of Oklahoma Health Sciences Center and the VA Medical Center (11AZ), Oklahoma City, OK 73104, USA.
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Della Nave R, Foresti S, Pratesi A, Ginestroni A, Inzitari M, Salvadori E, Giannelli M, Diciotti S, Inzitari D, Mascalchi M. Whole-brain histogram and voxel-based analyses of diffusion tensor imaging in patients with leukoaraiosis: correlation with motor and cognitive impairment. AJNR Am J Neuroradiol 2007; 28:1313-9. [PMID: 17698534 PMCID: PMC7977673 DOI: 10.3174/ajnr.a0555] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral white matter changes, termed leukoaraiosis (LA), appearing as areas of increased signal intensity in T2-weighted MR images, are common in elderly subjects, but the possible correlation of LA with cognitive or motor deficit has not been established. We hypothesized that histogram and voxel-based analyses of whole-brain mean diffusivity (MD) and fractional anisotropy (FA) maps calculated from diffusion tensor imaging (DTI) could be more sensitive tools than visual scales to investigate the clinical correlates of LA. MATERIALS AND METHODS Thirty-six patients of the Leukoaraiosis and Disability Study were evaluated with fluid-attenuated inversion recovery for LA extension, T1-weighted images for volume, and DTI for MD and FA. The extent of LA was rated visually. The normalized total, gray, and white matter brain volumes were computed, as well as the 25th percentile, 50th percentile, kurtosis, and skewness of the MD and FA maps of the whole brain. Finally, voxel-based analysis on the maps of gray and white matter volume, MD, and FA was performed with SPM2 software. Correlation analyses between visual or computerized data and motor or neuropsychologic scale scores were performed using the Spearman rank test and the SPM2 software. RESULTS The visual score correlated with some MD and FA histogram metrics (P<.01). However, only the 25th and 50th percentiles, kurtosis, and skewness of the MD and FA histograms correlated with motor or neuropsychologic deficits. Voxel-based analysis revealed a correlation (P<.05 corrected for multiple comparisons) between a large cluster of increased MD in the corpus callosum and pericallosal white matter and motor deficit. CONCLUSIONS These results are consistent with the hypothesis that histogram and voxel-based analyses of the whole-brain MD and FA maps are more sensitive tools than the visual evaluation for clinical correlation in patients with LA.
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Affiliation(s)
- R Della Nave
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, and Medical Physics, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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Frisoni GB, Galluzzi S, Pantoni L, Filippi M. The effect of white matter lesions on cognition in the elderly—small but detectable. ACTA ACUST UNITED AC 2007; 3:620-7. [DOI: 10.1038/ncpneuro0638] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 09/07/2007] [Indexed: 11/09/2022]
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Ross ED, Prodan CI, Monnot M. Human Facial Expressions Are Organized Functionally Across the Upper-Lower Facial Axis. Neuroscientist 2007; 13:433-46. [PMID: 17901253 DOI: 10.1177/1073858407305618] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Most clinical research has focused on intensity differences of facial expressions between the right and left hemiface to explore lateralization of emotions in the brain. Observations by social psychologists, however, suggest that control of facial expression is organized predominantly across the upper-lower facial axis because of the phenomena of facial blends: simultaneous display of different emotions on the upper and lower face. Facial blends are related to social emotions and development of display rules that allow individuals to sculpt facial expressions for social and manipulative purposes. We have demonstrated that facial blends of emotion are more easily and accurately posed on the upper-lower than right-left hemiface, and that upper facial emotions are processed preferentially by the right hemisphere whereas lower facial emotions are processed preferentially by the left hemisphere. Based on these results, recent anatomical studies showing separate cortical areas for motor control of upper and lower face and the neurology of posed and spontaneous expressions of emotion, a functional-anatomic model of how the forebrain modulates facial expressions, is presented. The unique human ability to produce facial blends of emotion is, most likely, an adaptive modification linked to the evolution of speech and language. NEUROSCIENTIST 13(5):433—446, 2007.
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Affiliation(s)
- Elliott D Ross
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Abstract
PURPOSE OF REVIEW To summarize recent findings and developments in the field of the relation between white-matter lesions and cognition. RECENT FINDINGS Recent studies have provided further evidence that white-matter lesions exert a detrimental effect on cognitive profile. New magnetic-resonance techniques may help in clarifying the meaning and extent of this effect. Evidence is also increasing about lesion progression occurring over time, at least in patients with severe white-matter lesions, and this progression is one of the factors related to cognitive decline in the elderly. The need to delay or halt the progression of white-matter lesions has led to clarification of the role of some risk factors and to performance of therapeutic trials where white-matter lesions are used as a surrogate marker for the end point of small-vessel disease. In addition to cognitive effects, white-matter lesions have a role in the decline of other functional performances, and this places individuals with higher-grade lesions at increased risk of developing disability. SUMMARY White-matter lesions cannot be considered as mere incidental findings, at least in patients who show severe lesions. The pathogenesis of white-matter lesions must be clarified further and strategies found to delay their progression.
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Affiliation(s)
- Leonardo Pantoni
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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Ross ED, Shah SN, Prodan CI, Monnot M. Changing relative prevalence of Alzheimer disease versus non-Alzheimer disease dementias: have we underestimated the looming dementia epidemic? Dement Geriatr Cogn Disord 2007; 22:273-7. [PMID: 16914924 DOI: 10.1159/000095127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2005] [Indexed: 11/19/2022] Open
Abstract
The relative prevalence of neurodegenerative dementias in our Veterans' Affairs dementia clinic has shifted from predominantly Alzheimer disease (AD) to predominantly non-AD diagnoses. Because our clinic was the only Veterans' Affairs clinic in Oklahoma that could initiate cholinesterase inhibitors, we had a captured patient referral source. If future epidemiologic studies establish that non-AD dementias are as, or more, prevalent than AD, then the looming dementia epidemic in the United States will be greater in magnitude than currently predicted.
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Affiliation(s)
- Elliott D Ross
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, Okla., USA.
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van Harten B, Laman DM, van Duijn H, Knol DL, Stam CJ, Scheltens P, Weinstein HC. The auditory oddball paradigm in patients with vascular cognitive impairment: a prolonged latency of the N2 complex. Dement Geriatr Cogn Disord 2006; 21:322-7. [PMID: 16484811 DOI: 10.1159/000091474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The event-related potential (ERP) evoked by the auditory oddball paradigm has been investigated mainly in patients with Alzheimer's disease and in patients with different causes of subcortical dementia. Subcortical ischemic vascular disease (SIVD) seems to be an important cause of vascular cognitive impairment (VCI) frequently not fulfilling the criteria for dementia. Recognition of VCI is needed in order to provide adequate care and therapy. The aim of this study was to investigate the diagnostic value of the different elements of this response (N(1), N(2) complex and P(3) latencies) in a group of elderly patients with VCI caused by SIVD. METHODS The study population consisted of patients with a clinical and neuropsychological diagnosis of VCI caused by SIVD (n = 38) and healthy control subjects (n = 53) aged 60 years or older. The mean Mini Mental State Examination score of both groups was 27.6, and the mean HIV Dementia Scale score was 6.1 in the patient group and 12.3 in the control group. In all subjects, the ERP was recorded under standardized conditions, and the latencies and amplitudes of N(1), N(2) and P(3) were analyzed by two clinical neurophysiologists in consensus. Both were blinded to the diagnosis. RESULTS The N(2) latency was significantly longer in patients with VCI than in age-matched controls, whereas the latencies of the P(3) and N(1) were not significantly different. The peak-to-peak amplitude of the N(2) complex to the P(3) wave was significantly lower in the patient group. White matter abnormalities on MRI were not significantly correlated with the N(2) latency. CONCLUSION Our findings suggest that the latency of the N(2) complex is prolonged and the peak-to-peak amplitude of the N(2) complex to the P(3) wave is lowered in patients with VCI caused by SIVD.
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Affiliation(s)
- B van Harten
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
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Rypma B, Berger JS, Prabhakaran V, Bly BM, Kimberg DY, Biswal BB, D'Esposito M. Neural correlates of cognitive efficiency. Neuroimage 2006; 33:969-79. [PMID: 17010646 DOI: 10.1016/j.neuroimage.2006.05.065] [Citation(s) in RCA: 226] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 05/14/2006] [Accepted: 05/15/2006] [Indexed: 11/26/2022] Open
Abstract
Since its inception, experimental psychology has sought to account for individual differences in human performance. Some neuroimaging research, involving complex behavioral paradigms, has suggested that faster-performing individuals show greater neural activity than slower performers. Other research has suggested that faster-performing individuals show less neural activity than slower performers. To examine the neural basis of individual performance differences, we had participants perform a simple speeded-processing task during fMRI scanning. In some prefrontal cortical (PFC) brain regions, faster performers showed less cortical activity than slower performers while in other PFC and parietal regions they showed greater activity. Regional-causality analysis indicated that PFC exerted more influence over other brain regions for slower than for faster individuals. These results suggest that a critical determinant of individual performance differences is the efficiency of interactions between brain regions and that slower individuals may require more prefrontal executive control than faster individuals to perform successfully.
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Affiliation(s)
- Bart Rypma
- Rutgers University Psychology Department, USA.
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