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Ariko TA, Aimagambetova B, Gardener H, Gutierrez J, Elkind MSV, Wright CB, Zhao W, Rundek T. Estimated Pulse-Wave Velocity and Magnetic Resonance Imaging Markers of Cerebral Small-Vessel Disease in the NOMAS. J Am Heart Assoc 2024; 13:e035691. [PMID: 39023069 DOI: 10.1161/jaha.124.035691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Pulse-wave velocity is a measure of arterial stiffness and a risk factor for cardiovascular disease. Recently, an estimated pulse-wave velocity (ePWV) was introduced that was predictive of increased risk of cardiovascular disease. Our objective was to determine whether ePWV was associated with cerebral small-vessel disease on magnetic resonance imaging. METHODS AND RESULTS We included 1257 participants from the NOMAS (Northern Manhattan Study). The ePWV values were calculated using a nonlinear function of age and mean arterial blood pressure. The association between ePWV and white matter hyperintensity volume was assessed. Modification by race and ethnicity was evaluated. Associations between ePWV and other cerebral small-vessel disease markers, covert brain infarcts, cerebral microbleeds, and enlarged perivascular spaces, were explored as secondary outcomes. Mean±SD age of the cohort was 64±8 years; 61% were women; 18% self-identified as non-Hispanic Black, 67% as Hispanic, and 15% as non-Hispanic White individuals. Mean±SD ePWV was 11±2 m/s in the total NOMAS population and was similar across race and ethnic groups. The ePWV was significantly associated with white matter hyperintensity volume (β=0.23 [95% CI, 0.20-0.26]) after adjustment. Race and ethnicity modified the association between ePWV and white matter hyperintensity volume, with stronger associations in Hispanic and non-Hispanic Black individuals. Significant associations were found between ePWV and covert brain infarcts, cerebral microbleeds, and perivascular spaces after adjustment. CONCLUSIONS The ePWV function may provide a vascular mechanism for deleterious cerebrovascular outcomes in individuals with cerebral small-vessel disease and is particularly apparent in the racial and ethnic minorities represented in the NOMAS cohort.
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Affiliation(s)
- Taylor A Ariko
- Evelyn F. McKnight Brain Institute, University of Miami Miami FL
- Department of Biomedical Engineering University of Miami Miami FL
| | - Botagoz Aimagambetova
- Evelyn F. McKnight Brain Institute, University of Miami Miami FL
- Department of Neurology University of Miami Miller School of Medicine Miami FL
| | - Hannah Gardener
- Evelyn F. McKnight Brain Institute, University of Miami Miami FL
- Department of Neurology University of Miami Miller School of Medicine Miami FL
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons Columbia University New York NY
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons Columbia University New York NY
- American Heart Association Dallas TX
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke Bethesda MD
| | - Weizhao Zhao
- Department of Biomedical Engineering University of Miami Miami FL
- Department of Neurology University of Miami Miller School of Medicine Miami FL
| | - Tatjana Rundek
- Evelyn F. McKnight Brain Institute, University of Miami Miami FL
- Department of Biomedical Engineering University of Miami Miami FL
- Department of Neurology University of Miami Miller School of Medicine Miami FL
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Aimagambetova B, Ariko T, Gardener H, Levin B, Sun X, Gutierrez J, Elkind MSV, Wright CB, Rundek T. Association of estimated pulse wave velocity with cognitive function in a multiethnic diverse population: The Northern Manhattan Study. Alzheimers Dement 2024; 20:4903-4913. [PMID: 38895994 PMCID: PMC11247703 DOI: 10.1002/alz.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Arterial stiffness is linked to age-related cognitive dysfunction. Estimated pulse wave velocity (ePWV) is associated with cerebrovascular disease. We sought to determine whether ePWV was associated with cognition in a multiethnic population. METHODS We included 1257 participants enrolled in a Northern Manhattan Study magnetic resonance imaging MRI-cognitive study (mean age 64 ± 8 years, 61% women, 67% Hispanic, 18% non-Hispanic Black, 15% non-Hispanic white) and analyzed cognitive performance at two time points, at enrollment and on an average 5.0 ± 0.6 years later. ePWV was calculated using baseline age and blood pressure. Cognition and cognitive change scores were regressed on ePWV in multivariable linear regression models. RESULTS In adjusted models, ePWV (mean 11 ± 2 m/s) was significantly associated with cognition (b = -0.100, 95% CI, -0.120, -0.080) and cognitive change over time (b = -0.063, 95% CI, -0.082, -0.045). Effect modification by race and sex was found. DISCUSSION In this multiethnic population, the associations of ePWV with cognitive performance underline the role of vascular stiffness in age-related cognitive decline. HIGHLIGHTS ePWV is a modest but independent predictor of cognitive function and cognitive decline among older individuals. After adjustment, the ePWV measure was inversely associated with performance and decline in global cognition, processing speed, episodic memory, executive function, and semantic memory. After adjustment, modification of the association between ePWV and change in episodic memory and executive function by race and ethnicity was suggested by a significant interaction term. The association between ePWV and episodic memory decline was stronger in females.
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Affiliation(s)
- Botagoz Aimagambetova
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Taylor Ariko
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of Biomedical EngineeringUniversity of MiamiMiamiFloridaUSA
| | - Hannah Gardener
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Bonnie Levin
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Xiaoyan Sun
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jose Gutierrez
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Mitchell SV. Elkind
- Department of NeurologyVagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Clinton B. Wright
- Stroke BranchDivision of Intramural ResearchNational Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
| | - Tatjana Rundek
- Evelyn F. McKnight Brain InstituteMiamiFloridaUSA
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
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Abdul Hamid H, Hambali A, Okon U, Che Mohd Nassir CMN, Mehat MZ, Norazit A, Mustapha M. Is cerebral small vessel disease a central nervous system interstitial fluidopathy? IBRO Neurosci Rep 2024; 16:98-105. [PMID: 39007087 PMCID: PMC11240297 DOI: 10.1016/j.ibneur.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/20/2023] [Accepted: 12/22/2023] [Indexed: 07/16/2024] Open
Abstract
A typical anatomical congregate and functionally distinct multicellular cerebrovascular dynamic confer diverse blood-brain barrier (BBB) and microstructural permeabilities to conserve the health of brain parenchymal and its microenvironment. This equanimity presupposes the glymphatic system that governs the flow and clearance of metabolic waste and interstitial fluids (ISF) through venous circulation. Following the introduction of glymphatic system concept, various studies have been carried out on cerebrospinal fluid (CSF) and ISF dynamics. These studies reported that the onset of multiple diseases can be attributed to impairment in the glymphatic system, which is newly referred as central nervous system (CNS) interstitial fluidopathy. One such condition includes cerebral small vessel disease (CSVD) with poorly understood pathomechanisms. CSVD is an umbrella term to describe a chronic progressive disorder affecting the brain microvasculature (or microcirculation) involving small penetrating vessels that supply cerebral white and deep gray matter. This review article proposes CSVD as a form of "CNS interstitial fluidopathy". Linking CNS interstitial fluidopathy with CSVD will open a better insight pertaining to the perivascular space fluid dynamics in CSVD pathophysiology. This may lead to the development of treatment and therapeutic strategies to ameliorate the pathology and adverse effect of CSVD.
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Affiliation(s)
- Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Aqilah Hambali
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Udemeobong Okon
- Department of Physiology, Faculty of Basic Medical Science, University of Calabar, Etagbor, PMB 1115 Calabar, Nigeria
| | - Che Mohd Nasril Che Mohd Nassir
- Department of Anatomy and Physiology, School of Basic Medical Sciences, Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), 20400 Kuala Terengganu, Terengganu, Malaysia
| | - Muhammad Zulfadli Mehat
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Anwar Norazit
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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Lao P, Edwards N, Flores-Aguilar L, Alshikho M, Rizvi B, Tudorascu D, Rosas HD, Yassa M, Christian BT, Mapstone M, Handen B, Zimmerman ME, Gutierrez J, Wilcock D, Head E, Brickman AM. Cerebrovascular disease emerges with age and Alzheimer's disease in adults with Down syndrome. Sci Rep 2024; 14:12334. [PMID: 38811657 PMCID: PMC11137035 DOI: 10.1038/s41598-024-61962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Adults with Down syndrome have a genetic form of Alzheimer's disease (AD) and evidence of cerebrovascular disease across the AD continuum, despite few systemic vascular risk factors. The onset and progression of AD in Down syndrome is highly age-dependent, but it is unknown at what age cerebrovascular disease emerges and what factors influence its severity. In the Alzheimer's Biomarker Consortium-Down Syndrome study (ABC-DS; n = 242; age = 25-72), we estimated the age inflection point at which MRI-based white matter hyperintensities (WMH), enlarged perivascular spaces (PVS), microbleeds, and infarcts emerge in relation to demographic data, risk factors, amyloid and tau, and AD diagnosis. Enlarged PVS and infarcts appear to develop in the early 30s, while microbleeds, WMH, amyloid, and tau emerge in the mid to late 30s. Age-residualized WMH were higher in women, in individuals with dementia, and with lower body mass index. Participants with hypertension and APOE-ε4 had higher age-residualized PVS and microbleeds, respectively. Lifespan trajectories demonstrate a dramatic cerebrovascular profile in adults with Down syndrome that appears to evolve developmentally in parallel with AD pathophysiology approximately two decades prior to dementia symptoms.
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Affiliation(s)
- Patrick Lao
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Natalie Edwards
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
| | - Lisi Flores-Aguilar
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Mohamad Alshikho
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA
| | - Batool Rizvi
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Dana Tudorascu
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - H Diana Rosas
- Department of Neurology, Massachusetts General Hospital, Harvard Medical Center, Boston, MA, 02114, USA
| | - Michael Yassa
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | | | - Mark Mapstone
- Department of Neurology, University of California, Irvine, Irvine, CA, 92697, USA
| | - Benjamin Handen
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | | | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Donna Wilcock
- Departments of Neurology and Anatomy, Cell Biology, and Physiology, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elizabeth Head
- Department of Pathology and Laboratory Medicine, University of California, Irvine, Irvine, CA, 92697, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, 92697, USA
| | - Adam M Brickman
- Gertrude H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, PS Box 16, New York, NY, 10032, USA.
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
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Roh DJ, Murguia-Fuentes R, Gurel K, Khasiyev F, Rahman S, Bueno PP, Kozii K, Spagnolo-Allende AJ, Cottarelli A, Simonetto M, Ji R, Guo J, Spektor V, Hod EA, Burke DJ, Konofagou E, Rundek T, Wright CB, Marshall RS, Elkind MSV, Gutierrez J. Relationships of Hematocrit With Chronic Covert and Acute Symptomatic Lacunar Ischemic Lesions. Neurology 2024; 102:e207961. [PMID: 38165319 PMCID: PMC10870744 DOI: 10.1212/wnl.0000000000207961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Red blood cell (RBC) concentrations are known to associate with ischemic stroke. It is unclear whether RBC concentrations associate specifically with small vessel disease lacunar infarcts. We investigated the hypothesis that RBC concentrations associate with both chronic covert and acute symptomatic brain MRI lacunar infarcts. METHODS A cross-sectional observational analysis was performed across 2 cohorts with available hematocrit (as the assessment of RBC concentration exposure) and MRI outcome data. The primary setting was a population-based cohort of stroke-free, older adult (>50 years) participants from the Northern Manhattan Study (NOMAS) enrolled between 2003 and 2009. A second replication sample consisted of patients admitted with acute stroke and enrolled into the Columbia Stroke Registry (CSR) between 2005 and 2020. Associations of hematocrit with (1) chronic, covert lacunar infarcts and (2) symptomatic (i.e., acute) lacunar strokes were separately assessed from the NOMAS and CSR cohorts, respectively, using general additive models after adjusting for relevant covariates. RESULTS Of 1,218 NOMAS participants analyzed, 6% had chronic, covert lacunar infarcts. The association between hematocrit and these covert lacunar infarcts was U-shaped (χ2 = 9.21 for nonlinear associations; p = 0.03), with people with hematocrit extremes being more likely to have covert lacunar infarcts. Of the 1,489 CSR patients analyzed, 23% had acute lacunar strokes. In this sample, only the relationships of increased hematocrit concentrations and lacunar strokes were replicated (adjusted coefficient β = 0.020; SE = 0.009; p = 0.03). DISCUSSION We identified relationships of hematocrit with MRI lacunar infarcts in both stroke-free and ischemic stroke cohorts, respectively. The relationship between increased hematocrit concentrations with lacunar infarcts was replicated in both cohorts. Further studies are required to clarify the mechanisms behind the relationships of hematocrit with ischemic cerebral small vessel disease.
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Affiliation(s)
- David J Roh
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ricardo Murguia-Fuentes
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Kursat Gurel
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Farid Khasiyev
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Salwa Rahman
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Pedro Paiva Bueno
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Khrystyna Kozii
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Antonio J Spagnolo-Allende
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Azzurra Cottarelli
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Marialaura Simonetto
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Robin Ji
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jia Guo
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Vadim Spektor
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Eldad A Hod
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Devin J Burke
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Elisa Konofagou
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Clinton B Wright
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Randolph S Marshall
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jose Gutierrez
- From the Departments of Neurology (D.J.R., K.G., S.R., P.P.B., K.K., A.J.S.-A., D.J.B., R.S.M., J. Gutierrez), Pathology and Cell Biology (A.C., E.A.H.), Biomedical Engineering (R.J., E.K.), Psychiatry (J. Guo), and Department of Radiology (V.S.), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology (R.M.-F.), Louisiana State University Health Shreveport; Department of Neurology (F.K.), St. Louis University, MO; Department of Neurology (M.S.), Weill Cornell Medical Center, New York, NY; Department of Neurology (T.R.), University of Miami/Jackson Memorial Hospital, FL; National Institute of Neurological Disorders and Stroke (C.B.W.),, Bethesda, MD; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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6
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Okar SV, Hu F, Shinohara RT, Beck ES, Reich DS, Ineichen BV. The etiology and evolution of magnetic resonance imaging-visible perivascular spaces: Systematic review and meta-analysis. Front Neurosci 2023; 17:1038011. [PMID: 37065926 PMCID: PMC10098201 DOI: 10.3389/fnins.2023.1038011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesPerivascular spaces have been involved in neuroinflammatory and neurodegenerative diseases. Upon a certain size, these spaces can become visible on magnetic resonance imaging (MRI), referred to as enlarged perivascular spaces (EPVS) or MRI-visible perivascular spaces (MVPVS). However, the lack of systematic evidence on etiology and temporal dynamics of MVPVS hampers their diagnostic utility as MRI biomarker. Thus, the goal of this systematic review was to summarize potential etiologies and evolution of MVPVS.MethodsIn a comprehensive literature search, out of 1,488 unique publications, 140 records assessing etiopathogenesis and dynamics of MVPVS were eligible for a qualitative summary. 6 records were included in a meta-analysis to assess the association between MVPVS and brain atrophy.ResultsFour overarching and partly overlapping etiologies of MVPVS have been proposed: (1) Impairment of interstitial fluid circulation, (2) Spiral elongation of arteries, (3) Brain atrophy and/or perivascular myelin loss, and (4) Immune cell accumulation in the perivascular space. The meta-analysis in patients with neuroinflammatory diseases did not support an association between MVPVS and brain volume measures [R: −0.15 (95%-CI −0.40–0.11)]. Based on few and mostly small studies in tumefactive MVPVS and in vascular and neuroinflammatory diseases, temporal evolution of MVPVS is slow.ConclusionCollectively, this study provides high-grade evidence for MVPVS etiopathogenesis and temporal dynamics. Although several potential etiologies for MVPVS emergence have been proposed, they are only partially supported by data. Advanced MRI methods should be employed to further dissect etiopathogenesis and evolution of MVPVS. This can benefit their implementation as an imaging biomarker.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346564, identifier CRD42022346564.
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Affiliation(s)
- Serhat V. Okar
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Fengling Hu
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Benjamin V. Ineichen
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Reproducible Science, University of Zurich, Zurich, Switzerland
- *Correspondence: Benjamin V. Ineichen, , ; orcid.org/0000-0003-1362-4819
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7
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Li Z, Wang W, Sang F, Zhang Z, Li X. White matter changes underlie hypertension-related cognitive decline in older adults. Neuroimage Clin 2023; 38:103389. [PMID: 37004321 PMCID: PMC10102561 DOI: 10.1016/j.nicl.2023.103389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
Hypertension has been well recognized as a risk factor for cognitive impairment and dementia. Although the underlying mechanisms of hypertension-affected cognitive deterioration are not fully understood, white matter changes (WMCs) seem to play an important role. WMCs include low microstructural integrity and subsequent white matter macrostructural lesions, which are common on brain imaging in hypertensive patients and are critical for multiple cognitive domains. This article provides an overview of the impact of hypertension on white matter microstructural and macrostructural changes and its link to cognitive dysfunction. Hypertension may induce microstructural changes in white matter, especially for the long-range fibers such as anterior thalamic radiation (ATR) and inferior fronto-occipital fasciculus (IFOF), and then macrostructural abnormalities affecting different lobes, especially the periventricular area. Different regions' WMCs would further exert different effects to specific cognitive domains and accelerate brain aging. As a modifiable risk factor, hypertension might provide a new perspective for alleviating and delaying cognitive impairment.
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Affiliation(s)
- Zilin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Wenxiao Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Feng Sang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China
| | - Xin Li
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China; Beijing Aging Brain Rejuvenation Initiative Centre, Beijing Normal University, Beijing 100875, China.
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8
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Ramaswamy S, Khasiyev F, Gutierrez J. Brain Enlarged Perivascular Spaces as Imaging Biomarkers of Cerebrovascular Disease: A Clinical Narrative Review. J Am Heart Assoc 2022; 11:e026601. [PMID: 36533613 PMCID: PMC9798817 DOI: 10.1161/jaha.122.026601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Perivascular spaces or Virchow-Robin spaces form pathways along the subarachnoid spaces that facilitate the effective clearance of brain metabolic by-products through intracellular exchange and drainage of cerebrospinal fluid. Best seen on magnetic resonance imaging of the brain, enlarged perivascular spaces (EPVSs) are increasingly recognized as potential imaging biomarkers of neurological conditions. EPVSs are an established subtype of cerebral small-vessel disease; however, their associations with other cerebrovascular disorders are yet to be fully understood. In particular, there has been great interest in the association between the various parameters of EPVSs, such as number, size, and topography, and vascular neurological conditions. Studies have identified cross-sectional and longitudinal relationships between EPVS parameters and vascular events, such as ischemic stroke (both clinical and silent), intracerebral hemorrhage, vascular risk factors, such as age and hypertension, and neurodegenerative processes, such as vascular dementia and Alzheimer disease. However, these studies are limited by heterogeneity of data and the lack of consistent results across studied populations. Existing meta-analyses also fail to provide uniformity of results. We performed a qualitative narrative review with an aim to provide an overview of the associations between EPVSs and cerebrovascular diseases, which may help recognize gaps in our knowledge, inform the design of future studies, and advance the role of EPVSs as imaging biomarkers.
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Affiliation(s)
- Srinath Ramaswamy
- Department of NeurologySUNY Downstate Health Sciences UniversityBrooklynNY
| | - Farid Khasiyev
- Department of NeurologySt. Louis University School of MedicineSt. LouisMO
| | - Jose Gutierrez
- Department of NeurologyColumbia University Irving Medical CenterNew YorkNY
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9
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Khasiyev F, Rundek T, Di Tullio MR, Wright CB, Sacco RL, Elkind MSV, Gutierrez J. Systemic Arterial Correlates of Cervical Carotid Artery Tortuosity : The Northern Manhattan Study. Clin Neuroradiol 2022; 32:435-443. [PMID: 34132845 PMCID: PMC8720277 DOI: 10.1007/s00062-021-01044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The association between cervical internal carotid artery (cICA) tortuosity and atherosclerosis is a matter of debate. Additionally, some genetic syndromes characterized by connective tissue remodeling are associated with arterial tortuosity, raising the possibility that cICA tortuosity may not only be atherosclerotic. In this study, we hypothesized that cICA tortuosity is not associated with imaging biomarkers of atherosclerosis. METHODS The Northern Manhattan Study (NOMAS) was a prospective, multiethnic cohort of stroke-free individuals who underwent brain MRA, carotid ultrasound and transthoracic echocardiogram from 2003-2008. The cICA tortuosity was scored in each carotid as 0 = no tortuosity, 1 = tortuosity <90°, 2 = tortuosity ≥90°. A summary cICA tortuosity score (possible range 0-4) was created by adding up the tortuosity score from each carotid. Participants were assessed for atherosclerotic markers by using B‑mode carotid sonography and transthoracic echocardiography. RESULTS Of 558 participants 178 (31.9%) had any cervical ICA tortuosity (tortuosity score >0). The cICA tortuosity score was higher in women and was associated with diastolic and systolic blood pressures and height (all P < 0.05). In models adjusted for demographics and risk factors, only the association with diastolic blood pressure remained significant (β = 0.002, P = 0.02). Similarly, cICA tortuosity was associated with larger aortic root diameter (B = 1.03 ± 0.36, P = 0.004) but not with other markers of carotid or aortic atherosclerosis. CONCLUSION Cervical ICA tortuosity is associated with a higher diastolic blood pressure and larger aortic root diameter but not with other measures of atherosclerosis. Determining the risks of vascular events associated with this non-atherosclerotic phenotype may help for a better risk stratification for individuals with cICA tortuosity.
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Affiliation(s)
- Farid Khasiyev
- Department of Neurology, St. Louis University, St. Louis, MO, USA.
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Jose Gutierrez
- Department of Neurology, Columbia University, New York, NY, USA
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Liu M, Sariya S, Khasiyev F, Tosto G, Dueker ND, Cheung YK, Wright CB, Sacco RL, Rundek T, Elkind MS, Gutierrez J. Genetic determinants of intracranial large artery stenosis in the northern Manhattan study. J Neurol Sci 2022; 436:120218. [PMID: 35259553 PMCID: PMC9018518 DOI: 10.1016/j.jns.2022.120218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/01/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intracranial stenosis is one of the most common causes of stroke worldwide. Several single nucleotide polymorphisms have been associated with intracranial atherosclerosis, which is inferred to be the most common underlying cause of intracranial large artery stenosis (ILAS). We previously reviewed known genetic variants related to ILAS in predominantly Asian cohorts, but their prevalence and role in ILAS among western multiethnic populations are uncertain. METHODS We leveraged existing imaging and genetic data from the Northern Manhattan Study, a multiethnic prospective cohort study. Based on literature review, we selected adiponectin Q (ADIPOQ) rs2241767 and rs182052, ring finger protein 213 (RNF213) rs112735431, apolipoprotein E (APOE) rs429358, phosphodiesterase 4D (PDE4D) rs2910829, lipoprotein lipase (LPL) rs320, and aldosterone synthase (CYP11B2) rs1799998 variants as candidates to explore. We defined ILAS as luminal stenosis >50% in any intracranial large artery using time-of-flight magnetic resonance angiography (MRA). RESULTS We included 1109 participants (mean age 70 ± 9 years, 70% Hispanic, 60% women) in this study. ILAS was identified in 81 (7%) NOMAS participants. Logistic regression analyses adjusted for age, sex, principal components, and vascular risk factors showed ILAS prevalence associated with CYP11B2 rs1799998 under the dominant model (OR = 0.56, 95%CI: 0.35-0.89) and LPL rs320 heterozygote genotype (OR = 1.68, 95%CI: 1.05-2.71). The genotype distributions of ADIPOQ rs2241767 and rs182052, APOE rs429358 and CYP11B2 rs1799998 variants were significantly different among non-Hispanic white and Black, and Hispanic groups. When participants were further stratified by race/ethnicity, the estimates were consistent for CYP11B2 rs1799998 across race/ethnic groups but not for LPL rs320. CONCLUSION The CYP11B2 rs1799998 variant may be a protective genetic factor for ILAS across race/ethnic groups, but the risk of ILAS associated with LPL rs320 varies by race/ethnic group. Further functional studies may help elucidate the role that these variants play in the pathophysiology of ILAS.
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Beaman C, Kozii K, Hilal S, Liu M, Spagnolo-Allende AJ, Polanco-Serra G, Chen C, Cheng CY, Zambrano D, Arikan B, Del Brutto VJ, Wright C, Flowers XE, Leskinen SP, Rundek T, Mitchell A, Vonsattel JP, Cortes E, Teich AF, Sacco RL, Elkind MSV, Roh D, Gutierrez J. Cerebral Microbleeds, Cerebral Amyloid Angiopathy, and Their Relationships to Quantitative Markers of Neurodegeneration. Neurology 2022; 98:e1605-e1616. [PMID: 35228332 PMCID: PMC9052569 DOI: 10.1212/wnl.0000000000200142] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Age-related cognitive impairment is driven by the complex interplay of neurovascular and neurodegenerative disease. There is a strong relationship between cerebral microbleeds (CMBs), cerebral amyloid angiopathy (CAA), and the cognitive decline observed in conditions such as Alzheimer disease. However, in the early, preclinical phase of cognitive impairment, the extent to which CMBs and underlying CAA affect volumetric changes in the brain related to neurodegenerative disease remains unclear. METHODS We performed cross-sectional analyses from 3 large cohorts: The Northern Manhattan Study (NOMAS), Alzheimer's Disease Neuroimaging Initiative (ADNI), and the Epidemiology of Dementia in Singapore study (EDIS). We conducted a confirmatory analysis of 82 autopsied cases from the Brain Arterial Remodeling Study (BARS). We implemented multivariate regression analyses to study the association between 2 related markers of cerebrovascular disease-MRI-based CMBs and autopsy-based CAA-as independent variables and volumetric markers of neurodegeneration as dependent variables. NOMAS included mostly dementia-free participants age 55 years or older from northern Manhattan. ADNI included participants living in the United States age 55-90 years with a range of cognitive status. EDIS included community-based participants living in Singapore age 60 years and older with a range of cognitive status. BARS included postmortem pathologic samples. RESULTS We included 2,657 participants with available MRI data and 82 autopsy cases from BARS. In a meta-analysis of NOMAS, ADNI, and EDIS, superficial CMBs were associated with larger gray matter (β = 4.49 ± 1.13, p = 0.04) and white matter (β = 4.72 ± 2.1, p = 0.03) volumes. The association between superficial CMBs and larger white matter volume was more evident in participants with 1 CMB (β = 5.17 ± 2.47, p = 0.04) than in those with ≥2 CMBs (β = 1.97 ± 3.41, p = 0.56). In BARS, CAA was associated with increased cortical thickness (β = 6.5 ± 2.3, p = 0.016) but not with increased brain weight (β = 1.54 ± 1.29, p = 0.26). DISCUSSION Superficial CMBs are associated with larger morphometric brain measures, specifically white matter volume. This association is strongest in brains with fewer CMBs, suggesting that the CMB/CAA contribution to neurodegeneration may not relate to tissue loss, at least in early stages of disease.
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Affiliation(s)
- Charles Beaman
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Krystyna Kozii
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Saima Hilal
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Minghua Liu
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Anthony J Spagnolo-Allende
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Guillermo Polanco-Serra
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Christopher Chen
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ching-Yu Cheng
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Daniela Zambrano
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Burak Arikan
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Victor J Del Brutto
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Clinton Wright
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Xena E Flowers
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Sandra P Leskinen
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Amanda Mitchell
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jean Paul Vonsattel
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Etty Cortes
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Andrew F Teich
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - David Roh
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jose Gutierrez
- From the Departments of Neurology (C.B., K.K., M.L., A.J.S.-A., D.Z., A.M., A.F.T., M.S.V.E., D.R., J.G.) and Pathology and Cell Biology (X.E.F., S.P.L., J.P.V., A.F.T.), Columbia University Irving Medical Center, New York, NY; Department of Neurology (C.B.), UCLA Medical Center, Los Angeles, CA; Memory Aging and Cognition Center (S.H., C.C.), National University Health System, Singapore; Department of Pharmacology (S.H., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Saw Swee Hock School of Public Health (S.H.), National University of Singapore and National University Health System, Singapore; College of Medicine (G.P.-S.), SUNY Upstate Medical University, Syracuse, NY; Singapore Eye Research Institute (C.-Y.C.), Singapore National Eye Centre; Ophthalmology and Visual Sciences Academic Clinical Program (C.-Y.C.), Duke-NUS Medical School, National University of Singapore; Istanbul University Cerrahpasa School of Medicine (B.A.), Turkey; Department of Neurology and Evelyn F. McKnight Brain Institute (V.J.D.B., T.R., R.L.S.), Miller School of Medicine, University of Miami Miller School of Medicine, FL; National Institutes of Health (C.W.), Bethesda, MD; Department of Pathology (E.C.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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12
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Abstract
Despite advances in acute management and prevention of cerebrovascular disease, stroke and vascular cognitive impairment together remain the world's leading cause of death and neurological disability. Hypertension and its consequences are associated with over 50% of ischemic and 70% of hemorrhagic strokes but despite good control of blood pressure (BP), there remains a 10% risk of recurrent cerebrovascular events, and there is no proven strategy to prevent vascular cognitive impairment. Hypertension evolves over the lifespan, from predominant sympathetically driven hypertension with elevated mean BP in early and mid-life to a late-life phenotype of increasing systolic and falling diastolic pressures, associated with increased arterial stiffness and aortic pulsatility. This pattern may partially explain both the increasing incidence of stroke in younger adults as well as late-onset, chronic cerebrovascular injury associated with concurrent systolic hypertension and historic mid-life diastolic hypertension. With increasing arterial stiffness and autonomic dysfunction, BP variability increases, independently predicting the risk of ischemic and intracerebral hemorrhage, and is potentially modifiable beyond control of mean BP. However, the interaction between hypertension and control of cerebral blood flow remains poorly understood. Cerebral small vessel disease is associated with increased pulsatility in large cerebral vessels and reduced reactivity to carbon dioxide, both of which are being targeted in early phase clinical trials. Cerebral arterial pulsatility is mainly dependent upon increased transmission of aortic pulsatility via stiff vessels to the brain, while cerebrovascular reactivity reflects endothelial dysfunction. In contrast, although cerebral autoregulation is critical to adapt cerebral tone to BP fluctuations to maintain cerebral blood flow, its role as a modifiable risk factor for cerebrovascular disease is uncertain. New insights into hypertension-associated cerebrovascular pathophysiology may provide key targets to prevent chronic cerebrovascular disease, acute events, and vascular cognitive impairment.
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Affiliation(s)
- Alastair J S Webb
- Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
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13
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Rundek T, Del Brutto V, Goryawala M, Dong C, Agudelo C, Saporta AS, Merritt S, Camargo C, Ariko T, Loewenstein DA, Duara R, Haq I. Associations Between Vascular Risk Factors and Perivascular Spaces in Adults with Intact Cognition, Mild Cognitive Impairment, and Dementia. J Alzheimers Dis 2022; 89:437-448. [PMID: 35871327 PMCID: PMC10410400 DOI: 10.3233/jad-215585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perivascular spaces (PVS) are fluid-filled compartments surrounding small intracerebral vessels that transport fluid and clear waste. OBJECTIVE We examined associations between PVS count, vascular and neurodegenerative risk factors, and cognitive status among the predominantly Hispanic participants of the FL-VIP Study of Alzheimer's Disease Risk. METHODS Using brain MRI (n = 228), we counted PVS in single axial image through the basal ganglia (BG) and centrum semiovale (CSO). PVS per region were scored as 0 (none), 1 (<10), 2 (11-20), 3 (21-40), and 4 (>40). Generalized linear models examined PVS associations with vascular risk factors and a composite vascular comorbidity risk (VASCom) score. RESULTS Our sample (mean age 72±8 years, 61% women, 60% Hispanic, mean education 15±4 years, 33% APOE4 carriers) was 59% hypertensive, 21% diabetic, 66% hypercholesteremic, and 30% obese. Mean VASCom score was 2.3±1.6. PVS scores ranged from 0-4 in the BG (mean 1.3±0.7) and CSO (mean 1.2±0.9), and 0-7 combined (mean 2.5±1.4). In multivariable regression models, BG PVS was associated with age (β= 0.03/year, p < 0.0001), Hispanic ethnicity (β= 0.29, p = 0.01), education (β= 0.04/year, p = 0.04), and coronary bypass surgery (β= 0.93, p = 0.02). CSO PVS only associated with age (β= 0.03/year, p < 0.01). APOE4 and amyloid-β were not associated with PVS. CONCLUSION BG PVS may be a marker of subclinical cerebrovascular disease. Further research is needed to validate associations and identify mechanisms linking BG PVS and cerebrovascular disease markers. PVS may be a marker of neurodegeneration despite our negative preliminary findings and more research is warranted. The association between BG PVS and Hispanic ethnicity also requires further investigation.
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Affiliation(s)
- Tatjana Rundek
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor Del Brutto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mohammed Goryawala
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuanhui Dong
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christian Agudelo
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anita Seixas Saporta
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stacy Merritt
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christian Camargo
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Taylor Ariko
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David A. Loewenstein
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- The Center for Neurocognitive Sciences and Aging, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ranjan Duara
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ihtsham Haq
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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14
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Gronewold J, Jokisch M, Schramm S, Jockwitz C, Miller T, Lehmann N, Moebus S, Jöckel KH, Erbel R, Caspers S, Hermann DM. Association of Blood Pressure, Its Treatment, and Treatment Efficacy With Volume of White Matter Hyperintensities in the Population-Based 1000BRAINS Study. Hypertension 2021; 78:1490-1501. [PMID: 34628935 DOI: 10.1161/hypertensionaha.121.18135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Janine Gronewold
- Department of Neurology, University Hospital Essen, Germany (J.G., M.J., D.M.H.)
| | - Martha Jokisch
- Department of Neurology, University Hospital Essen, Germany (J.G., M.J., D.M.H.)
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology (S.S., N.L., K.-H.J., R.E.), University Hospital Essen, University Duisburg-Essen, Germany
| | - Christiane Jockwitz
- Institute of Neuroscience and Medicine, Research Centre Jülich, Germany (C.J., T.M., S.C.).,Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Germany (C.J., T.M., S.C.)
| | - Tatiana Miller
- Institute of Neuroscience and Medicine, Research Centre Jülich, Germany (C.J., T.M., S.C.).,Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Germany (C.J., T.M., S.C.)
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology (S.S., N.L., K.-H.J., R.E.), University Hospital Essen, University Duisburg-Essen, Germany
| | - Susanne Moebus
- Centre for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology (S.M.), University Hospital Essen, University Duisburg-Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (S.S., N.L., K.-H.J., R.E.), University Hospital Essen, University Duisburg-Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (S.S., N.L., K.-H.J., R.E.), University Hospital Essen, University Duisburg-Essen, Germany
| | - Svenja Caspers
- Institute of Neuroscience and Medicine, Research Centre Jülich, Germany (C.J., T.M., S.C.).,Institute for Anatomy I, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Germany (C.J., T.M., S.C.)
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, Germany (J.G., M.J., D.M.H.)
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15
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Guzman VA, Cham H, Gutierrez J, Byrd D, Morris EP, Tureson K, Morgello S, Mindt MR. The Longitudinal Effects of Blood Pressure and Hypertension on Neurocognitive Performance in People Living With HIV. J Acquir Immune Defic Syndr 2021; 88:197-205. [PMID: 34081663 PMCID: PMC8434985 DOI: 10.1097/qai.0000000000002740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertension (HTN) and HIV are salient risk factors for cerebral small vessel disease and neurocognitive (NC) impairment, yet the effects of HTN on NC performance in persons living with HIV remain poorly understood. This is the first study to examine the longitudinal associations between blood pressure (BP), HTN, and pulse pressure (PP) with NC performance in persons living with HIV. SETTING New York City. METHODS Analysis of medical, NC, and virologic data from 485 HIV+ participants was collected by the Manhattan HIV Brain Bank, a prospective, observational, longitudinal study of neuroHIV. A series of multilevel linear growth curve models with random intercepts and slopes were estimated for BP, HTN status, and PP to predict the change in NC performance. RESULTS The baseline prevalence of HTN was 23%. Longitudinal changes in diastolic and systolic pressure were associated with a 10.5-second and 4-second increase in the Grooved Pegboard Test nondominant hand performance, respectively. A longitudinal change in diastolic BP was also associated with a 0.3-point decline in correct categories and 3-point increase in perseverative responses and total errors on the Wisconsin Card Sorting Test. Increasing odds of prevalent and/or incident HTN were associated with a 0.1-point decrease in correct categories and a 0.8-point increase in total errors on the Wisconsin Card Sorting Test. There was no association between PP and NC performance. CONCLUSIONS The results indicate linear longitudinal relations for BP and HTN with poorer NC test performance, particularly in psychomotor and executive functions in persons with HIV.
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Affiliation(s)
- Vanessa A. Guzman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Fordham University, New York, NY, USA
| | - Heining Cham
- Department of Psychology, Fordham University, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree Byrd
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Queens College and The Graduate Center, CUNY, Queens, New York, USA
| | - Emily P. Morris
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kayla Tureson
- Department of Psychology, Fordham University, New York, NY, USA
- Department of Psychology, University of Southern California, Los Angeles, USA
| | - Susan Morgello
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Departments of Pathology and Neuroscience, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Rivera Mindt
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Fordham University, New York, NY, USA
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16
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Gutierrez J, Porras TN, Yoo-Jeong M, Khasiyev F, Igwe KC, Laing KK, Brickman AM, Pavol M, Schnall R. Cerebrovascular Contributions to Neurocognitive Disorders in People Living With HIV. J Acquir Immune Defic Syndr 2021; 88:79-85. [PMID: 34397745 PMCID: PMC8371714 DOI: 10.1097/qai.0000000000002729] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND To investigate a comprehensive array of magnetic resonance imaging (MRI)-based biomarkers of cerebrovascular disease (CVD) in a cohort of people living with HIV (PLWH) and relate these imaging biomarkers to cognition. SETTINGS Cross-sectional, community-based study. METHODS Participants were PLWH in New York City, aged 50 years or older. They underwent a brain magnetic resonance angiography or MRI to ascertain 7 MRI markers of CVD: silent brain infarcts, dilated perivascular spaces, microhemorrhages, white matter hyperintensity volume, white matter fractional anisotropy and mean diffusivity (measures of white matter integrity), and intracranial large artery stenosis. Participants underwent a battery of neurocognitive tests to obtain individual and global cognitive scores representative of various aspects of cognition. RESULTS We included 85 participants (mean age 60 ± 6 years, 48% men, 78% non-Hispanic Black), most of them with well-controlled HIV (75% with CD4 cell count > 200 cells/mm3 and viral load < 400 copies/mL at or near the time of the MRI scan). Silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity were associated with poorer performance in at least one cognitive domain, but the sum of these 3 MRI markers of CVD was associated with lower working memory (B = -0.213, P = 0.028), list learning (B = -0.275, P = 0.019), and global cognition (B = -0.129, P = 0.007). CONCLUSIONS We identified silent brain infarcts, intracranial large artery stenosis, and poor white matter integrity as exposures that may be modifiable and may, therefore, influence cognitive decline. In addition, these MRI markers of CVD may help in identifying PLWH at higher risk of cognitive decline, which may be more amenable to targeted therapies.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - Tiffany N Porras
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Moka Yoo-Jeong
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA
| | - Farid Khasiyev
- Department of Neurology, Saint Louis University, Saint Louis, MI
| | - Kay C Igwe
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Krystal K Laing
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Adam M Brickman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY
| | - Marykay Pavol
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Rebecca Schnall
- School of Nursing, Columbia University Irving Medical Center, New York, NY; and
- Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
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17
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Matsumoto K, Jin Z, Homma S, Elkind MSV, Schwartz JE, Rundek T, Mannina C, Ito K, Sacco RL, Di Tullio MR. Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study. Hypertension 2021; 78:851-858. [PMID: 34247509 DOI: 10.1161/hypertensionaha.121.17308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kenji Matsumoto
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics (Z.J.), Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY (M.S.V.E.)
| | - Joseph E Schwartz
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY.,Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S.)
| | - Tatjana Rundek
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Carlo Mannina
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Kazato Ito
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Clinical and Translational Science Institute (R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Marco R Di Tullio
- Department of Medicine (K.M., S.H., J.E.S., C.M., K.I., M.R.D.T.), Columbia University, New York, NY
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18
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Del Brutto OH, Mera RM, Recalde BY, Torpey AP, Hill JP, Generale LM, Peralta LD, Sedler MJ. Association Between Pulsatile Components of Blood Pressure and Severe Tooth Loss in Rural Ecuador: The Three Villages Study. J Prim Care Community Health 2021; 11:2150132720928670. [PMID: 32476552 PMCID: PMC7265074 DOI: 10.1177/2150132720928670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Arterial hypertension has been associated with severe tooth loss, but differential associations with individual components of blood pressure (BP) have scarcely been investigated. We assessed the independent associations between pulsatile/steady components of BP and severe tooth loss in community-dwelling adults residing in 3 rural Ecuadorian villages. Methods: Individuals aged ≥40 years living in Atahualpa, El Tambo, and Prosperidad were identified during door-to-door surveys. Data collection focused on the number of remaining teeth and measurements of pulsatile/steady components of BP. Multivariate models were fitted to assess independent associations between pulsatile/steady BP components and severe tooth loss, after adjusting for relevant covariates. Results: A total of 1543 individuals were included. Oral exams identified 426 (28%) individuals with severe tooth loss. BP levels ≥140/90 mm Hg were determined in 481 (31%) individuals. The mean pulse pressure (PP) level was 55.3 ± 19 mm Hg. For systolic BP (SBP), the mean level was 133.1 ± 23.5 mm Hg, and for diastolic BP (DBP) it was 77.8 ± 11.5 mm Hg. Univariate models showed significant associations between severe tooth loss and SBP and PP, but not with DBP. However, the significance was taken away in fully adjusted generalized linear models. Age remained as an independent significant covariate in models using SBP and PP. Causal mediation analyses disclosed that percentages of the effect of severe tooth loss mediated by age were 99.5% for SBP and 98.9% for PP. Conclusion: This study shows that age captures most of the effect of the association between pulsatile components of BP and severe tooth loss.
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19
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Wartolowska KA, Webb AJS. Blood Pressure Determinants of Cerebral White Matter Hyperintensities and Microstructural Injury: UK Biobank Cohort Study. Hypertension 2021; 78:532-539. [PMID: 34058855 PMCID: PMC8260341 DOI: 10.1161/hypertensionaha.121.17403] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Supplemental Digital Content is available in the text. Small vessel disease and related stroke and dementia risks are linked to aging and hypertension, but it is unclear whether the pulsatile or steady blood pressure (BP) component is more important for the development of macrostructural hyperintensities and microstructural white matter damage. This was a cross-sectional analysis of the UK Biobank cohort study of community-based adults from 22 UK centers. Linear associations were determined between neuroimaging markers (white matter hyperintensity [WMH] volume and diffusion imaging indices) and mean arterial pressure and pulse pressure (PP), both unadjusted and adjusted for age, sex, cardiovascular risk factors, antihypertensive medication, BP source, and assessment center. In 37 041 participants aged 45 to 82 years (53% female), univariable analyses demonstrated that increases in both BP components were associated with greater WMH volume and white matter injury on diffusion indices, with a larger effect for PP (standardized effect size for WMH: mean arterial BP: 0.182 [95% CIs, 0.170–0.193]; PP: 0.285 [95% CIs, 0.274–0.296]). In multivariable analyses, associations with mean arterial pressure remained similar, but associations with PP diminished, reflecting covariance with age and risk factors (standardized effect size for WMH: mean arterial BP: 0.106 [95% CIs, 0.095–0.117]; PP: 0.011 [95% CIs, −0.001 to 0.023]). The synergistic interaction between PP and age increased the effect of age on WMH and diffusion indices. Both macrostructural and microstructural white matter injury had similar associations with the pulsatile and steady components of hypertension, although PP accentuated the relationship between age and white matter damage.
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Affiliation(s)
- Karolina A Wartolowska
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Alastair J S Webb
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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20
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Liu J, Ke X, Lai Q. Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities. Acta Radiol 2021; 62:515-523. [PMID: 32551801 DOI: 10.1177/0284185120932386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter. PURPOSE To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals. MATERIAL AND METHODS A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV). RESULTS Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities. CONCLUSION Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.
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Affiliation(s)
- Jiyang Liu
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Xiaoting Ke
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
| | - Qingquan Lai
- Department of Medical Imaging, The Second Affiliated Hospital of Fujian Medical University, Quanzhou City, Fujian Province, PR China
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21
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Salman E, Kadota A, Hisamatsu T, Segawa H, Torii S, Fujiyoshi A, Kondo K, Watanabe Y, Arima H, Shiino A, Nozaki K, Ueshima H, Miura K, The Sessa Research Group F. Relationship of Four Blood Pressure Indexes to Subclinical Cerebrovascular Diseases Assessed by Brain MRI in General Japanese Men. J Atheroscler Thromb 2021; 29:174-187. [PMID: 33487617 PMCID: PMC8803566 DOI: 10.5551/jat.58537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim:
The relationship of blood pressure (BP) indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], mean arterial pressure [MAP]) to subclinical cerebrovascular diseases (SCVDs) remains unclear. This study aimed to elucidate the relationship of four BP indexes measured at two visits on SCVDs assessed by magnetic resonance imaging (MRI) in general Japanese men.
Methods:
In general Japanese men aged 40–79 years (
N
=616), office BP indexes were measured at two visits (Visits 1 [2006–2008] and 2 [2010–2014]). MRI images obtained on the third visit (2012–2015) were examined for prevalent SCVDs: lacunar infarction, periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DSWMH), microbleeds, and intracranial artery stenosis (ICAS). Using a multivariable logistic regression analysis, we computed and estimated the odds ratio of each prevalent SCVD for one standard deviation higher BP indexes. The same analyses were performed using home BP.
Results:
All four office BP indexes at both visits associated with lacunar infarction. Visit 1 and 2 DBP and Visit 1 MAP associated with PVH and DSWMH, and Visit 1 SBP associated with DSWMH. All Visit 2 BP indexes appear to show stronger association with microbleeds than Visit 1 indexes, and Visit 1 and 2 SBP, PP, and MAP showed similar associations with ICAS. Additional analyses using home BP indexes revealed similar relationships; however, the significance of some relationships decreased.
Conclusion:
In general Japanese men, BP indexes were associated with most of SCVDs, and BP indexes measured at different periods associated with different SCVDs assessed by MRI.
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Affiliation(s)
- Ebtehal Salman
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Takashi Hisamatsu
- Department of Public Health, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University
| | - Hiroyoshi Segawa
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science
| | - Akira Fujiyoshi
- Department of Public Health, Shiga University of Medical Science.,Department of Hygiene, School of Medicine, Wakayama Medical University
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | | | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Akihiko Shiino
- Molecular Neuroscience Research Center, Shiga University of Medical Science
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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22
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Díaz A, Pascaner AF, Wray S, Fischer EC. Characteristics and Determinants of Pulse Pressure-Age Relationship in Healthy and Non-treated Hypertensive Subjects of Argentinean Population. Curr Hypertens Rev 2020; 17:137-148. [PMID: 33305707 DOI: 10.2174/1573402116999201210195123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These findings are supported by large-cohort analyzes conducted in well-known populations, such as Framingham Study. However, there is evidence that an age-PP curvilinear relationship may exist in hypertensive subjects. This study aimed to evaluate the age-related change in pulse pressure and arterial stiffness in a population-based study. METHODS Carotid-femoral Pulse Wave Velocity (cfPWV) were obtained in 2075 subjects. RESULTS Age-related changes of PP showed a curvilinear relationship (R=0.39, p<0.0001) in normotensive subjects, with a nadir at around 50 years of age. On the other hand, the age-cfPWV relationship showed a linear and positive correlation (R=0.72, p<0.0001). PP also showed a curvilinear relationship with age (R=0.36, p<0.0001) in hypertensive subjects, with a nadir around 50 years of age. The age-cfPWV relationship showed a linear and positive correlation (R=0.55, p<0.0001). Similar results were observed in the adult population (age≥16 years). Multivariate analysis showed that age, sex, cfPWV, and mean arterial pressure are determinants of PP values in the entire population; however, this result was not uniform when different subgroups were analyzed. CONCLUSION In conclusion, age-related changes in PP showed a curvilinear relationship and no parallelism with the age-cfPWV relationship for both normotensive and hypertensive subjects. The determinants of PP impact it differently depending on age and the pathological condition of the subject.
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Affiliation(s)
- Alejandro Díaz
- Instituto de Investigación en Ciencias de la Salud, UNICEN-CONICET, Tandil, Argentina
| | - Ariel F Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMTTYB) - CONICET-UF, Buenos Aires, Argentina
| | - Sandra Wray
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMTTYB) - CONICET-UF, Buenos Aires, Argentina
| | - Edmundo C Fischer
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMTTYB) - CONICET-UF, Buenos Aires, Argentina
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23
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Parikh NS, Dueker N, Varela D, Del Brutto VJ, Rundek T, Wright CB, Sacco RL, Elkind MSV, Gutierrez J. Association between PNPLA3 rs738409 G variant and MRI cerebrovascular disease biomarkers. J Neurol Sci 2020; 416:116981. [PMID: 32592869 DOI: 10.1016/j.jns.2020.116981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Nonalcoholic fatty liver disease (NAFLD) has been associated with greater cerebral white matter hyperintensity (WMH) volume and microbleeds. The adiponutrin (PNPLA3) rs738409 G variant, a robust NAFLD susceptibility variant, has been variably associated with carotid atherosclerosis. We hypothesized that this variant is associated with WMH volume, microbleeds, covert brain infarction (CBI), and small perivascular spaces. METHODS We performed a cross-sectional analysis of the Northern Manhattan Study-MRI Substudy. The associations between the rs738409 G variant allele and outcomes were assessed using linear regression for WMH volume, logistic regression for microbleeds and CBI, and Poisson regression for small perivascular spaces. Models were adjusted for age, sex, principal components, diabetes, and body mass index. RESULTS We included 1063 Northern Manhattan Study participants who had brain MRI and genotype data available (mean age 70 ± 9 years, 61% women). The G allele frequency was 24%. The prevalence of any microbleeds and CBI were 8% and 18%, respectively. The median WMH volume and small perivascular space count score were 7.7 mL and 6, respectively. GG homozygosity, but not heterozygosity, was associated with WMH volume (β = 0.27; 95% CI, 0.03, 0.51) compared to non-carriers. Having at least one G allele was associated with the presence of microbleeds (Odds ratio, 1.78; 95% CI, 1.02, 3.12); the association was attenuated in other models. No associations were observed for CBI and small perivascular spaces. CONCLUSION The PNPLA3 rs738409 G allele was associated with greater WMH volume, and inconsistent associations with microbleeds were seen.
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Affiliation(s)
- Neal S Parikh
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Nicole Dueker
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, FL, USA
| | - Dalila Varela
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Victor J Del Brutto
- Department of Neurology, Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Ralph L Sacco
- John P. Hussman Institute for Human Genomics, University of Miami, Miami, FL, USA; Department of Neurology, Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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24
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Du H, Chen C, Ye C, Lin F, Wei J, Xia P, Chen R, Wu S, Yuan Q, Chen H, Xiao Y, Liu N. Association Between Steno-Occlusive Middle Cerebral Artery and Basal Ganglia Perivascular Spaces. Front Neurol 2020; 11:293. [PMID: 32390930 PMCID: PMC7191059 DOI: 10.3389/fneur.2020.00293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Enlarged perivascular spaces in the basal ganglia (BG-EPVS) share common vascular risk factors with atherosclerosis. However, little is known about the relationship between steno-occlusive middle cerebral artery (MCA) and BG-EPVS. In this cross-sectional study, we aimed to test the hypothesis that severe MCA stenosis or occlusion is associated with increased MRI-visible BG-EPVS. Methods: We retrospectively reviewed 112 patients with a steno-occlusive MCA from Fujian Medical University Union Hospital between January 2014 and December 2018. We rated BG-EPVS, white matter hyperintensities (WMH), and lacunes as markers of cerebral small vessel disease (CSVD) on magnetic resonance image (MRI). The severity of steno-occlusive MCA was assessed by computed tomography angiography (CTA) and was classified into moderate (50-69%), severe (70-99%), and occlusion (100%). We evaluated the association of steno-occlusive MCA for >10 BG-EPVS using logistic regression model adjusted for age, gender, hypertension, MR-visible WMH, and lacunes. We also compared the number of BG-EPVS between the affected side and unaffected side in patients with only unilateral steno-occlusive MCA. Results: In multivariable logistic regression analysis, age (OR = 1.07, 95%CI: 1.03-1.13, p = 0.003), hypertension (OR = 2.77, 95%CI: 1.02-7.51, p = 0.046), severe MCA stenosis (OR = 3.65, 95%CI: 1.12-11.87, p = 0.032), or occlusion (OR = 3.67, 95%CI: 1.20-11.27, p = 0.023) were significantly associated with >10 BG-EPVS. The number of BG-EPVS in the affected side was higher than the unaffected side in patients with severe MCA stenosis (12 [9-14] vs. 8 [6-11], p = 0.001) or occlusion (11 [7-14] vs. 8 [5-11], p = 0.028). Conclusions: BG-EPVS were more prevalent in patients with severe MCA atherosclerosis. Our findings suggest a biological link between severe steno-occlusive MCA and increased BG-EPVS. These results need confirmation in prospective studies.
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Affiliation(s)
- Houwei Du
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao Chen
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Neurology, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Chengbin Ye
- Department of Radiology, The People's Hospital of Fujian Traditional Chinese Medicine University, Fuzhou, China
| | - Feifei Lin
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jin Wei
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.,School of Health Sciences, College of Health and Medicine, University of Tasmania, Newham, VIC, Australia
| | - Pincang Xia
- Department of STDs and HIV/AIDS Control and Prevention, Fujian Province Center for Disease Control and Prevention, Fuzhou, China
| | - Ronghua Chen
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sangru Wu
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qilin Yuan
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hongbin Chen
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yingchun Xiao
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Nan Liu
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China.,Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China
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25
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Caunca MR, Simonetto M, Cheung YK, Alperin N, Lee SH, Elkind MS, Sacco RL, Rundek T, Wright CB. Diastolic Blood Pressure Is Associated With Regional White Matter Lesion Load: The Northern Manhattan Study. Stroke 2020; 51:372-378. [PMID: 31910743 PMCID: PMC7219602 DOI: 10.1161/strokeaha.119.025139] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/11/2019] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Few studies have examined the separate contributions of systolic blood pressure and diastolic blood pressures (DBP) on subclinical cerebrovascular disease, especially using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines. Furthermore, associations with region-specific white matter hyperintensity volume (WMHV) are underexplored. Methods- Using data from the NOMAS (Northern Manhattan Study), a prospective cohort study of stroke risk and cognitive aging, we examined associations between systolic blood pressure and DBP, defined by the 2017 American College of Cardiology/American Heart Association guidelines, with regional WMHV. We used a linear mixed model approach to account for the correlated nature of regional brain measures. Results- The analytic sample (N=1205; mean age 64±8 years) consisted of 61% women and 66% Hispanics/Latinos. DBP levels were significantly related to WMHV differentially across regions (P for interaction<0.05). Relative to those with DBP 90+ mm Hg, participants with DBP <80 mm Hg had 13% lower WMHV in the frontal lobe (95% CI, -21% to -3%), 11% lower WMHV in the parietal lobe (95% CI, -19% to -1%), 22% lower WMHV in the anterior periventricular region (95% CI, -30% to -14%), and 16% lower WMHV in the posterior periventricular region (95% CI, -24% to -6%). Participants with DBP 80 to 89 mm Hg also exhibited about 12% (95% CI, -20% to -3%) lower WMHV in the anterior periventricular region and 9% (95% CI, -18% to -0.4%) lower WMHV in the posterior periventricular region, relative to participants with DBP 90≥ mm Hg. Post hoc pairwise t tests showed that estimates for periventricular WMHV were significantly different from estimates for temporal WMHV (Holms stepdown-adjusted P<0.05). Systolic blood pressure was not strongly related to regional WMHV. Conclusions- Lower DBP levels, defined by the 2017 American College of Cardiology/American Heart Association guidelines, were related to lower white matter lesion load, especially in the periventricular regions relative to the temporal region.
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Affiliation(s)
- Michelle R. Caunca
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Marialaura Simonetto
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Noam Alperin
- Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Sang H. Lee
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Mitchell S.V. Elkind
- Department of Epidemiology, Mailman School of Public Health, and Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ralph L. Sacco
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Tatjana Rundek
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
- Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL
| | - Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD
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26
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Shi Y, Thrippleton MJ, Blair GW, Dickie DA, Marshall I, Hamilton I, Doubal FN, Chappell F, Wardlaw JM. Small vessel disease is associated with altered cerebrovascular pulsatility but not resting cerebral blood flow. J Cereb Blood Flow Metab 2020; 40:85-99. [PMID: 30295558 PMCID: PMC6928551 DOI: 10.1177/0271678x18803956] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral small vessel disease (SVD) contributes to 25% of ischemic strokes and 45% of dementias. We aimed to investigate the role of cerebral blood flow (CBF) and intracranial pulsatility in SVD. We scanned 60 patients with minor ischemic stroke, representing a range of white matter hyperintensities (WMH). We rated WMH and perivascular spaces (PVS) using semi-quantitative scales and measured WMH volume. We measured flow and pulsatility in the main cerebral vessels and cerebrospinal fluid (CSF) using phase-contrast MRI. We investigated the association between flow, pulsatility and SVD features. In 56/60 patients (40 male, 67.8±8.3 years) with complete data, median WMH volume was 10.7 mL (range 1.4-75.0 mL), representing median 0.77% (0.11-5.17%) of intracranial volume. Greater pulsatility index (PI) in venous sinuses was associated with larger WMH volume (e.g. superior sagittal sinus, β = 1.29, P < 0.01) and more basal ganglia PVS (e.g. odds ratio = 1.38, 95% confidence interval 1.06, 1.79, per 0.1 increase in superior sagittal sinus PI) independently of age, sex and blood pressure. CSF pulsatility and CBF were not associated with SVD features. Our results support a close association of SVD features with increased intracranial pulsatility rather than with low global CBF, and provide potential targets for mechanistic research, treatment and prevention of SVD.
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Affiliation(s)
- Yulu Shi
- Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China.,Department of Neurology, Tiantan Hospital, Beijing, China.,Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael J Thrippleton
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | - Gordon W Blair
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | - David A Dickie
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ian Marshall
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK
| | - Iona Hamilton
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Francesca Chappell
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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27
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Matsumoto K, Jin Z, Homma S, Elkind MSV, Rundek T, Mannina C, Lee TC, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Association Between Central Blood Pressure and Subclinical Cerebrovascular Disease in Older Adults. Hypertension 2019; 75:580-587. [PMID: 31865782 DOI: 10.1161/hypertensionaha.119.13478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Elevated blood pressure (BP) level is one of the most consistently identified risk factors for silent brain disease. BP values obtained at the proximal segment of the aorta (central BP) are more directly involved than brachial BP in the pathogenesis of cardiovascular disease. However, the association between central BP and silent cerebrovascular disease has not been clearly established. Participants in the CABL (Cardiovascular Abnormalities and Brain Lesions) study (n=993; mean age, 71.7±9.3 years; 37.9% men) underwent 2-dimensional echocardiography, arterial wave reflection analysis for determination of central BPs, and brain magnetic resonance imaging. Central BPs were calculated from the radial pulse waveform. Subclinical silent cerebrovascular disease was defined as silent brain infarction and white matter hyperintensity volume. Both brachial (P=0.014) and central pulse pressure (P=0.026) were independently associated with silent brain infarctions after adjustment for clinical variables, but not adjusting for each other. None of the brachial BP values was associated with upper quartile of white matter hyperintensity volume in multivariable analysis. Both central systolic BP (P<0.001) and central pulse pressure (P<0.001) were significantly associated with upper quartile of white matter hyperintensity volume in multivariable analysis, even after adjustment for brachial BP. In a predominantly older population-based cohort, both brachial and central pulse pressure were independently associated with silent brain infarction. However, higher central systolic BP and central pulse pressure, but not brachial BP, were significantly associated with white matter hyperintensity volume.
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Affiliation(s)
- Kenji Matsumoto
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Zhezhen Jin
- Department of Biostatistics (Z.J.), Columbia University, New York
| | - Shunichi Homma
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Mitchell S V Elkind
- Department of Neurology (M.S.V.E.), Columbia University, New York.,Department of Epidemiology (M.S.V.E.), Columbia University, New York
| | - Tatjana Rundek
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Carlo Mannina
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Tetz C Lee
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
| | - Mitsuhiro Yoshita
- Department of Neurology, Hokuriku National Hospital, Nanto, Japan (M.Y.)
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Sacramento (C.D.)
| | - Clinton B Wright
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- Department of Neurology (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL.,Clinical and Translational Science Institute (R.L.S.), Miller School of Medicine, University of Miami, FL
| | - Marco R Di Tullio
- From the Department of Medicine (K.M., S.H., C.M., T.C.L., M.R.D.T.), Columbia University, New York
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28
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Gutierrez J, Gil-Guevara A, Ramaswamy S, DeRosa J, Di Tullio MR, Cheung K, Rundek T, Sacco RL, Wright CB, Elkind MSV. Classification of Covert Brain Infarct Subtype and Risk of Death and Vascular Events. Stroke 2019; 51:90-98. [PMID: 31766980 DOI: 10.1161/strokeaha.119.026068] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- To test the hypothesis that covert brain infarcts (CBIs) are more likely to be located in noneloquent brain areas compared with clinical strokes and that CBI etiological subtypes carry a differential risk of vascular events compared with people without CBI. Methods- We used brain magnetic resonance imaging from 1290 stroke-free participants in the NOMAS (Northern Manhattan Study) to evaluate for CBI. We classified CBI as cardioembolic (ie, known atrial fibrillation), large artery atherosclerosis (extracranial and intracranial), penetrating artery disease, and cryptogenic (no apparent cause). CBI localized in the nonmotor areas of the right hemisphere were considered noneloquent. We then evaluated risk of events by CBI subtype with adjusted Cox proportional models. Results- At the time of magnetic resonance imaging, 236 participants (18%) had CBI (144 [61%] distal cryptogenic, 29 [12%] distal cardioembolic, 26 [11%] large artery atherosclerosis, and 37 [16%] penetrating artery disease). Smaller (per mm, odds ratio, 0.8 [0.8-0.9]) and nonbrain stem infarcts (odds ratio, 0.2 [0.1-0.6]) were more likely to be covert. During the follow-up period (10.4±3.1 years), 398 (31%) died (162 [13%] of vascular death) and 117 (9%) had a stroke (99 [85%]) were ischemic. Risks of events varied by CBI subtype, with the highest risk of stroke (hazard ratio, 2.2 [1.3-3.7]) and vascular death (hazard ratio, 2.24 [1.29-3.88]) noted in participants with intracranial large artery atherosclerosis-related CBI. Conclusions- CBI can be classified into subtypes that have differential outcomes. Certain CBI subtypes such as those related to intracranial large artery atherosclerosis have a high risk of adverse vascular outcomes and could warrant consideration of treatment trials.
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Affiliation(s)
- Jose Gutierrez
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | | | - Srinath Ramaswamy
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Janet DeRosa
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
| | - Marco R Di Tullio
- Department of Cardiology (M.R.D.T.), Mailman School of Public Health, Columbia University, New York, NY
| | - Ken Cheung
- Division of Biostatistics (K.C.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- Departments of Neurology (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Evelyn F. McKnight Brain Institute (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- Departments of Neurology (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.,Evelyn F. McKnight Brain Institute (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology (J.G., S.R., J.D., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY.,Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY
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Chen X, Zhu Y, Geng S, Li Q, Jiang H. Association of Blood Pressure Variability and Intima-Media Thickness With White Matter Hyperintensities in Hypertensive Patients. Front Aging Neurosci 2019; 11:192. [PMID: 31447663 PMCID: PMC6691147 DOI: 10.3389/fnagi.2019.00192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Ambulatory blood pressure variability (ABPV), ABP, and carotid intima-media thickness (IMT) are closely associated with white matter hyperintensities (WMH), and few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the WMH burden. We aimed to evaluate the value of a predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden. Methods: We retrospectively enrolled 140 hypertensive inpatients for physical examinations in Shanghai East Hospital, Tongji University School of Medicine between February 2018 and January 2019. The basic clinical information of all subjects was recorded, and we also collected the metrics of ABP, ABPV, and IMT. Patients with Fazekas scale grade ≥2 were classified into heavy burden of WMH group. Then, we analyzed the association between all characteristics and the WMH burden. Multivariate analysis was performed to assess whether the metrics of ABP, ABPV, and IMT were independently associated with WMH, and we used receiver operating characteristic (ROC) to evaluate the value of predictive model based on the metrics of ABP, ABPV, and IMT. Results: Higher WMH grade was associated with increasing age, diabetes mellitus, higher total cholesterol (TC), higher low-density lipoprotein (LDL), higher IMT, higher 24-h systolic blood pressure (SBP), higher daytime SBP, higher nocturnal SBP, 24-h and daytime standard deviation (SD) of SBP, and 24-h SBP weight SD; 24-h SBP, 24-h SBP-SD, and IMT were independently related to the burden of WMH even after adjusting for the clinical variables. In addition, we also established a model that has a higher predictive capacity using 24-h SBP, 24-h SBP-SD, and IMT in the ROC analysis to assess the WMH burden in hypertensive patients. Conclusions: Higher 24-h SBP, higher 24-h SBP-SD, and larger IMT were independently associated with a greater burden of WMH among elderly primary hypertension Asian patients. Establishing a model based on these factors might provide a new approach for enhancing the accuracy of diagnosis of WMH using metrics in 24-h ABPM and carotid ultrasound.
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Affiliation(s)
- Xin Chen
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingqian Zhu
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shasha Geng
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingqing Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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30
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Vasan RS, Short MI, Niiranen TJ, Xanthakis V, DeCarli C, Cheng S, Seshadri S, Mitchell GF. Interrelations Between Arterial Stiffness, Target Organ Damage, and Cardiovascular Disease Outcomes. J Am Heart Assoc 2019; 8:e012141. [PMID: 31303106 PMCID: PMC6662123 DOI: 10.1161/jaha.119.012141] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 01/01/2023]
Abstract
Background Excess transmission of pressure pulsatility caused by increased arterial stiffness may incur microcirculatory damage in end organs (target organ damage [TOD] ) and, in turn, elevate risk for cardiovascular disease ( CVD ) events. Methods and Results We related arterial stiffness measures (carotid-femoral pulse wave velocity, mean arterial pressure, central pulse pressure) to the prevalence and incidence of TOD (defined as albuminuria and/or echocardiographic left ventricular hypertrophy) in up to 6203 Framingham Study participants (mean age 50±15 years, 54% women). We then related presence of TOD to incident CVD in multivariable Cox regression models without and with adjustment for arterial stiffness measures. Cross-sectionally, greater arterial stiffness was associated with a higher prevalence of TOD (adjusted odds ratios ranging from 1.23 to 1.54 per SD increment in arterial stiffness measure, P<0.01). Prospectively, increased carotid-femoral pulse wave velocity was associated with incident albuminuria (odds ratio per SD 1.28, 95% CI, 1.02-1.61; P<0.05), whereas higher mean arterial pressure and central pulse pressure were associated with incident left ventricular hypertrophy (odds ratio per SD 1.37 and 1.45, respectively; P<0.01). On follow-up, 297 of 5803 participants experienced a first CVD event. Presence of TOD was associated with a 33% greater hazard of incident CVD (95% CI , 0-77%; P<0.05), which was attenuated upon adjustment for baseline arterial stiffness measures by 5-21%. Conclusions Elevated arterial stiffness is associated with presence of TOD and may partially mediate the relations of TOD with incident CVD . Our observations in a large community-based sample suggest that mitigating arterial stiffness may lower the burden of TOD and, in turn, clinical CVD .
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Affiliation(s)
- Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Section of CardiologyDepartment of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public HealthBostonMA
| | - Meghan I. Short
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | - Teemu J. Niiranen
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Department of MedicineTurku University Hospital and University of TurkuFinland
- Department of Public Health SolutionsNational Institute for Health and WelfareTurkuFinland
| | - Vanessa Xanthakis
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Section of Preventive MedicineDepartment of MedicineBoston University School of MedicineBostonMA
- Department of BiostatisticsBoston University School of Public HealthBostonMA
| | | | - Susan Cheng
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Smidt Heart InstituteCedars‐Sinai Medical CenterLos AngelesCA
| | - Sudha Seshadri
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart StudyFraminghamMA
- Biggs Institute for Alzheimer's DiseaseUniversity of Texas Health Sciences Center at San AntonioTX
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Caunca MR, De Leon-Benedetti A, Latour L, Leigh R, Wright CB. Neuroimaging of Cerebral Small Vessel Disease and Age-Related Cognitive Changes. Front Aging Neurosci 2019; 11:145. [PMID: 31316367 PMCID: PMC6610261 DOI: 10.3389/fnagi.2019.00145] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/31/2019] [Indexed: 01/04/2023] Open
Abstract
Subclinical cerebrovascular disease is frequently identified in neuroimaging studies and is thought to play a role in the pathogenesis of cognitive disorders. Identifying the etiologies of different types of lesions may help investigators differentiate between age-related and pathological cerebrovascular damage in cognitive aging. In this review article, we aim to describe the epidemiology and etiology of various brain magnetic resonance imaging (MRI) measures of vascular damage in cognitively normal, older adult populations. We focus here on population-based prospective cohort studies of cognitively unimpaired older adults, as well as discuss the heterogeneity of MRI findings and their relationships with cognition. This review article emphasizes the need for a better understanding of subclinical cerebrovascular disease in cognitively normal populations, in order to more effectively identify and prevent cognitive decline in our rapidly aging population.
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Affiliation(s)
- Michelle R Caunca
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, Leonard M. Miller School of Medicine, Evelyn F. McKnight Brain Institute, University of Miami, Miami, FL, United States.,Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Andres De Leon-Benedetti
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lawrence Latour
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Richard Leigh
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
| | - Clinton B Wright
- National Institute of Neurological Diseases and Stroke (NINDS), National Institutes of Health, Bethesda, MD, United States
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Uric acid association with pulsatile and steady components of central and peripheral blood pressures. J Hypertens 2019; 36:495-501. [PMID: 28957851 DOI: 10.1097/hjh.0000000000001573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Whether the cardiovascular risk attributed to elevated uric acid levels may be explained by changes in central and peripheral pulsatile and/or steady blood pressure (BP) components remains controversial. METHODS In a cross-sectional analysis of normotensive and untreated hypertensive participants of the CARTaGENE populational cohort, we examined the relationship between uric acid, and both pulsatile and steady components of peripheral and central BP, using sex-stratified linear regressions. RESULTS Of the 20 004 participants, 10 161 individuals without antihypertensive or uric acid-lowering drugs had valid pulse wave analysis and serum uric acid levels. In multivariate analysis, pulsatile components of BP were not associated with uric acid levels, whereas steady components [mean BP (MBP), peripheral and central DBP] were all associated with higher levels of uric acid levels in women and men (all P < 0.001). Furthermore, there was a gradual increase of central SBP (cSBP), DBP and MBP from the lowest to the highest quintiles of uric acid levels but not for MBP-adjusted cSBP. Peripheral and cSBP, which are aggregate measures of pulsatile and steady BP, were also associated with uric acid levels in women (β = 0.063 and 0.072, respectively, both P < 0.001) and men (β = 0.043 and 0.051, both P ≤ 0.003). After further adjustments for MBP to account for the concomitant increase in steady component of BP, SBPs were no longer associated with uric acid levels. CONCLUSION Serum uric acid levels appear to be associated with both central and peripheral steady but not pulsatile BP, regardless of sex.
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Gutierrez J, DiTullio M, K Cheung YK, Alperin N, Bagci A, L Sacco R, B Wright C, Sv Elkind M, Rundek T. Brain arterial dilatation modifies the association between extracranial pulsatile hemodynamics and brain perivascular spaces: the Northern Manhattan Study. Hypertens Res 2019; 42:1019-1028. [PMID: 30932017 DOI: 10.1038/s41440-019-0255-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/11/2018] [Accepted: 01/10/2019] [Indexed: 11/09/2022]
Abstract
Pulsatile hemodynamics are associated with brain small perivascular spaces (SPVS). It is unknown whether the stiffness of intermediary arteries connecting the aorta and brain modifies this association. Participants from the Northern Manhattan Study were assessed for SPVS (defined as ≤3 mm T1 voids) and white matter hyperintensity volume (WMH) using MRI. Middle (MCA) and anterior cerebral arterial (ACA) diameters (measured on time-of-flight MRA) and CCA strain (assessed by ultrasound) were used as surrogates of stiffness. Brachial and aortic pulse pressure (PP) and aortic augmentation index (Aix, assessed by applanation tonometry) were used as markers of pulsatility. We tested whether stiffness in intermediary arteries modifies the association between extracranial pulsatility with SPVS and WMH. We found that among 941 participants (mean age 71 ± 9 years, 60% women, 66% Hispanic), the right MCA/ACA diameter was associated with right anterior SPVS (B = 0.177, P = 0.002). Brachial PP was associated with right anterior SPVS (B = 0.003, P = 0.02), and the effect size was bigger with right MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). The association between right CCA strain and ipsilateral SPVS was modified by MCA/ACA diameter, with the largest effect size in those with ipsilateral MCA/ACA diameter in the upper tertile (P = 0.001 for the interaction). Similar dose-effects and statistical interactions were replicated using aortic AIx or aortic PP. We found no evidence of effect modification between pulsatile measures and WMH by stiffness measures. In summary, pulsatile hemodynamics relate to brain SPVS, and the association is the strongest among individuals with dilated brain arteries.
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Affiliation(s)
- Jose Gutierrez
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Marco DiTullio
- Department of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Ying Kuen K Cheung
- Division of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Noam Alperin
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ahmet Bagci
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
| | - Clinton B Wright
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Mitchell Sv Elkind
- Department of Neurology, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami School of Medicine, Miami, FL, USA
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Brain arterial dilatation and the risk of Alzheimer's disease. Alzheimers Dement 2019; 15:666-674. [PMID: 30827874 DOI: 10.1016/j.jalz.2018.12.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 12/11/2018] [Accepted: 12/29/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We tested the hypothesis that brain arterial dilatation increases the risk of Alzheimer's dementia (AD). METHODS We studied dementia-free participants in the Washington Heights-Inwood Columbia Aging Project who had a brain MRI and post-MRI dementia adjudication. We measured the axial T2-proton density diameters of the intracranial carotids and basilar diameters and used Cox models to obtain AD hazard ratios and 95% intervals. RESULTS Of 953 participants (mean age 77 ± 7 y, women 64%, 71% nonwhite) followed on average for 3 ± 3 years, 76 (8%) developed AD. In a model adjusted for demographics, vascular risks, apolipoprotein E (APOE)-ε4, and white matter hyperintensities, larger carotid diameters increased the risk of AD, defined categorically as ≥ 90th percentile (HR 4.34, 1.70-11.11) or continuously (HR 1.44 per SD, 1.07-1.94). DISCUSSION Understanding the pathophysiology of the association between AD and brain arterial dilatation may reveal new clues to the vascular contributions to AD.
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Francis F, Ballerini L, Wardlaw JM. Perivascular spaces and their associations with risk factors, clinical disorders and neuroimaging features: A systematic review and meta-analysis. Int J Stroke 2019; 14:359-371. [PMID: 30762496 DOI: 10.1177/1747493019830321] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perivascular spaces, visible on brain magnetic resonance imaging, are thought to be associated with small vessel disease, neuroinflammation, and to be important for cerebral hemodynamics and interstitial fluid drainage. AIMS To benchmark current knowledge on perivascular spaces associations with risk factors, neurological disorders, and neuroimaging lesions, using systematic review and meta-analysis. SUMMARY OF REVIEW We searched three databases for perivascular spaces publications, calculated odds ratios with 95% confidence interval and performed meta-analyses to assess adjusted associations with perivascular spaces. We identified 116 relevant studies (n = 36,108) but only 23 (n = 12,725) were meta-analyzable. Perivascular spaces assessment, imaging and clinical definitions varied. Perivascular spaces were associated (n; OR, 95%CI, p) with ageing (8395; 1.47, 1.28-1.69, p = 0.00001), hypertension (7872; 1.67, 1.20-2.31, p = 0.002), lacunes (4894; 3.56, 1.39-9.14, p = 0.008), microbleeds (5015; 2.26, 1.04-4.90, p = 0.04) but not WMH (4974; 1.54, 0.71-3.32, p = 0.27), stroke or cognitive impairment. There was between-study heterogeneity. Lack of appropriate data on other brain disorders and demographic features such as ethnicity precluded analysis. CONCLUSIONS Despite many studies, more are required to determine potential pathophysiological perivascular spaces involvement in cerebrovascular, neurodegenerative and neuroinflammatory disorders.
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Affiliation(s)
- Farah Francis
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- 1 Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK.,2 UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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Cheng PN, Chen JY, Chiu YC, Chiu HC, Tsai LM. Augmenting central arterial stiffness following eradication of HCV by direct acting antivirals in advanced fibrosis patients. Sci Rep 2019; 9:1426. [PMID: 30723238 PMCID: PMC6363767 DOI: 10.1038/s41598-018-37829-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/14/2018] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis C (CHC) is strongly associated with risks of cardiovascular diseases. The impact of direct acting antiviral (DAA) therapy on central blood pressure remains unclear. This investigation evaluates changes in central blood pressure following DAA therapy. One hundred and two DAA-treated patients were prospectively enrolled. Lipid profiles and pulse wave analysis of brachial artery by cuff sphygmomanometry including augmentation index (AIx), a parameter of central artery stiffness, were evaluated. All of the 102 patients achieved sustained virological response (SVR12). Cholesterol and LDL significantly increased following SVR12. Along with lipid changes, significantly higher central diastolic pressure (78.2 ± 14.2 mm Hg at baseline vs. 83.3 ± 13.9 mm Hg at SVR12, p = 0.011) and AIx (33.0 ± 12.7% at baseline vs. 36.9 ± 12.9% at SVR12, p = 0.012) were only observed in the advanced fibrosis patients. Co-morbid diseases, including hypertension (33.4 ± 13.0% vs. 39.7 ± 12.6%, p = 0.003), abnormal waist circumference (33.8 ± 12.2% vs. 38.0 ± 13.2%, p = 0.027), and metabolic syndrome (34.5 ± 12.1% vs. 39.0 ± 11.2%, p = 0.043) were associated with augmented AIx upon SVR12. The augmented central artery stiffness following viral eradication by DAA therapy may raise the concern of short-term cardiovascular risk in CHC patients.
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Affiliation(s)
- Pin-Nan Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yen-Cheng Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chih Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang-Miin Tsai
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Electrocardiographic left atrial abnormality and silent vascular brain injury: The Northern Manhattan Study. PLoS One 2018; 13:e0203774. [PMID: 30312297 PMCID: PMC6193576 DOI: 10.1371/journal.pone.0203774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/27/2018] [Indexed: 12/17/2022] Open
Abstract
Hypothesis We hypothesized that P wave terminal Force in the V1 lead (PTFV1) would be associated with leukoaraiosis and subclinical infarcts, especially cortical infarcts, in a population-based, multi-ethnic cohort. Methods PTFV1 was collected manually from baseline electrocardiograms of clinically stroke-free Northern Manhattan Study participants. Investigators read brain MRIs for superficial infarcts, deep infarcts, and white matter hyperintensity volume (WMHV). WMHV was adjusted for head size and log transformed, achieving a normal distribution. Logistic regression models investigated the association of PTFV1 with cortical and with all subclinical infarcts. Linear regression models examined logWMHV. Models were adjusted for demographics and risk factors. Results Among 1174 participants with PTFV1 measurements, the mean age at MRI was 70 ± 9 years. Participants were 14.4% white, 17.6% black, and 65.8% Hispanic. Mean PTFV1 was 3587.35 ± 2315.62 μV-ms. Of the 170 subclinical infarcts, 40 were cortical. PTFV1 ≥ 5000 μV-ms was associated with WMHV in a fully adjusted model (mean difference in logWMHV 0.15, 95% confidence interval 0.01–0.28). PTFV1 exhibited a trend toward an association with cortical infarcts (unadjusted OR per SD change logPTFV1 1.30, 95% CI 0.94–1.81), but not with all subclinical infarcts. Conclusion Electrocardiographic evidence of left atrial abnormality was associated with leukoaraiosis.
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Dhamoon MS, Cheung YK, DeRosa JT, Gutierrez J, Moon YP, Sacco RL, Elkind MSV, Wright CB. Association Between Subclinical Brain Infarcts and Functional Decline Trajectories. J Am Geriatr Soc 2018; 66:2144-2150. [PMID: 30251251 DOI: 10.1111/jgs.15557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 02/07/2018] [Accepted: 04/07/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test associations between subclinical brain infarcts (SBIs) and functional decline independently of intervening clinical vascular events and other vascular risk factors. DESIGN Longitudinal follow-up for a mean 7.3 years. Generalized estimating equation models were used to test associations between SBIs, number of perivascular spaces (PVSs), baseline Barthel Index (BI), and change in BI, adjusting for sociodemographic, vascular, and cognitive risk factors and for stroke and myocardial infarction occurring during follow-up. SETTING Population-based prospective cohort study. PARTICIPANTS Stroke-free individuals from the racially and ethnically diverse Northern Manhattan Study (N=1,290). MEASUREMENTS Annual functional assessments using the BI (range 0-100). RESULTS Mean age was 70.6 ± 9.0, 40% of participants were male, 66% were Hispanic, 193 (16%) had SBIs, and 508 (42%) had large PVSs. SBIs were not associated with baseline BI. In a fully adjusted model, there was a change in BI of -0.85 points per year (95% confidence interval (CI)=-1.01 to -0.69); those with SBI had an additional change in BI 0f -0.88 points (95% CI=-1.43 to -0.32). There were no associations between PVS and baseline BI or change in BI. CONCLUSION In a large population-based study, we found a strong and independent association between "subclinical" markers of cerebrovascular injury and important clinical, person-centered functional trajectories. Future research could clarify the evolution of such subclinical markers over time and test strategies to prevent their progression and minimize related disability. J Am Geriatr Soc 66:2144-2150, 2018.
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Affiliation(s)
- Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ying-Kuen Cheung
- Department of Biostatistics, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York
| | - Janet T DeRosa
- Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York
| | - Yeseon P Moon
- Department of Biostatistics, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York
| | - Ralph L Sacco
- McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, Florida.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.,Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mitchell S V Elkind
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York.,Department of Neurology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, New York, New York
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Tarraf W, Rodríguez CJ, Daviglus ML, Lamar M, Schneiderman N, Gallo L, Talavera GA, Kaplan RC, Fornage M, Conceicao A, González HM. Blood Pressure and Hispanic/Latino Cognitive Function: Hispanic Community Health Study/Study of Latinos Results. J Alzheimers Dis 2018; 59:31-42. [PMID: 28582859 DOI: 10.3233/jad-170017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hispanics/Latinos are at increased risk for cardiovascular disease and cognitive decline and dementias. High blood pressure (BP) has been implicated in both stroke and dementias. Associations between BP and cognition among diverse Latinos are still unpublished. OBJECTIVE We examined associations between cognition and four BP based measures among diverse Hispanics/Latinos. We hypothesized that higher BP, particularly systolic pressure, and increased arterial stiffness (i.e., pulse pressure), would be associated with lower cognitive function. METHODS We used baseline (2008-2011) Hispanic Community Health Study/Study of Latinos (HCHS/SOL; n = 9,019; ages 45-74 years) data to examine cognition in relation to BP measures. RESULTS In age, sex, and education adjusted models, systolic, pulse, and mean arterial pressure were consistently negatively associated with executive function, psychomotor speed and sustained attention, verbal episodic learning and memory, speech fluency, and mental status measures. These associations were attenuated but remained statistically significant in fully adjusted models. CONCLUSION Among middle-aged and older diverse Hispanics/Latinos, we found modest but consistent associations between indicators of arterial stiffness, and compromised blood flow and lower cognitive function. Clinical management and public health interventions to raise awareness and enhance BP management beginning in midlife could reduce disparities and improve population health by reducing cognitive decline burdens.
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Affiliation(s)
- Wassim Tarraf
- Department of Healthcare Sciences and Wayne State University, Institute of Gerontology, Detroit, MI, USA
| | - Carlos J Rodríguez
- Department of Medicine and Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Martha L Daviglus
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA
| | - Melissa Lamar
- University of Illinois at Chicago, Institute for Minority Health Research, College of Medicine at Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Linda Gallo
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Gregory A Talavera
- San Diego State University, Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego, CA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA
| | - Myriam Fornage
- University of Texas Health Science Center, Institute of Molecular Medicine and Human Genetics Center, San Antonio, TX, USA
| | - Alan Conceicao
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Hector M González
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
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Abstract
OBJECTIVES To test the hypothesis that brain arterial diameters are associated with cognitive performance, particularly in arteries supplying domain-specific territories. METHODS Stroke-free participants in the Northern Manhattan Study were invited to have a brain MRI from 2003-2008. The luminal diameters of 13 intracranial arterial segments were obtained using time-of-flight magnetic resonance angiogram (MRA), and then averaged and normalized into a global score and region-specific arterial diameters. Z-Scores for executive function, semantic memory, episodic memory and processing speed were obtained at MRI and during follow-up. Adjusted generalized additive models were used to assess for associations. RESULTS Among the 1034 participants with neurocognitive testing and brain MRI, there were non-linear relationships between left anterior (ACA) and middle cerebral artery (MCA) diameter and semantic memory Z-scores (χ2=10.00; DF=3; p=.019), and left posterior cerebral artery (PCA) and posterior communicating artery (Pcomm) mean diameter and episodic memory Z-scores (χ2=9.88; DF=3; p=.020). Among the 745 participants who returned for 2nd neuropsychological testing, on average 5.0±0.4 years after their MRI, semantic memory change was associated non-linearly with the left PCA/Pcomm mean diameter (χ2=13.09; DF=3; p=.004) and with the right MCA/ACA mean diameter (χ2=8.43; DF=3; p=.03). In both cross-sectional and longitudinal analyses, participants with the larger brain arterial diameters had more consistently lower Z-scores and greater decline than the rest of the participants. CONCLUSIONS Brain arterial diameters may have downstream effects in brain function presenting as poorer cognition. Identifying the mechanisms and the directionality of such interactions may increase the understanding of the vascular contribution to cognitive impairment and dementia. (JINS, 2018, 24, 335-346).
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Dhamoon MS, Cheung YK, Gutierrez J, Moon YP, Sacco RL, Elkind MSV, Wright CB. Functional Trajectories, Cognition, and Subclinical Cerebrovascular Disease. Stroke 2018; 49:549-555. [PMID: 29374104 PMCID: PMC5911688 DOI: 10.1161/strokeaha.117.019595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Cognition and education influence functional trajectories, but whether associations differ with subclinical brain infarcts (SBI) or white matter hyperintensity volume (WMHV) is unknown. We hypothesized that SBI and WMHV moderated relationships between cognitive performance and education and functional trajectories. METHODS A total of 1290 stroke-free individuals underwent brain magnetic resonance imaging and were followed for 7.3 years (mean) with annual functional assessments with the Barthel index (range, 0-100). Magnetic resonance imaging measurements included pathology-informed SBI (PI-SBI) and WMHV (% total cranial volume). Generalized estimating equation models tested associations between magnetic resonance imaging variables and baseline Barthel index and change in Barthel index, adjusting for demographic, vascular, cognitive, and social risk factors, and stroke and myocardial infarction during follow-up. We tested interactions among education level, baseline cognitive performance (Mini-Mental State score), and functional trajectories and ran models stratified by levels of magnetic resonance imaging variables. RESULTS Mean age was 70.6 (SD, 9.0) years; 19% had PI-SBI, and mean WMHV was 0.68%. Education did not modify associations between cognition and functional trajectories. PI-SBI modified associations between cognition and functional trajectories (P=0.04) with a significant protective effect of better cognition on functional decline seen only in those without PI-SBI. There was no significant interaction for WMHV (P=0.8). PI-SBI, and greater WMHV, were associated with 2- to 3-fold steeper functional decline, holding cognition constant. CONCLUSIONS PI-SBI moderated the association between cognition and functional trajectories, with 3-fold greater decline among those with PI-SBI (compared with no PI-SBI) and normal baseline cognition. This highlights the strong and independent association between subclinical markers and patient-centered trajectories over time.
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Affiliation(s)
- Mandip S Dhamoon
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.).
| | - Ying-Kuen Cheung
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Jose Gutierrez
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Yeseon P Moon
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (M.S.D.); Departments of Epidemiology (M.S.V.E.), Biostatistics (Y.-K.C., Y.P.M.), and Neurology, College of Physicians and Surgeons, Mailman School of Public Health (J.G., M.S.V.E.), Columbia University, New York, NY; McKnight Brain Institute (R.L.S.) and Departments of Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, FL; and National Institutes of Health, Bethesda, MD (C.B.W.)
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Del Brutto OH, Mera RM. Enlarged Basal Ganglia Perivascular Spaces are Associated with Pulsatile Components of Blood Pressure. Eur Neurol 2018; 79:86-89. [PMID: 29316559 DOI: 10.1159/000486308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Pathogenetic mechanisms involved in enlargement of basal ganglia perivascular spaces (BG-PVSs) are controversial. Here, we assessed whether pulsatile or steady components of blood pressure (BP) are associated with enlarged BG-PVS. METHODS We evaluated the association between BG-PVS and pulsatile and steady components of BP in Atahualpa residents aged ≥60 years, by the use of regression models and receiver operator characteristics (ROC) curve analysis, after taking into account the effect of demographics, cardiovascular risk factors, and other signatures of cerebral small vessel disease (SVD). RESULTS Of 437 candidates, 363 (83%) were included. MRI showed >10 enlarged BG-PVS in 103 (28%) subjects. In univariate analysis, the association between enlarged BG-PVS and systolic pressure (SP) and pulse pressure (PP) were highly significant, while the association with diastolic pressure (DP) was not. ROC curve analysis showed a higher area under the curve for PP than for DP (p < 0.05). The area under the curve for SP was also higher than that of DP, but not significantly better due to overlapping 95% CI. CONCLUSION Enlarged BG-PVS are associated with pulsatile components of BP, although some of the effect is taken away by the strong interaction between BG-PVS and other signatures of SVD.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
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Lamarche F, Agharazii M, Nadeau-Fredette AC, Madore F, Goupil R. Central and Brachial Blood Pressures, Statins, and Low-Density Lipoprotein Cholesterol: A Mediation Analysis. Hypertension 2018; 71:415-421. [PMID: 29295849 DOI: 10.1161/hypertensionaha.117.10476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/25/2017] [Accepted: 12/09/2017] [Indexed: 01/20/2023]
Abstract
Central blood pressure may be a better predictor of cardiovascular disease than brachial pressure. Although statins reduce brachial pressure, their impact on central pressure remains unknown. Furthermore, whether this effect is mediated through a decrease in low-density lipoprotein cholesterol (LDL-c) is unknown. This study aims to characterize the association of statins and LDL-c with central and brachial blood pressures and to quantify their respective effects. Of the 20 004 CARTaGENE participants, 16 507 had available central blood pressure, LDL-c, and Framingham risk score. Multivariate analyses were used to evaluate the association between central pressure and LDL-c in subjects with or without statins. The impact of LDL-c on the association between statin and pressure parameters was determined through mediation analyses. LDL-c was positively associated with systolic and diastolic central pressure in nonusers (β=0.077 and 0.106; P<0.001) and in participants with statins for primary (β=0.086 and 0.114; P<0.001) and secondary prevention (β=0.120 and 0.194; P<0.003). Statins as primary prevention were associated with lower central systolic, diastolic, and pulse pressures (-3.0, -1.6, and -1.3 mm Hg; P<0.001). Mediation analyses showed that LDL-c reduction contributed to 15% of central systolic and 44% of central diastolic pressure changes associated with statins and attenuated 22% of the effects on central pulse pressure. Similar results were found with brachial pressure components. In conclusion, reduction of LDL-c was associated with only a fraction of the lower blood pressures in statin user and seemed to be mostly associated with improvement of steady (diastolic) pressure, whereas non-LDL-c-mediated pathways were mostly associated with changes in pulsatile pressure components.
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Affiliation(s)
- Florence Lamarche
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Mohsen Agharazii
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Annie-Claire Nadeau-Fredette
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - François Madore
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Rémi Goupil
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.).
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Della-Morte D, Dong C, Markert MS, Elkind MSV, Sacco RL, Wright CB, Rundek T. Carotid Intima-Media Thickness Is Associated With White Matter Hyperintensities: The Northern Manhattan Study. Stroke 2017; 49:304-311. [PMID: 29284725 DOI: 10.1161/strokeaha.117.018943] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Brain white matter hyperintensities (WMH) have been associated with increased risk of stroke, cognitive decline, and dementia. WMH can be a manifestation of small vessel disease, although the total microvascular contribution to multifactorial WMH pathophysiology remains unknown. We hypothesized a possible relationship between carotid intima-media thickness (cIMT), an ultrasound imaging marker of subclinical vascular disease, and brain WMH in a multiethnic, elderly stroke-free community-based cohort. METHODS We evaluated the relationship between cIMT and WMH in the population-based Northern Manhattan Study, among individuals free of stroke. We used linear regression to examine the association of continuous measures of cIMT with quantitatively derived WMH volume, as a proportion of cranial volume, measured from fluid-attenuaded inversion recovery magnetic resonance imaging while adjusting for sociodemographics, lifestyle, and vascular risk factors. RESULTS In a cohort of 1229 participants (mean age, 71±9 years; 60% women, 15% White; 18% Black; 65% Hispanics), the mean cIMT was 0.71±0.08 mm and the median log-transformed WMH volume was 0.36 (interquartile range, 0.21-0.76). In a multivariable model, larger cIMT was significantly associated with greater WMH volume (β=0.046 per SD cIMT; P=0.04). Age and race/ethnicity were significant modifiers (P for age, 0.02; and P for race/ethnicity, 0.04). cIMT was associated with WMH volume in participants 70 years or older (β=0.088 per SD cIMT; P=0.01) and among Hispanics (β=0.084 per SD cIMT; P=0.003). CONCLUSIONS Larger cIMT was associated with greater burden of cerebral WM lesions independently of demographics and traditional vascular risk factors, particularly among elderly and Hispanic participants, who are at high risk for stroke and cognitive decline.
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Affiliation(s)
- David Della-Morte
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Chuanhui Dong
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Matthew S Markert
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.)
| | - Tatjana Rundek
- From the Department of Neurology, Evelyn F. McKnight Brain Institute (D.D.-M., C.D., R.L.S., T.R.) and Department of Public Health Sciences (R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine, School of Medicine, University of Rome Tor Vergata, Italy (D.D.-M.); Department of Human Sciences and Quality of Life Promotion, San Raffaele Roma Open University, Rome, Italy (D.D.-M.); Department of Neurology, Kansas University Medical Center (M.S.M.); Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.).
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Taniguchi D, Shimura H, Watanabe M, Hattori N, Urabe T. Widespread enlarged perivascular spaces associated with dementia and focal brain dysfunction: case report. BMC Neurol 2017; 17:210. [PMID: 29212461 PMCID: PMC5719666 DOI: 10.1186/s12883-017-0997-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/29/2017] [Indexed: 12/14/2022] Open
Abstract
Background Enlarged perivascular spaces (PVS) are common magnetic resonance imaging (MRI) findings, whereas widespread enlarged PVS are extremely rare. Although most patients with widespread enlarged PVS remain asymptomatic, some develop neurological dysfunctions; however, it remains unclear whether these are the consequence of widespread enlarged PVS. Case presentation A 64-year-old female patient developed consciousness disturbance, cognitive dysfunctions, fluent aphasia, agraphia, acalculia, and left-right disorientation after suffering from bronchopneumonia. Brain MRI revealed unusually widespread enlarged PVS predominantly in the left cerebral hemisphere. Following bronchopneumonia treatment, her cognitive dysfunction, fluent aphasia, agraphia, acalculia, and left-right disorientation persisted despite improvement of her general condition. Furthermore, the hypoperfusion area on single photon emission computed tomography and slow wave sites on electroencephalography were consistent with the location of enlarged PVS, indicating that severe enlarged PVS impaired focal brain functions. Conclusions This case suggested that widespread enlarged PVS could be a potential cause of neurological deficits. We propose that impaired perivascular circulation due to enlarged PVS might lead to focal brain dysfunction.
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Affiliation(s)
- Daisuke Taniguchi
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Hideki Shimura
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Yong F, Heiss G, Couper D, Meyer ML, Cheng S, Tanaka H. Measurement Repeatability of Central and Peripheral Blood Pressures: The ARIC Study. Am J Hypertens 2017; 30:978-984. [PMID: 28531255 PMCID: PMC5654294 DOI: 10.1093/ajh/hpx084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Central systolic and pulse pressures are markers of risk for small vessel disease in the brain and kidneys. The extent to which these markers are reproducible in the setting of population studies is less well established. We estimated short-term repeatability of central systolic and pulse pressures, and those of their peripheral measures for comparison. METHODS Participants aged 65 years and over (n = 79, 56% women) were drawn from the 2011-2013 examination of the ARIC cohort. Measurements were obtained with automated devices in the supine position, except for conventional sitting pressures, from paired measurements at each of 2 visits separated by 4 to 8 weeks. Three-level variance component models with between-participant, between-visit, and within-visit components estimated reliability metrics. RESULTS Mean central systolic and pulse pressures were higher than conventional brachial measures, yet their 4 to 8 week measurement repeatability was similar: reliability coefficients were 0.62 (95% confidence interval: 0.49, 0.74) and 0.63 (0.51, 0.76) for central and sitting brachial systolic pressures, and 0.66 (0.54. 0.77) and 0.73 (0.63, 0.82) for their corresponding pulse pressures. Between-participant variation contributed to two-thirds of the short-term repeatability for all measures. Within-visit variation remained uniformly low across visits. CONCLUSIONS Our results indicate that the average of 2 standardized measurements obtained at a single visit can provide reliable estimates of central systolic and pulse pressures. The reliability coefficients of central and peripheral blood pressure measures were comparable. Estimates are presented of minimal detectable change and difference to aid in study design and evaluation of analytic results.
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Affiliation(s)
- Fran Yong
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David Couper
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle L Meyer
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan Cheng
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Location of Cerebral Microbleeds And Their Association with Carotid Intima-media Thickness: A Community-based Study. Sci Rep 2017; 7:12058. [PMID: 28935928 PMCID: PMC5608757 DOI: 10.1038/s41598-017-12176-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/05/2017] [Indexed: 12/23/2022] Open
Abstract
To assess whether high cerebral microbleeds (CMBs) are associated with carotid intima-media thickness (CIMT), a marker of systemic atherosclerosis, we cross-sectionally evaluated participants from a community-based study, the I-Lan Longitudinal Aging Study. The participants' demographics and cardiovascular risk factors were determined by questionnaire and/or laboratory measurements. CIMT was measured by ultrasonography. CMBs were assessed by susceptibility-weighted-imaging on 3 T MRI. Of the 962 subjects [62.5(8.6) years, 44.2% men] included, CMBs were found in 134(14.0%) subjects. Among the subjects with identified CMB's, 85(63.4%) had deep or infratentorial (DI) and 49(36.6%) had strictly lobar(SL) CMBs. After the results were adjusted for age and sex, the analysis revealed that hypertension, hyperlipidemia, obesity, and higher triglyceride levels correlated with DI but not SL CMBs. The subjects with DI CMBs also had a higher mean CIMT and higher prevalence of top quartile CIMT. The multivariate analysis demonstrated that high CIMT (top quartile) significantly predicted the presence of DI CMBs (odds ratio = 2.1; 95% confidence interval = 1.3-3.4; P = 0.004), independent of age, sex, cardiovascular risk factors, and other cerebral small vessel diseases, lacune, and white matter hyperintensity. There was no association between CIMT and SL CMBs. Our results support that there are distinct pathogenesis in DI and SL CMBs.
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Leung LY, Bartz TM, Rice K, Floyd J, Psaty B, Gutierrez J, Longstreth WT, Mukamal KJ. Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults. Arterioscler Thromb Vasc Biol 2017; 37:1579-1586. [PMID: 28663254 PMCID: PMC5551454 DOI: 10.1161/atvbaha.117.309298] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/14/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In people without previous stroke, covert findings on serial magnetic resonance imaging (MRI) of incident brain infarcts and worsening leukoaraiosis are associated with increased risk for ischemic stroke and dementia. We evaluated whether various measures of blood pressure (BP) and heart rate are associated with these MRI findings. APPROACH AND RESULTS In the CHS (Cardiovascular Health Study), a longitudinal cohort study of older adults, we used relative risk regression to assess the associations of mean, variability, and trend in systolic BP, diastolic BP, and heart rate measured at 4 annual clinic visits between 2 brain MRIs with incident covert brain infarction and worsening white matter grade (using a 10-point scale to characterize leukoaraiosis). We included participants who had both brain MRIs, no stroke before the follow-up MRI, and no change in antihypertensive medication status during follow-up. Among 878 eligible participants, incident covert brain infarction occurred in 15% and worsening white matter grade in 27%. Mean systolic BP was associated with increased risk for incident covert brain infarction (relative risk per 10 mm Hg, 1.28; 95% confidence interval, 1.12-1.47), and mean diastolic BP was associated with increased risk for worsening white matter grade (relative risk per 10 mm Hg, 1.45; 95% confidence interval, 1.24-1.69). These findings persisted in secondary and sensitivity analyses. CONCLUSIONS Elevated mean systolic BP is associated with increased risk for covert brain infarction, and elevated mean diastolic BP is associated with increased risk for worsening leukoaraiosis. These findings reinforce the importance of hypertension in the development of silent cerebrovascular diseases, but the pathophysiologic relationships to BP for each may differ.
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Affiliation(s)
- Lester Y Leung
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
| | - Traci M Bartz
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kenneth Rice
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - James Floyd
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Bruce Psaty
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Jose Gutierrez
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - W T Longstreth
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Kenneth J Mukamal
- From the Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Tufts Medical Center, Boston, MA (L.Y.L.); Department of Biostatistics (T.M.B., K.R.), Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology (J.F.), Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.P.), and Departments of Neurology and Epidemiology (W.T.L.), University of Washington, Seattle; Group Health Research Institute, Group Health Cooperative, Seattle, WA (B.P.); Division of Stroke and Cerebrovascular Disease, Department of Neurology, Columbia University Medical Center, New York City, NY (J.G.); and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
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Tamura Y, Kimbara Y, Yamaoka T, Sato K, Tsuboi Y, Kodera R, Chiba Y, Mori S, Fujiwara Y, Tokumaru AM, Ito H, Sakurai T, Araki A. White Matter Hyperintensity in Elderly Patients with Diabetes Mellitus Is Associated with Cognitive Impairment, Functional Disability, and a High Glycoalbumin/Glycohemoglobin Ratio. Front Aging Neurosci 2017; 9:220. [PMID: 28729834 PMCID: PMC5498506 DOI: 10.3389/fnagi.2017.00220] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/23/2017] [Indexed: 01/07/2023] Open
Abstract
Aims: Although evidence has accumulated that white matter hyperintensity (WMH) is associated with the deterioration of cognitive function and impairment of activities of daily living (ADL), the clinical relevance of WMH in elderly patients with diabetes mellitus (DM) is not still clear. The aim of this study was to examine whether WMH volume is associated with ADL and cognitive function and whether glucose control and glucose variability can affect WMH volume in these patients. Methods: This cross-sectional study investigated the associations of WMH with cognitive function and instrumental ADL (IADL), as well as metabolic and vascular risk factors in a total of 178 elderly patients with diabetes. The study assessed WMH volumes and the functional status of cognition and IADL. WMH volumes were evaluated by obtaining axial T2-weighted and fluid-attenuated inversion recovery sequence images on brain magnetic resonance imaging and assessing the images using Software for Neuro-Image Processing in Experimental Research. Results: We found a significant association between WMH volumes and Mini-Mental State Examination (MMSE) scores (p = 0.039) and between WMH and IADL status (p = 0.006). Furthermore, we found significant relations of large WMH volumes with a high glycoalbumin/glycohemoglobin ratio (GA/HbA1c) (p < 0.001). Large WMH volumes were also found to be associated with a low body mass index (p = 0.014) and a low diastolic blood pressure (p = 0.024), but not with HbA1c. Multiple regression analysis showed that high GA/HbA1c, which reflects high glucose variability, was a significant determining factor for large WMH volumes. We also found that GA/HbA1c was negatively associated with both MMSE (p = 0.036) and IADL (p < 0.001). Conclusion: GA/HbA1c, which is a marker of glucose variability, was independently associated with WMH volumes, which could lead to the decline of cognition and IADL in elderly patients with DM.
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Affiliation(s)
- Yoshiaki Tamura
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yoshiyuki Kimbara
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Takuya Yamaoka
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Ken Sato
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yuki Tsuboi
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Remi Kodera
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yuko Chiba
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Seijiro Mori
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of GerontologyTokyo, Japan
| | - Aya M Tokumaru
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Hideki Ito
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and GerontologyAichi, Japan
| | - Atsushi Araki
- Departments of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric HospitalTokyo, Japan
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Rundek T, Della-Morte D, Gardener H, Dong C, Markert MS, Gutierrez J, Roberts E, Elkind MSV, DeCarli C, Sacco RL, Wright CB. Relationship between carotid arterial properties and cerebral white matter hyperintensities. Neurology 2017; 88:2036-2042. [PMID: 28446647 DOI: 10.1212/wnl.0000000000003951] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/28/2017] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Since arterial stiffness is a functional measure of arterial compliance and may be an important marker of cerebrovascular disease, we examined the association of carotid artery stiffness with white matter hyperintensity volume (WMHV) in a cross-sectional study of 1,166 stroke-free participants. METHODS Carotid beta stiffness index (STIFF) was assessed by M-mode ultrasound of the common carotid artery and calculated as the ratio of natural log of the difference between systolic and diastolic blood pressure over STRAIN, a ratio of the difference between carotid systolic and diastolic diameter (DD) divided by DD. WMHV was measured by fluid-attenuated inversion recovery MRI. The associations of STIFF, DD, and STRAIN with WMHV were examined using linear regression after adjusting for sociodemographic, lifestyle, and vascular risk factors. RESULTS In a fully adjusted model, larger carotid DD was significantly associated with greater log-WMHV (β = 0.09, p = 0.001). STIFF and STRAIN were not significantly associated with WMHV. In adjusted analyses stratified by race-ethnicity, STRAIN (β = -1.78, p = 0.002) and DD (β = 0.11, p = 0.001) were both associated with greater log-WMHV among Hispanic participants, but not among black or white participants. CONCLUSIONS Large carotid artery diameters are associated with greater burden of white matter hyperintensity (WMH) in this multiethnic population. The association between increased diameters, decreased STRAIN, and greater WMH burden is more pronounced among Hispanics. These associations suggest a potential important pathophysiologic role of extracranial large artery remodeling in the burden of WMH.
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Affiliation(s)
- Tatjana Rundek
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - David Della-Morte
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis.
| | - Hannah Gardener
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Chuanhui Dong
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Matthew S Markert
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Jose Gutierrez
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Eugene Roberts
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Mitchell S V Elkind
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Charles DeCarli
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Ralph L Sacco
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
| | - Clinton B Wright
- From the Evelyn F. McKnight Brain Institute (T.R., C. Dong, R.L.S., C.B.W.), Department of Neurology (T.R., D.D.-M., H.G., C. Dong, E.R., R.L.S., C.B.W.), and Department of Public Health Sciences (T.R., R.L.S., C.B.W.), Miller School of Medicine, University of Miami, FL; Department of Systems Medicine (D.D.-M.), School of Medicine, University of Rome Tor Vergata; San Raffaele Roma Open University (D.D.-M.), Rome, Italy; Department of Neurology (M.S.M.), Kansas University Medical Center, Kansas City; Department of Neurology (J.G., M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology (J.G., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; and Department of Neurology and Center for Neuroscience (C. DeCarli), University of California Davis
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