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Sun S, Liu D, Zhou Y, Yang G, Cui LB, Xu X, Guo Y, Sun T, Jiang J, Li N, Wang Y, Li S, Wang X, Fan L, Cao F. Longitudinal real world correlation study of blood pressure and novel features of cerebral magnetic resonance angiography by artificial intelligence analysis on elderly cognitive impairment. Front Aging Neurosci 2023; 15:1121152. [PMID: 36819723 PMCID: PMC9935573 DOI: 10.3389/fnagi.2023.1121152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This study aims to investigate novel clinical risk factors for cognitive impairment (CI) in elderly. Methods A total of 3221 patients (259 patients with CI and 2,962 subjects without CI) were recruited into this nested case-control study who underwent cerebral magnetic resonance angiography (MRA) from 2007 to 2021. All of the clinical data with MRA imaging were recorded followed by standardization processing blindly. The maximum stenosis score of the posterior circulatory artery, including the basilar artery, and bilateral posterior cerebral artery (PCA), was calculated by the cerebral MRA automatic quantitative analysis method. Logistic regression (LR) analysis was used to evaluate the relationship between risk factors and CI. Four machine learning approaches, including LR, decision tree (DT), random forest (RF), and support vector machine (SVM), employing 5-fold cross-validation were used to establish CI predictive models. Results After matching with age and gender, 208 CI patients and 208 control subjects were finalized the follow-up (3.46 ± 3.19 years) with mean age at 84.47 ± 6.50 years old. Pulse pressure (PP) in first tertile (<58 mmHg) (OR 0.588, 95% confidence interval (CI): 0.362-0.955) was associated with a decreased risk for CI, and ≥50% stenosis of the left PCA (OR 2.854, 95% CI: 1.387-5.872) was associated with an increased risk for CI after adjusting for body mass index, myocardial infarction, and stroke history. Based on the means of various blood pressure (BP) parameters, the performance of the LR, DT, RF and SVM models accurately predicted CI (AUC 0.740, 0.786, 0.762, and 0.753, respectively) after adding the stenosis score of posterior circulatory artery. Conclusion Elderly with low pulse differential pressure may have lower risk for cognitive impairment. The hybrid model combined with the stenosis score of posterior circulatory artery, clinical indicators, and the means of various BP parameters can effectively predict the risk of CI in elderly individuals.
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Affiliation(s)
- Shasha Sun
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Dongyue Liu
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yanfeng Zhou
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China,Laboratory of Computational Biology and Machine Intelligence, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ge Yang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China,Laboratory of Computational Biology and Machine Intelligence, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Long-Biao Cui
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xian Xu
- Department of Radiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yuanhao Guo
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China,Laboratory of Computational Biology and Machine Intelligence, National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ting Sun
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jiacheng Jiang
- Department of Radiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Na Li
- Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Yabin Wang
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xinjiang Wang
- Department of Radiology, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Li Fan
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China,Li Fan,
| | - Feng Cao
- Department of Cardiology, Chinese PLA Medical School, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China,*Correspondence: Feng Cao,
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Álvarez-Bueno C, Cavero-Redondo I, Bruno RM, Saz-Lara A, Sequí-Dominguez I, Notario-Pacheco B, Martinez-Vizcaino V. Intima Media Thickness and Cognitive Function Among Adults: Meta-Analysis of Observational and Longitudinal Studies. J Am Heart Assoc 2022; 11:e021760. [PMID: 35179392 PMCID: PMC9075078 DOI: 10.1161/jaha.121.021760] [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: 11/29/2022]
Abstract
Background Carotid structural changes measured by intima media thickness (IMT) have been related to cognitive complaints during aging. Therefore, the aims of this meta‐analysis were (1) to elucidate the relationship between vascular status, measured as IMT, and cognitive domains distinguishing between global cognition, executive functions, memory and attention; and (2) to explore whether demographic (ie, age and sex), clinical (ie, body mass index and IMT baseline values), and procedure characteristics influence this association. Methods and Results We performed a systematic review of MEDLINE (via PubMed), Scopus, and Web of Science databases from their inception to June 2021. Studies meeting the following inclusion criteria were included: (1) the participants were adults; (2) the exposure was carotid IMT; (3) the outcome was cognitive function, including global cognition, executive function, memory, and attention measured using standardized tests; and (4) the study design was cross‐sectional or longitudinal including unadjusted and adjusted analyses. A total of 19 cross‐sectional and 15 longitudinal studies were included and demographic (age and sex), clinical (body mass index and baseline IMT values), and procedure characteristics were analyzed as potential mediator or moderators of the association. Conclusions Our data support negative associations between IMT and cognitive function in cross‐sectional studies. The association between IMT and cognition lost significance in longitudinal studies and when controlling for covariates in cross‐sectional studies. Finally, the strength of these associations seems not to be modified by age, sex, body mass index, and baseline IMT values. This systematic review and meta‐analysis adds to the evidence supporting the use of IMT as a measure for identifying patients at risk of cognitive decline.
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Affiliation(s)
- Celia Álvarez-Bueno
- Health and Social Research Center Universidad de Castilla-La Mancha Cuenca Spain.,Universidad Politécnica y Artística del Paraguay Asunción Paraguay
| | - Iván Cavero-Redondo
- Health and Social Research Center Universidad de Castilla-La Mancha Cuenca Spain.,Rehabilitation in Health Research Center (CIRES)Universidad de las Americas Santiago Chile
| | - Rosa Maria Bruno
- Department of Clinical and Experimental Medicine University of Pisa Italy.,INSERM U970 and Université de Paris Paris France
| | - Alicia Saz-Lara
- Health and Social Research Center Universidad de Castilla-La Mancha Cuenca Spain
| | | | | | - Vicente Martinez-Vizcaino
- Health and Social Research Center Universidad de Castilla-La Mancha Cuenca Spain.,Facultad de Ciencias de la Salud Universidad Autónoma de Chile Talca Chile
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Nath M, Misra S, Nair P, Kumar P. Carotid intima-media thickness and risk of mild cognitive impairment: A systematic review and meta-analysis. Acta Neurol Scand 2022; 145:139-150. [PMID: 34672362 DOI: 10.1111/ane.13542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023]
Abstract
Mild cognitive impairment (MCI) is an early phase of cognitive decline signalling the beginning of severe neurological diseases. Carotid intima-media thickness (cIMT) has shown some correlation with MCI development. This study was conducted to investigate the impact of elevated cIMT on the risk of MCI in adults. A literature search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Google Scholar and CINAHL databases till 30 July 2021, with keywords: ('Carotid Intima-Media Thickness' OR 'cIMT' OR 'IMT' AND 'Cognitive Impairment' OR 'Cognition' OR 'Cognitive Decline' AND 'Mild Cognitive Impairment' OR 'MCI'). Pooled standardized mean difference (SMD)/odds ratio (OR) and 95% confidence interval (CI) were determined for factor-disease association using either fixed (when I2 <50%) or random effect (when I2 >50%) models. Eight studies involving 1,585 MCI cases and 6,700 normal subjects were included in our meta-analysis which showed no significant association of increased cIMT with the risk of MCI [SMD 1.17, 95% CI -0.09 to 2.42]. However, sensitivity analysis revealed an outlier study significantly affecting the effect size. On omitting the outlier study, the re-evaluated meta-analysis revealed a significant association of cIMT with the risk of MCI [SMD 0.52, 95% CI 0.26 to 0.78]. This significant association was also observed during subgroup analysis in Caucasian population [SMD 0.65, 95% CI 0.13 to 1.18] but not in Asian population [SMD 0.39, 95% CI -0.01 to 0.79]. Elevated cIMT poses a potential risk for MCI. However, more population-based studies are required to corroborate these findings.
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Affiliation(s)
- Manabesh Nath
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Shubham Misra
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pallavi Nair
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Pradeep Kumar
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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Romero-Sevilla R, López-Espuela F, Fuentes JM, de San Juan BD, Portilla-Cuenca JC, Hijon CC, Casado-Naranjo I. Role of Inflammatory Cytokines in the Conversion of Mild Cognitive Im- pairment to Dementia: A Prospective Study. Curr Alzheimer Res 2022; 19:68-75. [PMID: 35086447 DOI: 10.2174/1567205019666220127102640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/13/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effect that cytokines can exert on the progression from mild cognitive impairment (MCI) to ongoing dementia is a matter of debate and the results obtained so far are controversial. OBJECTIVE The aim of the study is to analyze the influence of markers of subclinical inflammation on the progression of MCI to dementia. METHODS A prospective study involving a cohort of patients ≥ 65 years of age diagnosed with MCI and followed for 3 years was conducted. 105 patients were enrolled, and serum concentrations of several subclinical inflammatory markers were determined. RESULTS After 3.09 (2 - 3.79) years of follow-up, 47 (44.76%) patients progressed to dementia. Alpha 1-antichymotrypsin (ACT) was found to be significantly higher in patients who progressed to dementia (486.45 ± 169.18 vs. 400.91 ± 163.03; p = 0.012), and observed to significantly increase the risk of developing dementia in patients with mild cognitive impairment (1.004, 1.001-1.007; p= 0.007). IL-10 levels were significantly higher in those who remained stable (6.69 ± 18.1 vs. 32.54 ± 89.6; p = 0.04). Regarding the type of dementia to which our patients progressed, we found that patients who developed mixed dementia had higher IL-4 levels than those who converted to AD (31.54 ± 63.6 vs. 4.43 ± 12.9; p = 0.03). No significant differences were observed between the groups with regard to the ESR and LPa, CRP, IL-1 and TNF-α levels. CONCLUSION ACT levels have a significant predictive value in the conversion of MCI to dementia. IL-10 levels could be a protective factor. It is necessary to conduct studies with serial determinations of these and other inflammatory markers in order to determine their effect on the progression of MCI to dementia.
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Affiliation(s)
| | - Fidel López-Espuela
- Nursing Department. Nursing and Occupational Therapy College, University of Extremadura. Cáceres, Spain
| | - José Manuel Fuentes
- Department of Biochemistry and Molecular Biology and Genetics. Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED) Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Caceres, Spain
| | | | | | | | - Ignacio Casado-Naranjo
- Department of Neurology, Hospital Universitario de Caceres, Cáceres, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED) Madrid, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Caceres, Spain
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Wang Z, Zhu W, Xing Y, Jia J, Tang Y. B vitamins and prevention of cognitive decline and incident dementia: a systematic review and meta-analysis. Nutr Rev 2021; 80:931-949. [PMID: 34432056 DOI: 10.1093/nutrit/nuab057] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
CONTEXT Elevation of homocysteine (Hcy) levels is well-established as a risk factor for dementia, yet controversy exists regarding whether B-vitamin-mediated reduction of homocysteine levels can benefit cognitive function. OBJECTIVE To investigate whether B vitamin supplementation can reduce the risk of cognitive decline and incident dementia. DATA SOURCES The PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for articles published from the inception dates to March 1, 2020. Randomized controlled trials (RCT) were included if B vitamins were supplied to investigate their effect on the rate of cognitive decline. Cohort studies investigating dietary intake of B vitamins and the risk of incident dementia were eligible. Cross-sectional studies comparing differences in levels of B vitamins and Hcy were included. DATA EXTRACTION Two reviewers independently performed data extraction and assessed the study quality. DATA ANALYSIS Random-effect or fixed-effect models, depending on the degree of heterogeneity, were performed to calculate mean differences (MDs), hazard ratios (HRs), and odds ratios (ORs). RESULTS A total of 95 studies with 46175 participants (25 RCTs, 20 cohort studies, and 50 cross-sectional studies) were included in this meta-analysis. This meta-analysis supports that B vitamins can benefit cognitive function as measured by Mini-Mental State Examination score changes (6155 participants; MD, 0.14, 95%CI 0.04 to 0.23), and this result was also significant in studies where placebo groups developed cognitive decline (4211 participants; MD, 0.16, 95%CI 0.05 to 0.26), suggesting that B vitamins slow cognitive decline. For the > 12 months interventional period stratum, B vitamin supplementation decreased cognitive decline (3814 participants; MD, 0.15, 95%CI 0.05 to 0.26) compared to placebo; no such outcome was detected for the shorter interventional stratum (806 participants; MD, 0.18, 95%CI -0.25 to 0.61). In the non-dementia population, B vitamin supplementation slowed cognitive decline (3431 participants; MD, 0.15, 95%CI 0.04 to 0.25) compared to placebo; this outcome was not found for the dementia population (642 participants; MD, 0.20, 95%CI -0.35 to 0.75). Lower folate levels (but not B12 or B6 deficiency) and higher Hcy levels were significantly associated with higher risks of dementia (folate: 6654 participants; OR, 1.76, 95%CI 1.24 to 2.50; Hcy: 12665 participants; OR, 2.09, 95%CI 1.60 to 2.74) and cognitive decline (folate: 4336 participants; OR, 1.26, 95%CI 1.02 to 1.55; Hcy: 6149 participants; OR, 1.19, 95%CI 1.05 to 1.34). Among the population without dementia aged 50 years and above, the risk of incident dementia was significantly decreased among individuals with higher intake of folate (13529 participants; HR, 0.61, 95%CI 0.47 to 0.78), whereas higher intake of B12 or B6 was not associated with lower dementia risk. CONCLUSIONS This meta-analysis suggests that B vitamin supplementation is associated with slowing of cognitive decline, especially in populations who received early intervention and intervention of long duration; the study also indicates that higher intake of dietary folate, but not B12 or B6, is associated with a reduced risk of incident dementia in non-dementia aged population. Given the prevalence of dementia cases in many countries with aging populations, public health policies should be introduced to ensure that subgroups of the population at risk have an adequate B vitamin status.
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Affiliation(s)
- Zhibin Wang
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Wei Zhu
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Yi Xing
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Jianping Jia
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
| | - Yi Tang
- Zhibin Wang, Wei Zhu, Yi Xing, Jianping Jia, and Yi Tang are with the Innovation Center for Neurological Disorders, Department of Neurology, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing, China. Jianping Jia is with the Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, China. Jianping Jia is with the Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, China. Jianping Jia is with the Center of Alzheimer's Disease, Beijing Institute for Brain Disorders, Beijing, China. Yi Tang is with the Neurodegenerative Laboratory of Ministry of Education of the Peoples Republic of China, Beijing, China
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He M, Guo Z, Lu Z, Wei S, Wang Z. High milk consumption is associated with carotid atherosclerosis in middle and old-aged Chinese. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2021; 5:100031. [PMID: 33447760 PMCID: PMC7803059 DOI: 10.1016/j.ijchy.2020.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/06/2020] [Accepted: 05/08/2020] [Indexed: 10/25/2022]
Abstract
Background Carotid atherosclerosis (CA) can reflect atherosclerotic status of systemic vessels, and is associated with ischemic stroke and cognitive impairment. Milk consumption is growing in China, and data are limited on the association between milk and CA risk. Methods Participants aged ≥40 years in China National Stroke Prevention Project were recruited for carotid ultrasound examination, and those with carotid endarterectomy, carotid stenting stroke or coronary heart disease were excluded. Participants were defined as having CA when intima-media thickness (IMT) ≥1 mm or plaques were detected by ultrasonography. For milk consumption, though contents were not analyzed, people were divided into high consumption (≥200 ml/day and ≥5 day/week) and low consumption (occasional or never) groups. Multivariate logistics regression analyses were done in both full and propensity score-matched population to identify the association between milk consumption and CA. Results 84880 participants were included in the final analysis. After being adjusted by age, gender, living location, smoking habits, drinking habits, physical activity, obesity, hypertension, diabetes, and dyslipidemia, high milk consumption is associated with CA in both full population (odds ratio [OR] = 1.26, 95% confidence interval [CI] 1.19-1.33) and propensity score-matched population (OR = 1.25, 95%CI 1.17-1.34). High milk consumption is also a risk factor for IMT thickening (OR = 1.15, 95%CI 1.08-1.23), carotid plaque formation (OR = 1.17, 95%CI 1.09-1.25) and carotid stenosis over 50% (OR = 1.52, 95%CI 1.10-2.14) in the propensity score-matched population. Conclusions High milk consumption is related to CA in middle and old-aged Chinese population. More cautious advice on milk intake should be given in this population for prevention of atherosclerosis.
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Affiliation(s)
- Miao He
- Department of Epidemiology and Biostatistics, School of Public Health,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zaogeng Guo
- Health Science Center, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zuxun Lu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, School of Public Health,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihong Wang
- Health Science Center, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.,Guangdong Innovation Platform of Translational Research for Cerebrovascular Diseases, Shenzhen, China
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Characteristics of the carotid plaque in hypertensive patients with hyperhomocysteinemia using multimode ultrasound. J Stroke Cerebrovasc Dis 2020; 29:104925. [PMID: 32689606 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Ischemic stroke is related to the level of total homocysteine and the stability of carotid atherosclerotic plaque. In this study, the characteristics of carotid plaque in hypertensive patients with hyperhomocysteinemia were preliminarily studied by conventional ultrasound, contrast-enhanced ultrasound and virtual touch image quantification. METHODS Hypertensive patients (n=196) hospitalised in the Department of Neurology and Cardiology of our hospital from April 2016 to February 2019 were studied to compare and analyse differences in general clinical data, conventional ultrasound, contrast-enhanced ultrasound and virtual touch image quantification between hypertension with hyperhomocysteinemia and hypertension with normal tHcy. RESULTS 1. There was no statistical difference in other clinical data, except fasting blood sugar (P=0.021) and the history of cerebral infarction (P=0.0001). 2. There were significant differences in plaque thickness, stenosis degree, contrast-enhanced ultrasound level, The maximum shear wave velocity (SWVmax) , the minimum shear wave velocity (SWVmin) and the mean shear wave velocity (SWVmean) (P<0.05), except intima-media thickness between the two groups (t=0.160, P=0.873). 3. Blood tHcy level in hypertensive patients with hyperhomocysteinemia was positively correlated with carotid plaque thickness, stenosis degree and contrast-enhanced ultrasound level (r=0.349, 0.647, 0.421), but negatively correlated with SWVmax, SWVmin and SWVmean (r=-0.348, -0.409, -0.393). CONCLUSIONS Ultrasonography can reflect the vulnerability of hypertensive patients with hyperhomocysteinemia, providing reliable and comprehensive information for the prevention and treatment of stroke in hypertensive patients with hyperhomocysteinemia.
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Sun J, Lv X, Gao X, Chen Z, Wei D, Ling Y, Zhang J, Gu Q, Liu J, Chen W, Liu S. The association between serum uric acid level and the risk of cognitive impairment after ischemic stroke. Neurosci Lett 2020; 734:135098. [PMID: 32485287 DOI: 10.1016/j.neulet.2020.135098] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 01/07/2023]
Abstract
Post-stroke cognitive impairment (PSCI) is a severe complication of stroke. Predicting PSCI is difficult because some risk factors for stroke, such as blood glucose level and blood pressure, are affected by many other elements. Although recent studies have shown that high serum uric acid (UA) levels are associated with cognitive dysfunction and may be a risk factor for PSCI, its impact remains unclear. Accordingly, the present study aimed to explore the association between serum UA level and PSCI. In total, 274 patients who experienced acute cerebral infarction, confirmed between January 2016 and December 2018, were enrolled. Baseline data and biological indicators were recorded. According to the Montreal Cognitive Assessment (MoCA) scores, patients were divided into two groups: PSCI and non-PSCI. Logistic regression analysis was used to determine possible risk factors for PSCI. Results demonstrated that serum UA levels were significantly higher in the PSCI group than in the non-PSCI group. Multivariable logistic analysis revealed that age, years of education, and UA level were independent risk factors for PSCI. PSCI patients were subdivided according to serum UA level: high and low. Hypertension history and homocysteine (Hcy) levels differed significantly between the high and low UA level groups. Further analysis revealed that a history of hypertension and Hcy demonstrated a certain correlation (r = 0.163, 0.162; P < 0.05), suggesting that serum UA level was an independent risk factor for PSCI. These findings indicate that serum UA level was correlated with PSCI in post-stroke patients and is anticipated to be used in clinical practice to reduce the incidence of PSCI.
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Affiliation(s)
- Jing Sun
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xinhuang Lv
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Xinxin Gao
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Zewei Chen
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Dianhui Wei
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Yi Ling
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Junmei Zhang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Qilu Gu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China.
| | - Weian Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, China.
| | - Suzhi Liu
- Department of Neurology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, 150 Ximen Street, Linhai, Zhejiang, 317000, China.
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The Strong Heart Study: adding biological plausibility to the red meat-cardiovascular disease association. J Hypertens 2018; 35:1782-1784. [PMID: 28767487 DOI: 10.1097/hjh.0000000000001420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shan Y, Tan S, Wang Y, Li K, Zhang L, Liao S, Zhou L, Deng Z, Hu X, Li H, Men X, Zhang B, Peng L, Kang Z, Zou Y, Lu Z. Risk Factors and Clinical Manifestations of Juxtacortical Small Lesions: A Neuroimaging Study. Front Neurol 2017; 8:497. [PMID: 29018401 PMCID: PMC5614934 DOI: 10.3389/fneur.2017.00497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/05/2017] [Indexed: 01/16/2023] Open
Abstract
Background and objective White matter hyperintensities can be easily identified by brain imaging. Juxtacortical small lesion (JCSL) is a special type of white matter lesion, defined as no greater than 5 mm in diameter and adjacent to the cerebral cortex in location. We notice lately that JCSLs alone may be associated to various neurological symptoms. Here, we design the present study to determine the risk factors for JCSLs and their clinical manifestations in patients in our neurology clinic. Methods 206 participants suffered from neurological disorders and completed magnetic resonance imaging (MRI) examinations were divided into two groups: patients with JCSLs and patients without lesions on MRI. Meanwhile, 129 age- and sex-matched healthy volunteers were also recruited. Laboratory examinations and the phenotypes and distributions of the symptoms of the three groups were compared. Results The serum levels of apoB and homocysteine (HCY) were independently related to the appearance of JCSLs and HCY level was also associated with the number of JCSLs. Patients with JCSLs might present with headache, insomnia, and/or anxiety/depression, which were related with the anatomical locations of the lesions. Conclusion These data suggest that JCSLs are symptomatic and might in result fromarteriole atherosclerosis, which should raise our attention.
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Affiliation(s)
- Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sha Tan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kui Li
- Department of Physiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Siyuan Liao
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Zhou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhezhi Deng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyan Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuejiao Men
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuang Kang
- Department of Imaging, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Zou
- Department of Imaging, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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11
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Duan H, Li Y, Yan L, Yang H, Wu J, Qian P, Li B, Wang S. MicroRNA-217 suppresses homocysteine-induced proliferation and migration of vascular smooth muscle cells via N-methyl-D-aspartic acid receptor inhibition. Clin Exp Pharmacol Physiol 2017; 43:967-75. [PMID: 27333430 DOI: 10.1111/1440-1681.12611] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 11/29/2022]
Abstract
Hyperhomocysteine has become a critical risk for atherosclerosis and can stimulate proliferation and migration of vascular smooth muscle cells (VSMCs). N-methyl-D-aspartic acid receptor (NMDAR) is a receptor of homocysteine and mediates the effects of homocysteine on VSMCs. Bioinformatics analysis has shown NMDAR is a potential target of microRNA-217 (miR-217), which exerts multiple functions in cancer tumorigenesis and carotid plaque progression. In this study, we sought to investigate the role of miR-217 in VSMCs phenotype transition under homocysteine exposure and elucidate its effect on atherosclerotic plaque formation. After treating with several doses of homocysteine (0-8 × 10(-4) mol/L) for 24 hours, the expression of miR-217 in HA-VSMCs and rat aortic VSMCs was not altered. Intriguingly, the expression of NMDAR mRNA and protein was reduced by homocysteine in a dose-dependent manner. Transfection of miR-217 mimic significantly inhibited the proliferation and migration of VSMCs with homocysteine treatment, while transfection of miR-217 inhibitor promoted VSMCs migration. Moreover, miR-217 mimic down-regulated while miR-217 inhibitor up-regulated NMDAR protein expression but not NMDAR mRNA expression. Through luciferase reporter assay, we showed that miR-217 could directly bind to the 3'-UTR of NMDAR. MiR-217 mimic transfection also released the inhibition of cAMP-response element-binding protein (CREB)-PGC-1α signalling induced by homocysteine. Additionally, restoration of PGC-1α expression via AdPGC-1α infection markedly suppressed VSMCs proliferation through the degradation of NADPH oxidase (NOX1) and reduction of reactive oxygen species (ROS). Collectively, our study identified the role of miR-217 in regulating VSMCs proliferation and migration, which might serve as a target for atherosclerosis therapy.
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Affiliation(s)
- Hongyan Duan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yongqiang Li
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lijie Yan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haitao Yang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jintao Wu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Peng Qian
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bing Li
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Shanling Wang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, China
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12
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Malojcic B, Giannakopoulos P, Sorond FA, Azevedo E, Diomedi M, Oblak JP, Carraro N, Boban M, Olah L, Schreiber SJ, Pavlovic A, Garami Z, Bornstein NM, Rosengarten B. Ultrasound and dynamic functional imaging in vascular cognitive impairment and Alzheimer's disease. BMC Med 2017; 15:27. [PMID: 28178960 PMCID: PMC5299782 DOI: 10.1186/s12916-017-0799-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/21/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. METHODS At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. RESULTS Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. CONCLUSIONS US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.
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Affiliation(s)
- Branko Malojcic
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia.
| | | | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Elsa Azevedo
- Department of Neurology, São João Hospital Center and Faculty of Medicine of University of Porto, Porto, Portugal
| | - Marina Diomedi
- Cerebrovascular Disease Center, Stroke Unit, University of Rome Tor Vergata, Rome, Italy
| | - Janja Pretnar Oblak
- Department of Vascular Neurology and Intensive Therapy, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nicola Carraro
- Department of Medical Sciences, Clinical Neurology-Stroke Unit, University Hospital, University of Trieste, Trieste, Italy
| | - Marina Boban
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Laszlo Olah
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Stephan J Schreiber
- Department of Neurology, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zsolt Garami
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Nantan M Bornstein
- Neurology Department, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
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