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Lin K, Wen W, Lipnicki DM, Mewton L, Chen R, Du J, Wang D, Skoog I, Sterner TR, Najar J, Kim KW, Han JW, Kim JS, Ng TP, Ho R, Chua DQL, Anstey KJ, Cherbuin N, Mortby ME, Brodaty H, Kochan N, Sachdev PS, Jiang J. Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: The COSMIC consortium. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12567. [PMID: 38487075 PMCID: PMC10937819 DOI: 10.1002/dad2.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well documented in populations of different ethnicities and/or from different geographical regions. METHODS We investigated how WMHs were associated with vascular risk factors and cognition in both Whites and Asians, using data from five population-based cohorts of non-demented older individuals from Australia, Singapore, South Korea, and Sweden (N = 1946). WMH volumes (whole brain, periventricular, and deep) were quantified with UBO Detector and harmonized using the ComBat model. We also harmonized various vascular risk factors and scores for global cognition and individual cognitive domains. RESULTS Factors associated with larger whole brain WMH volumes included diabetes, hypertension, stroke, current smoking, body mass index, higher alcohol intake, and insufficient physical activity. Hypertension and stroke had stronger associations with WMH volumes in Whites than in Asians. No associations between WMH volumes and cognitive performance were found after correction for multiple testing. CONCLUSION The current study highlights ethnic differences in the contributions of vascular risk factors to WMHs.
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Affiliation(s)
- Keshuo Lin
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Wei Wen
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Darren M. Lipnicki
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Louise Mewton
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rory Chen
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Jing Du
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Dadong Wang
- Quantitative Imaging Research TeamCSIRO Informatics and StatisticsNorth RydeNew South WalesAustralia
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology UnitDepartment of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP)University of GothenburgGothenburgSweden
- Psychiatry, Cognition and Old Age Psychiatry ClinicSahlgrenska University HospitalGothenburgSweden
| | - Therese Rydberg Sterner
- Neuropsychiatric Epidemiology UnitDepartment of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP)University of GothenburgGothenburgSweden
- Aging Research CenterDepartment of NeurobiologyCare Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Jenna Najar
- Neuropsychiatric Epidemiology UnitDepartment of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Ageing and Health (AGECAP)University of GothenburgGothenburgSweden
- Section Genomics of Neurodegenerative Diseases and AgingDepartment of Human GeneticsAmsterdam Universitair Medische CentraAmsterdamthe Netherlands
| | - Ki Woong Kim
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulSouth Korea
- Department of Brain and Cognitive SciencesSeoul National University College of Natural SciencesSeoulSouth Korea
| | - Ji Won Han
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of PsychiatrySeoul National University College of MedicineSeoulSouth Korea
| | - Jun Sung Kim
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Tze Pin Ng
- Department of Psychological MedicineKhoo Teck Puat HospitalYishunSingapore
- Geriatric Education and Research InstituteMinistry of HealthSingaporeSingapore
| | - Roger Ho
- Institute for Health Innovation and Technology (iHealthtech)National University of SingaporeSingaporeSingapore
| | - Denise Qian Ling Chua
- Department of Psychological MedicineNational University of SingaporeSingaporeSingapore
| | - Kaarin J. Anstey
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Department of NeurodegenerationNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Ageing Futures InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population HealthCollege of Health and MedicineAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Moyra E. Mortby
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Department of NeurodegenerationNeuroscience Research AustraliaSydneyNew South WalesAustralia
- Ageing Futures InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Henry Brodaty
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nicole Kochan
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Neuropsychiatric InstituteThe Prince of Wales HospitalSydneyNew South WalesAustralia
| | - Jiyang Jiang
- Centre for Healthy Brain AgeingSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Lin K, Wen W, Lipnicki DM, Mewton L, Chen R, Du J, Wang D, Skoog I, Sterner TR, Najar J, Kim KW, Han JW, Kim JS, Ng TP, Ho R, Chua DQL, Anstey KJ, Cherbuin N, Mortby ME, Brodaty H, Kochan N, Sachdev PS, Jiang J. Risk factors and cognitive correlates of white matter hyperintensities in ethnically diverse populations without dementia: the COSMIC consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.30.23294876. [PMID: 37693599 PMCID: PMC10491386 DOI: 10.1101/2023.08.30.23294876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION White matter hyperintensities (WMH) are an important imaging marker for cerebral small vessel diseases, but their risk factors and cognitive associations have not been well-documented in populations of different ethnicities and/or from different geographical regions. METHOD Magnetic resonance imaging data of five population-based cohorts of non-demented older individuals from Australia, Singapore, South Korea, and Sweden (N = 1,946) were examined for WMH and their associations with vascular risk factors and cognition. RESULT Factors associated with larger whole brain WMH volumes included diabetes, hypertension, stroke, current smoking, body mass index, higher alcohol intake and insufficient physical activity. Participants with moderate or higher physical activity had less WMH than those who never exercised, but the former two groups did not differ. Hypertension and stroke had stronger associations with WMH volumes in the White, compared to Asian subsample. DISCUSSION The current study highlighted the ethnic differences in the contributions of vascular risk factors to WMH.
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Affiliation(s)
- Keshuo Lin
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Darren M. Lipnicki
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Louise Mewton
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Rory Chen
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jing Du
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Dadong Wang
- CSIRO Informatics and Statistics, Locked Bag 17, North Ryde, NSW 1670, Australia
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Box 100, 405 30, at the University of Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Box 100, 405 30, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Box 100, Goeteborg, Vaestra Goetaland 405 30, Sweden
| | - Therese Rydberg Sterner
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Box 100, 405 30, at the University of Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Box 100, 405 30, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Nobels väg 6, 171 77 Stockholm, Sweden
| | - Jenna Najar
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Box 100, 405 30, at the University of Gothenburg, Sweden
- Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Box 100, 405 30, Sweden
- Section Genomics of Neurodegenerative Diseases and Aging, Department of Human Genetics, Amsterdam Universitair Medische Centra, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul 03080, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jun Sung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Seongnam, Korea
| | - Tze Pin Ng
- Khoo Teck Puat Hospital, 768828, Singapore
- Geriatric Education and Research Institute, Ministry of Health, 768024, Singapore
| | - Roger Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, 119077, Singapore
| | - Denise Qian Ling Chua
- Department of Psychological Medicine, National University of Singapore, 119077, Singapore
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, NSW 2052,Australia
- Neuroscience Research Australia, NSW 2031, Australia
- Ageing Futures Institute, University of New South Wales, NSW 2052,Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, ACT 2600, Canberra, Australia
| | - Moyra E. Mortby
- School of Psychology, University of New South Wales, NSW 2052,Australia
- Neuroscience Research Australia, NSW 2031, Australia
- Ageing Futures Institute, University of New South Wales, NSW 2052,Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nicole Kochan
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia
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Relationship between obesity and structural brain abnormality: Accumulated evidence from observational studies. Ageing Res Rev 2021; 71:101445. [PMID: 34391946 DOI: 10.1016/j.arr.2021.101445] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 07/10/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022]
Abstract
We aimed to evaluate the relationship between obesity and structural brain abnormalities assessed by magnetic resonance imaging using data from 45 observational epidemiological studies, where five articles reported prospective longitudinal results. In cross-sectional studies' analyses, the pooled weighted mean difference for total brain volume (TBV) and gray matter volume (GMV) in obese/overweight participants was -11.59 (95 % CI: -23.17 to -0.02) and -10.98 (95 % CI: -20.78 to -1.18), respectively. TBV was adversely associated with BMI and WC, GMV with BMI, and hippocampal volume with BMI, WC, and WHR. WC/WHR are associated with a risk of lacunar and white matter hyperintensity (WMH). In longitudinal studies' analyses, BMI was not statistically associated with the overall structural brain abnormalities (for continuous BMI: RR = 1.02, 95 % CI: 0.94-1.12; for categorial BMI: RR = 1.18, 95 % CI: 0.75-1.85). Small sample size of prospective longitudinal studies limited the power of its pooled estimates. A higher BMI is associated with lower brain volume while greater WC/WHR, but not BMI, is related to a risk of lacunar infarct and WMH. Future longitudinal research is needed to further elucidate the specific causal relationships and explore preventive measures.
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Metabolic syndrome alters relationships between cardiometabolic variables, cognition and white matter hyperintensity load. Sci Rep 2019; 9:4356. [PMID: 30867458 PMCID: PMC6416472 DOI: 10.1038/s41598-019-40630-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/01/2019] [Indexed: 02/05/2023] Open
Abstract
Cardiometabolic risk factors influence white matter hyperintensity (WMH) development: in metabolic syndrome (MetS), higher WMH load is often reported but the relationships between specific cardiometabolic variables, WMH load and cognitive performance are uncertain. We investigated these in a Brazilian sample (aged 50–85) with (N = 61) and without (N = 103) MetS. Stepwise regression models identified effects of cardiometabolic and demographic variables on WMH load (from FLAIR MRI) and verbal recall performance. WMH volume was greater in MetS, but verbal recall performance was not impaired. Age showed the strongest relationship with WMH load. Across all participants, systolic blood pressure (SBP) and fasting blood glucose were also contributors, and WMH volume was negatively associated with verbal recall performance. In non-MetS, higher HbA1c, SBP, and number of MetS components were linked to poorer recall performance while higher triglyceride levels appeared to be protective. In MetS only, these relationships were absent but education exerted a strongly protective effect on recall performance. Thus, results support MetS as a construct: the clustering of cardiometabolic variables in MetS alters their individual relationships with cognition; instead, MetS is characterised by a greater reliance on cognitive reserve mechanisms. In non-MetS, strategies to control HbA1c and SBP should be prioritised as these have the largest impact on cognition.
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Diniz PHB, Valente TLA, Diniz JOB, Silva AC, Gattass M, Ventura N, Muniz BC, Gasparetto EL. Detection of white matter lesion regions in MRI using SLIC0 and convolutional neural network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 167:49-63. [PMID: 29706405 DOI: 10.1016/j.cmpb.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 02/12/2018] [Accepted: 04/17/2018] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVE White matter lesions are non-static brain lesions that have a prevalence rate up to 98% in the elderly population. Because they may be associated with several brain diseases, it is important that they are detected as soon as possible. Magnetic Resonance Imaging (MRI) provides three-dimensional data with the possibility to detect and emphasize contrast differences in soft tissues, providing rich information about the human soft tissue anatomy. However, the amount of data provided for these images is far too much for manual analysis/interpretation, representing a difficult and time-consuming task for specialists. This work presents a computational methodology capable of detecting regions of white matter lesions of the brain in MRI of FLAIR modality. The techniques highlighted in this methodology are SLIC0 clustering for candidate segmentation and convolutional neural networks for candidate classification. METHODS The methodology proposed here consists of four steps: (1) images acquisition, (2) images preprocessing, (3) candidates segmentation and (4) candidates classification. RESULTS The methodology was applied on 91 magnetic resonance images provided by DASA, and achieved an accuracy of 98.73%, specificity of 98.77% and sensitivity of 78.79% with 0.005 of false positives, without any false positives reduction technique, in detection of white matter lesion regions. CONCLUSIONS It is demonstrated the feasibility of the analysis of brain MRI using SLIC0 and convolutional neural network techniques to achieve success in detection of white matter lesions regions.
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Affiliation(s)
- Pedro Henrique Bandeira Diniz
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - Thales Levi Azevedo Valente
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - João Otávio Bandeira Diniz
- Federal University of Maranhão - UFMA Applied Computing Group - NCA Av. dos Portugueses, SN, Bacanga, MA, São Luís, 65085-580, Brazil.
| | - Aristófanes Corrêa Silva
- Federal University of Maranhão - UFMA Applied Computing Group - NCA Av. dos Portugueses, SN, Bacanga, MA, São Luís, 65085-580, Brazil.
| | - Marcelo Gattass
- Pontifical Catholic University of Rio de Janeiro - PUC - RioR. São Vicente, 225, Gávea, RJ, Rio de Janeiro, 22453-900, Brazil.
| | - Nina Ventura
- Paulo Niemeyer State Brain Institute - IECR. Lobo Júnior, 2293, Penha -RJ, 21070-060, Brazil.
| | - Bernardo Carvalho Muniz
- Paulo Niemeyer State Brain Institute - IECR. Lobo Júnior, 2293, Penha -RJ, 21070-060, Brazil.
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Metabolic Syndrome is Associated with White Matter Hyperintensity in Stroke Patients. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Some risk factors of stroke may play a role in white matter hyperintensity (WMH). Metabolic syndrome (MetS) is a recognised risk factor of stroke, but it is controversial whether MetS is also associated with WMH. We examined the association of MetS with the prevalence of WMH in acute stroke patients. We conducted a cross-sectional study in 246 acute ischemia stroke patients. The patients with acute stroke were clinically evaluated, including waistline circumference, blood pressure, glycaemia, serum triglyceride and high density lipoprotein cholesterol level. The degree of WMH was assessed by Fluid-attenuated inversion recovery (FLAIR) sequence of magnetic resonance imaging (MRI) scans. MetS was diagnosed using the criteria by the National Cholesterol Education Adult Treatment Panel III. MetS was the independent variable evaluated in Binary regression analyses. It is found that old age (>60 years old), MetS and smoking were significantly associated with WMH in univariate analysis (p < .05). Spearman rank correlation showed that old age and MetS are related to WMH (r = 0.18, p = .005 and r = 0.18, p = .004, respectively). Hypertension is weakly but not significantly associated with WMH in correlation analysis (r = 0.11, p = .08). In multiple regression analysis, age and MetS remained independently associated with WMH (OR = 7.6, 95% CI 0.2–0.7 and OR = 11.7, 95% CI 0.1–0.5). Hypertension and hyperglycaemia tend to be associated but not significantly with WMH (p = .07, p = .08). Other MetS components such as large waist circumference and dyslipidaemia showed no association with WMH. After adjustment for age, WMH is significantly associated with MetS in stroke patients. Hypertension and hyperglycaemia tend to associated but not significantly with WMH in stroke patients.
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Visceral obesity is associated with white matter hyperintensity and lacunar infarct. Int J Obes (Lond) 2017; 41:683-688. [DOI: 10.1038/ijo.2017.13] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/09/2016] [Accepted: 01/01/2017] [Indexed: 12/24/2022]
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Friedman JI, Tang CY, de Haas HJ, Changchien L, Goliasch G, Dabas P, Wang V, Fayad ZA, Fuster V, Narula J. Brain imaging changes associated with risk factors for cardiovascular and cerebrovascular disease in asymptomatic patients. JACC Cardiovasc Imaging 2015; 7:1039-53. [PMID: 25323165 DOI: 10.1016/j.jcmg.2014.06.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 11/27/2022]
Abstract
Reviews of imaging studies assessing the brain effects of vascular risk factors typically include a substantial number of studies with subjects with a history of symptomatic cardiovascular or cerebrovascular disease and/or events, limiting our ability to disentangle the primary brain effects of vascular risk factors from those of resulting brain and cardiac damage. The objective of this study was to perform a systematic review of brain changes from imaging studies in patients with vascular risk factors but without clinically manifest cardiovascular or cerebrovascular disease or events. The 77 studies included in this review demonstrate that in persons without symptomatic cardiovascular, cerebrovascular, or peripheral vascular disease, the vascular risk factors of hypertension, diabetes mellitus, obesity, hyperlipidemia, and smoking are all independently associated with brain imaging changes before the clinical manifestation of cardiovascular or cerebrovascular disease. We conclude that the identification of brain changes associated with vascular risk factors, before the manifestation of clinically significant cerebrovascular damage, presents a window of opportunity wherein adequate treatment of these modifiable vascular risk factors may prevent the development of irreversible deleterious brain changes and potentially alter patients' clinical course.
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Affiliation(s)
- Joseph I Friedman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Neuroscience Center, Pilgrim Psychiatric Center, West Brentwood, New York.
| | - Cheuk Y Tang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hans J de Haas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | - Lisa Changchien
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Neuroscience Center, Pilgrim Psychiatric Center, West Brentwood, New York
| | - Georg Goliasch
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | - Puneet Dabas
- Clinical Neuroscience Center, Pilgrim Psychiatric Center, West Brentwood, New York
| | - Victoria Wang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valentin Fuster
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Archibald SL, McCutchan JA, Sanders C, Wolfson T, Jernigan TL, Ellis RJ, Ances BM, Collier AC, McArthur JC, Morgello S, Simpson DM, Marra C, Gelman BB, Clifford DB, Grant I, Fennema-Notestine C. Brain morphometric correlates of metabolic variables in HIV: the CHARTER study. J Neurovirol 2014; 20:603-11. [PMID: 25227933 PMCID: PMC4268263 DOI: 10.1007/s13365-014-0284-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/20/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
Obesity and other metabolic variables are associated with abnormal brain structural volumes and cognitive dysfunction in HIV-uninfected populations. Since individuals with HIV infection on combined antiretroviral therapy (CART) often have systemic metabolic abnormalities and changes in brain morphology and function, we examined associations among brain volumes and metabolic factors in the multisite CNS HIV AntiRetroviral Therapy Effects Research (CHARTER) cohort, cross-sectional study of 222 HIV-infected individuals. Metabolic variables included body mass index (BMI), total blood cholesterol (C), low- and high-density lipoprotein C (LDL-C and HDL-C), blood pressure, random blood glucose, and diabetes. MRI measured volumes of cerebral white matter, abnormal white matter, cortical and subcortical gray matter, and ventricular and sulcal CSF. Multiple linear regression models allowed us to examine metabolic variables separately and in combination to predict each regional volume. Greater BMI was associated with smaller cortical gray and larger white matter volumes. Higher total cholesterol (C) levels were associated with smaller cortex volumes; higher LDL-C was associated with larger cerebral white matter volumes, while higher HDL-C levels were associated with larger sulci. Higher blood glucose levels and diabetes were associated with more abnormal white matter. Multiple atherogenic metabolic factors contribute to regional brain volumes in HIV-infected, CART-treated patients, reflecting associations similar to those found in HIV-uninfected individuals. These risk factors may accelerate cerebral atherosclerosis and consequent brain alterations and cognitive dysfunction.
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Affiliation(s)
- S L Archibald
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive #0949, La Jolla, CA, 92093-0949, USA,
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Yin ZG, Li L, Cui M, Zhou SM, Yu MM, Zhou HD. Inverse relationship between apolipoprotein A-I and cerebral white matter lesions: a cross-sectional study in middle-aged and elderly subjects. PLoS One 2014; 9:e97113. [PMID: 24820970 PMCID: PMC4018273 DOI: 10.1371/journal.pone.0097113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/14/2014] [Indexed: 12/19/2022] Open
Abstract
Background Apolipoprotein A-I (apoA-I), the major protein for high density lipoprotein, is essential for reverse cholesterol transport. Decreased serum levels of apoA-I have been reported to correlate with subcortical infarction and dementia, both of which are highly related to white matter lesions (WMLs). However, the association between apoA-I and WMLs has never been investigated. In this study, we sought to investigate the association between apoA-I and the presence of WMLs in middle-aged and elderly subjects. Methods Consecutive patients aged 50 years and older of our department were prospectively enrolled in this study (n = 1282, 606 men and 676 women, 65.9±9.4 years). All participants underwent MRI scans to assess the presence and severity of WMLs. Multivariate logistic regression analyses were performed to examine the association of apoA-I with WMLs. Results Patients with WMLs were older and showed significantly higher proportion of male sex, hypertension, diabetes mellitus, previous stroke, and coronary heart disease whereas levels of total cholesterol, high density lipoprotein cholesterol, and apoA-I were lower. After adjustment for potential confounders, the lowest apoA-I quartile was independently associated with an increased risk of WMLs (odds ratio: 1.87, 95% confidence interval: 1.29–2.72). In sex-specific analyses, this relationship was observed only in women. Conclusions Our findings demonstrated that apoA-I was inversely associated with the presence of WMLs in middle-aged and elderly subjects. This results suggest that therapies which increase apoA-I concentration may be beneficial to reduce the risk of WMLs, dementia and stroke.
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Affiliation(s)
- Ze-Gang Yin
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Ling Li
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Min Cui
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, Hubei, China
| | - Shi-Ming Zhou
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Ming-Ming Yu
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Hua-Dong Zhou
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
- * E-mail:
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11
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Park BJ, Kim JK, Lee YJ. Higher intraocular pressure is associated with leukoaraiosis among middle-aged and elderly Koreans without glaucoma or dementia. Eye (Lond) 2014; 28:715-9. [PMID: 24675583 DOI: 10.1038/eye.2014.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 02/07/2014] [Indexed: 11/09/2022] Open
Abstract
AIM Leukoaraiosis and high intraocular pressure are strongly associated with cardiovascular disease, vascular angiopathy, and geriatric syndrome. Until now, little is known about the relationship between intraocular pressure and leukoaraiosis in its preclinical stage. The aim of this study was to evaluate the association between intraocular pressure and leukoaraiosis among middle-aged and elderly Koreans without glaucoma or dementia. METHODS We examined the relationship of intraocular pressure with leukoaraiosis at a preclinical stage in 753 Korean adults (474 men, 279 women; mean age 57.8 ± 6.6 years). A multiple logistic regression analysis was performed in order to determine whether intraocular pressure is an independent determinant for leukoaraiosis. RESULTS The overall prevalence of leukoaraiosis was 7.3%. Mean ocular pressure (±SD) was significantly higher in the leukoaraiosis group than the control group (14.3 ± 2.9 and 13.5 ± 2.9, respectively; P=0.028). In multiple logistic regression analysis, the odds ratio for leukoaraiosis was 1.18 (95% confidence interval: 1.06-1.31) for each 1 mm Hg increase in intraocular pressure. CONCLUSION Intraocular pressure was found to be independently and positively associated with leukoaraiosis. This finding indicates that higher intraocular pressure may be a useful additional measure in assessing the risk of leukoaraiosis in the clinical setting.
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Affiliation(s)
- B-J Park
- Department of Family Medicine, CHA University School of Medicine, Seoul, Republic of Korea
| | - J-K Kim
- Department of Family Medicine, Health Promotion Center, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Y-J Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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12
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Yamashiro K, Tanaka R, Tanaka Y, Miyamoto N, Shimada Y, Ueno Y, Urabe T, Hattori N. Visceral fat accumulation is associated with cerebral small vessel disease. Eur J Neurol 2014; 21:667-73. [PMID: 24495037 DOI: 10.1111/ene.12374] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Obesity is associated with the risk of coronary artery disease and stroke. Visceral fat plays a significant role in the atherogenic effects of obesity. Whether visceral fat accumulation, as measured by computed tomography (CT), is an independent risk factor for the presence of cerebral small vessel disease (SVD) was investigated. METHODS This study comprised 506 Japanese subjects 35-74 years of age (mean 55.3 years) without a history of symptomatic cerebrovascular disease who underwent health screening tests, including brain magnetic resonance imaging, carotid echography and measurements of the visceral fat area (VFA) and subcutaneous fat area (SFA) on abdominal CT. Visceral fat accumulation was defined as VFA ≥ 100 cm(2) . Logistic regression analysis was performed to examine the associations between visceral fat accumulation and cerebral SVD such as white matter lesions (WMLs) and silent lacunar infarction (SLI). RESULTS The prevalence of WMLs and SLI but not carotid plaque were significantly higher in subjects with VFA ≥ 100 cm(2) than those with VFA < 100 cm(2) . A VFA ≥ 100 cm(2) was associated with WMLs and SLI independent of age, cardiovascular risk factors and other measurements of obesity, such as waist circumference and body mass index. A large waist circumference was independently associated with SLI. SFA, the combination of VFA and SFA, and body mass index were not associated with WMLs or SLI. CONCLUSIONS Visceral fat accumulation was independently associated with the presence of cerebral SVD in subjects without a history of symptomatic cerebrovascular disease.
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Affiliation(s)
- K Yamashiro
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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13
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Kim H, Yun CH, Thomas RJ, Lee SH, Seo HS, Cho ER, Lee SK, Yoon DW, Suh S, Shin C. Obstructive sleep apnea as a risk factor for cerebral white matter change in a middle-aged and older general population. Sleep 2013; 36:709-715B. [PMID: 23633753 PMCID: PMC3624825 DOI: 10.5665/sleep.2632] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE Obstructive sleep apnea (OSA) contributes to the development of systemic hypertension, and hypertension strongly predicts the development of white matter change (WMC). Thus, it is plausible that OSA mediates WMC. The goal of the current study is to determine whether a contextual relationship exists between OSA and cerebral WMC. DESIGN Cross-sectional analyses conducted in a population-based study. SETTING Korean community-based sample from the Korean Genome and Epidemiology Study (KoGES) who attended examinations in 2011 at a medical center. PARTICIPANTS There were 503 individuals (mean ± SD, age 59.63 ± 7.48 y) who were free of previously diagnosed cardiovascular and neurologic diseases. MEASUREMENTS AND RESULTS Participants underwent 1-night polysomnography and were classified as no OSA (obstructive apnea-hypopnea index [AHI] < 5, n = 289), mild OSA (AHI 5-15, n = 161), and moderate to severe OSA (AHI ≥ 15, n = 53). WMC was identified with brain magnetic resonance imaging (MRI) and was found in 199 individuals (39.56%). Multivariate logistic regression analyses adjusted for covariates revealed that moderate to severe OSA was significantly associated with the presence of WMC (odds ratio [OR] 2.08, 95%, confidence interval [CI] 1.05-4.13) compared with no OSA. Additional adjustment of hypertension to the model did not alter the significance of the association (OR 2.03, 95% CI 1.02-4.05). CONCLUSIONS Moderate to severe OSA is an independent risk factor for WMC in middle-aged and older individuals. Thus, early recognition and treatment of OSA could reduce the risk of stroke and vascular dementia.
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Affiliation(s)
- Hyun Kim
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Brain Korea 21 Program in Biomedical Science, School of Medicine, Korea University, Anam, Republic of Korea
| | - Chang-Ho Yun
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Robert Joseph Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Seung Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hyung Suk Seo
- Department of Radiology, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Eo Rin Cho
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Dae Wui Yoon
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Brain Korea 21 Program in Biomedical Science, School of Medicine, Korea University, Anam, Republic of Korea
| | - Sooyeon Suh
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Stanford University, Department of Psychiatry
| | - Chol Shin
- Institute of Human Genomic Study, School of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
- Brain Korea 21 Program in Biomedical Science, School of Medicine, Korea University, Anam, Republic of Korea
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
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14
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Association between serum total bilirubin level and leukoaraiosis in Korean adults. Clin Biochem 2012; 45:289-92. [DOI: 10.1016/j.clinbiochem.2011.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/23/2011] [Accepted: 12/27/2011] [Indexed: 11/21/2022]
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15
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Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011; 2011:617927. [PMID: 21876810 PMCID: PMC3163144 DOI: 10.4061/2011/617927] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 11/20/2022] Open
Abstract
Age-related white matter changes (WMC) are considered manifestation of arteriolosclerotic small vessel disease and are related to age and vascular risk factors. Most recent studies have shown that WMC are associated with a host of poor outcomes, including cognitive impairment, dementia, urinary incontinence, gait disturbances, depression, and increased risk of stroke and death. Although the clinical relevance of WMC has been extensively studied, to date, only very few clinical trials have evaluated potential symptomatic or preventive treatments for WMC. In this paper, we reviewed the current understanding in the pathophysiology, epidemiology, clinical importance, chemical biomarkers, and treatments of age-related WMC.
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Affiliation(s)
- Yun Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Shatin 999077, Hong Kong
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