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Mi J, Liu C, Chen H, Qian Y, Zhu J, Zhang Y, Liang Y, Wang L, Ta D. Light on Alzheimer's disease: from basic insights to preclinical studies. Front Aging Neurosci 2024; 16:1363458. [PMID: 38566826 PMCID: PMC10986738 DOI: 10.3389/fnagi.2024.1363458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Alzheimer's disease (AD), referring to a gradual deterioration in cognitive function, including memory loss and impaired thinking skills, has emerged as a substantial worldwide challenge with profound social and economic implications. As the prevalence of AD continues to rise and the population ages, there is an imperative demand for innovative imaging techniques to help improve our understanding of these complex conditions. Photoacoustic (PA) imaging forms a hybrid imaging modality by integrating the high-contrast of optical imaging and deep-penetration of ultrasound imaging. PA imaging enables the visualization and characterization of tissue structures and multifunctional information at high resolution and, has demonstrated promising preliminary results in the study and diagnosis of AD. This review endeavors to offer a thorough overview of the current applications and potential of PA imaging on AD diagnosis and treatment. Firstly, the structural, functional, molecular parameter changes associated with AD-related brain imaging captured by PA imaging will be summarized, shaping the diagnostic standpoint of this review. Then, the therapeutic methods aimed at AD is discussed further. Lastly, the potential solutions and clinical applications to expand the extent of PA imaging into deeper AD scenarios is proposed. While certain aspects might not be fully covered, this mini-review provides valuable insights into AD diagnosis and treatment through the utilization of innovative tissue photothermal effects. We hope that it will spark further exploration in this field, fostering improved and earlier theranostics for AD.
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Affiliation(s)
- Jie Mi
- Yiwu Research Institute, Fudan University, Yiwu, China
| | - Chao Liu
- Yiwu Research Institute, Fudan University, Yiwu, China
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
| | - Honglei Chen
- Yiwu Research Institute, Fudan University, Yiwu, China
| | - Yan Qian
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Shanghai, China
| | - Jingyi Zhu
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Yachao Zhang
- Medical Ultrasound Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yizhi Liang
- Guangdong Provincial Key Laboratory of Optical Fiber Sensing and Communications, Institute of Photonics Technology, Jinan University, Guangzhou, China
| | - Lidai Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Dean Ta
- Yiwu Research Institute, Fudan University, Yiwu, China
- Department of Electronic Engineering, Fudan University, Shanghai, China
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2
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Zhu X, Jing R, Li X, Zhang W, Tang Y, Liu T. Left ventricular hypertrophy, carotid atherosclerosis, and cognitive impairment in peritoneal dialysis patients. BMC Cardiovasc Disord 2023; 23:127. [PMID: 36890445 PMCID: PMC9996916 DOI: 10.1186/s12872-023-03130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) and carotid atherosclerosis (CAS) have been identified as factors associated with cognitive impairment (CI) but have not been studied in patients undergoing peritoneal dialysis (PD). This study investigated the relationship between LVH and CAS and cognitive function in patients undergoing PD. METHODS In this single-center cross-sectional study, the clinically stable patients who were over 18 years of age and had undergone PD for at least 3 months were enrolled. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), which included seven areas: visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation. LVH was defined as LVMI > 46.7 g/m2.7 in women and LVMI > 49.2 g/m2.7 in men. CAS was defined as carotid intima-media thickness ≥ 1.0 mm and/or the presence of plaque. RESULTS A total of 207 patients undergoing PD were recruited, with an average age of 52.14 ± 14.93 years and a median PD duration of 8 months (5-19 months). The CI rate was 56%, and the prevalence of CAS was 53.6%. LVH occurred in 110 patients (53.1%). Patients in the LVH group tended to be older, and had a higher body mass index, a higher pulse pressure, a higher male proportion, a lower ejection fraction, a higher prevalence of cardiovascular disease and CI, and a lower MoCA scores.Multivariate logistic regression analysis was conducted to analyze the association between LVH and CI (OR, 10.087; 95% confidence interval, 2.966-34.307). And the association between LVH and CI was still supported after propensity matching scores. CAS was not significantly associated with CI. CONCLUSION LVH is independently associated with CI in patients undergoing PD, while CAS is not significantly associated with CI.
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Affiliation(s)
- Xuejing Zhu
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China
| | - Ran Jing
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China
| | - XiaoPing Li
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China
| | - Wanfen Zhang
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China
| | - Yushang Tang
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China
| | - Tongqiang Liu
- Department of Nephrology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 68# Middle Gehu Road, Changzhou, 213164, Jiangsu Province, People's Republic of China.
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Linassi F, De Laurenzis A, Maran E, Gadaldi A, Spano' L, Gerosa G, Pittarello D, Zanatta P, Carron M. Influence of Previous General Anesthesia on Cognitive Impairment: An Observational Study Among 151 Patients. Front Hum Neurosci 2022; 16:810046. [PMID: 35652004 PMCID: PMC9148968 DOI: 10.3389/fnhum.2022.810046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Preoperative neurocognitive disorder (preO-NCD) is a common condition affecting 14–51. 7% of the elderly population. General anesthesia has already been associated with the one-year post-operative neurocognitive disorder (PostO-NCD), specifically, a deficit in executive function, measured by the Trail Making Test B (TMT-B), but its long-term effects on cognitive function have not been investigated. We aimed to detect preO-NCD prevalence in patients scheduled for cardiac surgery and further investigate the possible role of previous general anesthesia (pGA) in general preoperative cognitive status [measured via the Montreal Cognitive Assessment (MoCA)] and/or in executive functioning (measured via TMT-B). Methods In this observational, prospective study, 151 adult patients scheduled for elective cardiac surgery underwent MoCA and TMT-B. Data on age, education, pGA, comorbidities, and laboratory results were collected. Results We discovered a general cognitive function impairment of 79.5% and an executive function impairment of 22%. Aging is associated with an increased likelihood (OR 2.99, p = 0.047) and education with a decreased likelihood (OR 0.35, p = 0.0045) of general cognitive impairment, but only education was significantly associated with a decreased likelihood (OR 0.22, p = 0.021) of executive function impairment. While pGA did not significantly affect preO-NCD, a noteworthy interaction between aging and pGA was found, resulting in a synergistic effect, increasing the likelihood of executive function impairment (OR 9.740, p = 0.0174). Conclusion We found a high prevalence of preO-NCD in patients scheduled for cardiac surgery. General cognitive function impairment is highly associated with advancing age (not pGA). However, older patients with at least one pGA appeared to be at an increased risk of preO-NCD, especially executive function impairment, suggesting that TMT-B should be associated with MoCA in the preoperative cognitive evaluation in this population.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
- *Correspondence: Federico Linassi
| | - Alessandro De Laurenzis
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Eleonora Maran
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandra Gadaldi
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Leonardo Spano'
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Verona, Italy
| | - Michele Carron
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
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Ihle-Hansen H, Vigen T, Berge T, Hagberg G, Engedal K, Rønning OM, Thommessen B, Lyngbakken MN, Nygård S, Røsjø H, Tveit A, Ihle-Hansen H. Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study. J Alzheimers Dis 2020; 70:1041-1049. [PMID: 31306128 DOI: 10.3233/jad-190327] [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] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. OBJECTIVE We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63-65 years. METHODS All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. RESULTS We analyzed 3,413 individuals aged 63-65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = -0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. CONCLUSION Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.
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Affiliation(s)
- Håkon Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thea Vigen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Trygve Berge
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guri Hagberg
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Ole Morten Rønning
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Bente Thommessen
- Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Magnus N Lyngbakken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Ståle Nygård
- Bioinformatics Core facility, Oslo University Hospital and the University of Oslo, Norway
| | - Helge Røsjø
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Medicine, Akershus University Hospital, L-renskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Medical Research, B-rum Hospital, Vestre Viken Hospital Trust, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wang J, Huang R, Tian S, Lin H, Guo D, An K, Wang S. Elevated Plasma Level of D-dimer Predicts the High Risk of Early Cognitive Impairment in Type 2 Diabetic Patients as Carotid Artery Plaques become Vulnerable or Get Aggravated. Curr Alzheimer Res 2020; 16:396-404. [PMID: 30919777 DOI: 10.2174/1567205016666190321164741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE D-dimer prompts fibrinolysis system, which is involved in Alzheimer's disease and the complications of type 2 diabetic patients, especially among those with carotid artery plaques. Hence, this study aims to investigate the role of D-dimer in early cognitive impairment among type 2 diabetic patients with carotid artery plaques. METHODS A total of 175 Chinese patients with type 2 diabetes were recruited and divided into two groups according to the Montreal Cognitive Assessment score. Demographic data were collected, plasma D-dimer was tested through VIDAS D-dimer New, neuropsychological tests were examined, and carotid artery plaques were detected by ultrasound and further stratified by vulnerability and level. RESULTS A total of 67 types 2 diabetic patients with Mild Cognitive Impairment (MCI) displayed significantly increased plasma D-dimer levels compared with their health-cognition controls (p = 0.011). Plasma D-dimer concentration was negatively related with Digit Span Test scores in diabetic patients with vulnerable plaques (r=-0.471, p=0.023) and Stroop Color Word Test C (number) in diabetic patients with stable plaques (r=-0.482, p<0.001). Multivariable regression analysis further showed that D-dimer concentration was an independent factor of diabetic MCI with carotid artery plaque (p=0.005), and D-dimer concentration especially contributed to the high risk of MCI with vulnerable plaques (p=0.028) or high levels of carotid plaque (p=0.023). CONCLUSION Elevated D-dimer level predicts the high risk of early cognitive impairment in type 2 diabetic patients with carotid artery plaques, especially vulnerable plaques or high levels of carotid plaques.
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Affiliation(s)
- Jiaqi Wang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Rong Huang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Sai Tian
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Hongyan Lin
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Dan Guo
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Ke An
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China.,Medical School of Southeast University, Nanjing 210009, China
| | - Shaohua Wang
- Department of Endocrinology, Affiliated Zhongda Hospital of Southeast University, No.87 DingJiaQiao Road, Nanjing 210009, China
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Liu L, Huang Q, Yang S, Wen Y, He W, Liu H, Meng L, Jiang H, Xia J, Liao W, Liu Y. Micro-structural white matter abnormalities and cognitive impairment in asymptomatic carotid plaque patients: A DTI study using TBSS analysis. Clin Neurol Neurosurg 2020; 197:106096. [PMID: 32717561 DOI: 10.1016/j.clineuro.2020.106096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It has been shown that symptomatic or severe carotid atherosclerosis is closely related to cognitive impairment and brain white matter damage. However, there is still a lack of effective and non-invasive imaging biomarkers to identify early high-risk cerebrovascular diseases. Therefore, the purpose of this study is to explore the integrity of brain white matter and cognitive impairment in patients with asymptomatic carotid plaques by using imaging technology. METHODS All subjects were from a project of Stroke Risk Screening and Prevention and were defined as stroke high-risk patients (with three or more stroke risk factors). Tract-based spatial statistics (TBSS) based on diffusion tensor imaging (DTI) was used to analyze the whole brain white matter abnormalities in 61 patients with carotid artery plaque and in 40 healthy controls. At the same time, the general clinical data between the two groups were compared, such as age, gender, smoking, hypertension and cognitive function scores etc. Furthermore, the plaque group was divided into the have-hyperintensities group and the no-hyperintensities group to compare their microstructure of white matter injuries. RESULTS The cognitive scores of plaque group were significantly lower than that of control group. We found that when plaque group and control group were compared, no white matter fiber tracts with difference was found in FA, MD, AD and RD. However, the decrease of FA and the increase of RD were found in some white matter regions (P < 0.05) when comparing the have-hyperintensities group and the no-hyperintensities group. These white matter regions included anterior thalamic radiation, corticospinal tract, cingulum (cingulate gyrus), forceps minor, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus. What's more, there were significant differences in blood pressure between the two groups. CONCLUSION The cognitive function of patients with early high-risk cerebrovascular diseases (asymptomatic carotid plaques) has a downward trend. TBSS based on DTI can help to find out the actual damage of brain white matter in patients with early carotid plaque, and reflect the early pathological changes from the micro level.
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Affiliation(s)
- Lihui Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanbin Wen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei He
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hui Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Meng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Diseases, Central South University, Changsha, Huan, China; Key Laboratory of Hunan Province in Neurodegenerative Disorders, Central South University, Changsha, Hunan, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunhai Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Cerebrovascular Disease Clinical Research Center of Hunan Province, Changsha, Hunan, China; Department of Geriatrics Stroke Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zhang J, Wang Z, Zhou M, Jia J, Liu Y, Wang A, Guo M, Chen S, Zhao X. Association Between Asymptomatic Vulnerable Carotid Plaques and Cognitive Impairment in Rural Adults. Front Neurol 2020; 11:662. [PMID: 32733371 PMCID: PMC7358345 DOI: 10.3389/fneur.2020.00662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of cognitive impairment is growing and higher in rural areas. The association between carotid plaque and cognitive impairment remains uncertain, and few studies focused on the cognitive function of the rural population. We designed this study to investigate the association between carotid plaque and cognitive impairment in a rural community. Methods: We enrolled 3,336 participants who underwent carotid ultrasound and cognitive function measurements, free of cerebrovascular diseases, and without neurological deficits, from the China National Stroke Screen Survey program. Cognitive function was evaluated by the Montreal Cognitive Assessment (Beijing version). We used multivariable logistic regression to assess the association between asymptomatic carotid plaques and the presence of cognitive impairment. Results: Nine hundred seventy-six participants had cognitive impairment in this study. After adjustment for potential confounding factors, asymptomatic carotid plaques (odds ratio was 1.35; 95% confidence interval, 1.15-1.58), especially vulnerable carotid plaques (odds ratio was 1.54; 95% confidence interval, 1.28-1.85), were associated with cognitive impairment. Conclusion: In this community-based and observational study, asymptomatic vulnerable carotid plaque is an independent and significant risk factor for cognitive impairment in rural residents.
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Affiliation(s)
- Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zixuan Wang
- Department of Infectious Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyue Zhou
- Department of Neurology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Jiaokun Jia
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yanfang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengyi Guo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Shengyun Chen
- Department of Neurology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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8
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Moonis G, Subramaniam RM, Trofimova A, Burns J, Bykowski J, Chakraborty S, Holloway K, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Roca RP, Rosenow JM, Shih RY, Utukuri PS, Corey AS. ACR Appropriateness Criteria® Dementia. J Am Coll Radiol 2020; 17:S100-S112. [PMID: 32370954 DOI: 10.1016/j.jacr.2020.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022]
Abstract
Degenerative disease of the central nervous system is a growing public health concern. The primary role of neuroimaging in the workup of patients with probable or possible Alzheimer disease has typically been to exclude other significant intracranial abnormalities. In general, the imaging findings in structural studies, such as MRI, are nonspecific and have limited potential in differentiating different types of dementia. Advanced imaging methods are not routinely used in community or general practices for the diagnosis or differentiation of forms of dementia. Nonetheless, in patients who have been evaluated by a dementia expert, FDG-PET helps to distinguish Alzheimer disease from frontotemporal dementia. In patients with suspected dementia with Lewy bodies, functional imaging of the dopamine transporter (ioflupane) using SPECT may be helpful. In patients with suspected normal-pressure hydrocephalus, DTPA cisternography and HMPAO SPECT/CT brain may provide assessment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gul Moonis
- Columbia University Medical Center, New York, New York.
| | | | | | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada; Canadian Association of Radiologists
| | - Kathryn Holloway
- MCVH-Virginia Commonwealth University, Richmond, Virginia; Neurosurgery Expert
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Robert P Roca
- Sheppard Pratt Health System, Towson, Maryland; American Psychiatric Association
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Neurosurgery Expert
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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9
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Zardi EM, Giorgi C, Zardi DM. Diagnostic approach to neuropsychiatric lupus erythematosus: what should we do? Postgrad Med 2018; 130:536-547. [PMID: 29940795 DOI: 10.1080/00325481.2018.1492309] [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] [Indexed: 02/08/2023]
Abstract
Neuropsychiatric systemic lupus erythematosus is a diagnostic challenge due to the multifarious neurological and psychiatric manifestations that define it but, when suspected, diagnostic imaging can give a fundamental help. The advancements and variety of neuroimaging techniques allow us to perform more and more accurate evaluations of structure, perfusion, and metabolism of the brain and to detect cerebral and spinal lesions. Moreover, vascular districts of the neck and the brain, as well as the electrical brain and peripheral muscle activity may be accurately investigated, thus giving us a wide panoramic view. Although magnetic resonance is recognized as a fundamental neuroimaging technique to reach a correct diagnosis, the juxtaposition of other diagnostic techniques has improved the possibility to make diagnoses but has also increased the confusion about deciding which of them to use and when. Our aim was to combine the number of available techniques with the need to simplify the diagnostic path. Therefore, through the construction of an algorithm from an evidence based approach, we believe we are providing some added improvements to facilitate and expedite the diagnosis of NPSLE.
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Affiliation(s)
| | - Chiara Giorgi
- b Radiology Department , S Maria della Misericordia Hospital , Urbino , Italy
| | - Domenico Maria Zardi
- c Division of Cardiology, Faculty of Medicine and Psychology , University of Rome "Sapienza", Sant'Andrea Hospital , Rome , Italy
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10
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Chen WH, Jin W, Lyu PY, Liu Y, Li R, Hu M, Xiao XJ. Carotid Atherosclerosis and Cognitive Impairment in Nonstroke Patients. Chin Med J (Engl) 2018; 130:2375-2379. [PMID: 28937045 PMCID: PMC5634090 DOI: 10.4103/0366-6999.215331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: As a vascular risk factor, carotid atherosclerosis is crucial to cognitive impairment. While carotid intima-media thickness, carotid artery plaque, and carotid stenosis can reflect carotid atherosclerosis in different stages, this review aimed to explore researches on the role of carotid intima-media thickness, carotid artery plaque, and carotid stenosis in the progress of cognitive impairment in nonstroke patients and tried to illustrate the possible mechanisms. Data Sources: We searched the PubMed database for recently published research articles up to July 2017, with the key words of “carotid atherosclerosis,” “carotid intima-media thickness,” “carotid plaque,” “carotid stenosis,” “nonstroke,” and “cognitive impairment.” Study Selection: Articles were obtained and reviewed to analyze the role of carotid atherosclerosis such as carotid intima-thickness, carotid plaque, and carotid stenosis in the progress of cognitive impairment in nonstroke patients and the possible mechanisms. Results: In recent years, most studies proved that by evaluating carotid atherosclerosis with ultrasonography, carotid atherosclerosis accounts for the development of cognitive decline in nonstroke patients. Carotid atherosclerosis not only impairs the subtle general cognitive function but also decreases the specific domains of cognitive function, such as memory, motor function, visual perception, attention, and executive function. But, it is still controversial. The possible mechanisms of cognitive impairment in nonstroke patients with carotid atherosclerosis can be classified as systemic global cerebrovascular function, small-vessel diseases, and the mixed lesions. Conclusions: Carotid atherosclerosis can be used to predict the risk of cognitive impairment. Furthermore, diagnosing and treating carotid atherosclerosis at early stage might help clinicians prevent and treat vascular cognitive impairment in nonstroke patients.
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Affiliation(s)
- Wei-Hong Chen
- Graduate School, Hebei Medical University; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Wei Jin
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Pei-Yuan Lyu
- Graduate School, Hebei Medical University; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Yang Liu
- Graduate School, Hebei Medical University; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Rui Li
- Graduate School, Hebei Medical University; Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Ming Hu
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
| | - Xiang-Jian Xiao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China
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11
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Eltoft A, Arntzen KA, Wilsgaard T, Mathiesen EB, Johnsen SH. Interleukin-6 is an independent predictor of progressive atherosclerosis in the carotid artery: The Tromsø Study. Atherosclerosis 2018; 271:1-8. [PMID: 29453087 DOI: 10.1016/j.atherosclerosis.2018.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 01/31/2018] [Accepted: 02/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Novel biomarkers are linked to cardiovascular disease (CVD). The aim of the present study was to investigate the association between 28 blood biomarkers and the formation and progression of carotid plaque. METHODS In a nested case control study with 703 participants from the population based Tromsø Study, a large biomarker panel was measured in blood obtained at baseline. Carotid ultrasound was assessed both at baseline and at 6 years of follow-up. Four groups were defined: Group 1: no plaque at baseline or at follow-up (reference group); Group 2: novel plaque at follow-up; Group 3: stable plaque at follow-up; Group 4: progression of plaque at follow-up. By multinomial logistic regression analyses, we assessed the risk of being in the different plaque groups with regard to traditional cardiovascular risk factors and levels of biomarkers at baseline. RESULTS Adjusted for traditional risk factors, interleukin-6 (IL-6) was an independent predictor of plaque progression (OR 1.44, 95% CI 1.12-1.85 per SD increase in IL-6 level). This result remained significant after inclusion of other novel biomarkers to the model, and when subjects with former CVD were excluded. Neopterin was protective of novel plaque formation (OR 0.73, 95% CI 0.57-0.93). Myeloperoxidase and Caspase-1 were independent predictors of plaque progression, but this effect disappeared when excluding subjects with former CVD. CONCLUSIONS IL-6 is an independent predictor of plaque progression, suggesting that it may be a marker of progressive atherosclerosis in the general population and that its central role in CVD may be related to promotion of plaque growth.
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Affiliation(s)
- Agnethe Eltoft
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway.
| | - Kjell Arne Arntzen
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Stein Harald Johnsen
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
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12
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Wang A, Liu J, Meng X, Li J, Wang H, Wang Y, Su Z, Zhang N, Dai L, Wang Y, Wang Y. Association between oxidized low-density lipoprotein and cognitive impairment in patients with ischemic stroke. Eur J Neurol 2017; 25:185-191. [DOI: 10.1111/ene.13497] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- A. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
- Department of Epidemiology and Health Statistics; School of Public Health; Capital Medical University; Beijing
| | - J. Liu
- Department of Neurology; Yangquan Coalmine Group General Hospital; Yangquan China
| | - X. Meng
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
| | - J. Li
- Department of Neurology; Yangquan Coalmine Group General Hospital; Yangquan China
| | - H. Wang
- Department of Neurology; Yangquan Coalmine Group General Hospital; Yangquan China
| | - Y. Wang
- Department of Epidemiology and Health Statistics; School of Public Health; Capital Medical University; Beijing
| | - Z. Su
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
| | - N. Zhang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
| | - L. Dai
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
| | - Y. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
| | - Y. Wang
- Department of Neurology; Beijing Tiantan Hospital; Capital Medical University; Beijing
- China National Clinical Research Center for Neurological Diseases; Beijing
- Center of Stroke; Beijing Institute for Brain Disorders; Beijing
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Beijing
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13
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Gardener H, Caunca MR, Dong C, Cheung YK, Elkind MSV, Sacco RL, Rundek T, Wright CB. Ultrasound Markers of Carotid Atherosclerosis and Cognition: The Northern Manhattan Study. Stroke 2017; 48:1855-1861. [PMID: 28630235 PMCID: PMC5482565 DOI: 10.1161/strokeaha.117.016921] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/04/2017] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Ultrasound markers of carotid atherosclerosis may be related to cognitive status. We hypothesized that individuals with greater carotid intima-media thickness (cIMT) and carotid plaque burden would exhibit worse cognition. METHODS One thousand one hundred sixty-six stroke-free participants from the NOMAS (Northern Manhattan Study) underwent carotid ultrasound and neuropsychological examination. Among them, 826 underwent a second neuropsychological examination an average of 5 years later. cIMT and plaque were assessed by a standardized B-mode ultrasound imaging and reading protocol. We used multivariable linear regression to examine cIMT, carotid plaque presence, and carotid plaque area as correlates of domain-specific neuropsychological Z scores cross-sectionally and over time. We also investigated possible effect modification by APOE ε4 allele, age, and race/ethnicity. RESULTS Participants had a mean (SD) age of 70 (9) years and were 60% women, 66% Hispanic, 15% white, and 18% black. Those with greater cIMT exhibited worse episodic memory after adjustment for demographics and vascular risk factors (β=-0.60; P=0.04). APOE ε4 carriers with greater cIMT exhibited worse episodic memory (β=-1.31; P=0.04), semantic memory (β=-1.45; P=0.01), and processing speed (β=-1.21; P=0.03). Participants with greater cIMT at baseline did not exhibit significantly greater cognitive decline after adjustment. APOE ε4noncarriers with greater cIMT exhibited greater declines in executive function (β=-0.98; P=0.06). Carotid plaque burden was not significantly associated with cognition at baseline or over time. CONCLUSIONS Subclinical carotid atherosclerosis was associated with worse cognition among those at higher risk for Alzheimer disease. Interventions targeting early stages of atherosclerosis may modify cognitive aging.
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Affiliation(s)
- Hannah Gardener
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.).
| | - Michelle R Caunca
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Chuanhui Dong
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ying Kuen Cheung
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Mitchell S V Elkind
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Ralph L Sacco
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Tatjana Rundek
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
| | - Clinton B Wright
- From the Evelyn F. McKnight Brain Institute, Neuroscience Program (H.G., M.R.C., C.D., R.L.S., T.R.), Department of Neurology (H.G., M.R.C., C.D., R.L.S., T.R.), and Department of Public Health Sciences (M.R.C., R.L.S., T.R.), Miller School of Medicine, University of Miami, FL; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.), Department of Biostatistics, Mailman School of Public Health (Y.K.C.), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; and National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, MD (C.B.W.)
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14
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Wang A, Liu X, Chen G, Hao H, Wang Y, Wang Y. Association between Carotid Plaque and Cognitive Impairment in Chinese Stroke Population: The SOS-Stroke Study. Sci Rep 2017; 7:3066. [PMID: 28596524 PMCID: PMC5465192 DOI: 10.1038/s41598-017-02435-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/10/2017] [Indexed: 12/24/2022] Open
Abstract
We aimed to investigate the association between carotid plaques and cognitive impairment among patients with acute ischemic stroke, and to assess key clinical implications. In the Acute Ischemic Stroke Study, patients who received a cognitive testing and underwent complete carotid artery ultrasound scans were included. Cognitive function was measured by the mini-mental state examination. The cross-sectional relationships between cognitive impairment and carotid plaques were evaluated using multivariate logistic regression analysis. Of the 3116 patients included in this study, 826 (26.51%) patients were diagnosed with cognitive impairment. After adjusting for potential confounders, patients with ≥2 carotid plaques (odds ratio [OR] = 1.47; 95% confidence interval [CI]: 1.19–1.82), patients with ≥2 number of carotid arteries with plaque (OR = 1.48; 95% CI: 1.19–1.84) and patients with hypoechoic plaque (OR = 2.05; 95% CI: 1.24–3.38) are more likely to have cognitive impairment. In this acute ischemic stroke population, the number of carotid plaques, the number of carotid arteries with plaque and plaque stability are all associated with cognitive impairment.
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Affiliation(s)
- Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xiaoxue Liu
- Department of Cardiology, Tangshan People's Hospital, Tangshan, China
| | - Guojuan Chen
- Department of Neurology, Tangshan Gongren Hospital, North China University of Science and Technology, Tangshan, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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15
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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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Ryan CM, Klein BEK, Lee KE, Cruickshanks KJ, Klein R. Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes. J Diabetes Complications 2016; 30:1513-1518. [PMID: 27601058 PMCID: PMC5050129 DOI: 10.1016/j.jdiacomp.2016.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/09/2016] [Indexed: 01/21/2023]
Abstract
AIMS Mild cognitive dysfunction has been identified in children and adults with type 1 diabetes, but most studies have failed to find a relationship between severe hypoglycemia and cognition, despite reports of such associations in older adults with type 2 diabetes. Focusing on older adults with type 1 diabetes, we examined the associations between cognitive performance and recent episodes of severe hypoglycemia, retinal vessel diameters and the presence of micro- and macrovascular complications. METHODS Cognitive functioning was assessed in 244 participants enrolled in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. The mean (SD; range) age at assessment in 2012-14 was 55.2 (8.3; 37-82) years and the mean (SD) duration of diabetes was 41.1 (5.6) years. Three cognitive domains were assessed in this cross-sectional study: mental efficiency and executive function, nonverbal memory, and verbal memory. RESULTS Multivariate modeling demonstrated that although age and/or education are most strongly associated with performance on measures of mental efficiency, three diabetes-related variables were also associated with poorer test scores: an episode of severe hypoglycemia in the past year (β=-0.360 [95% CI, -0.672, -0.047]), retinal arteriolar and venular diameters (β=0.140 [95% CI, 0.062, 0.219]; β=-0.127 [95% CI -0.207, -0.047]), and carotid artery plaque (β=-0.372 [95% CI -0.741, -0.003]). In addition, recent severe hypoglycemia was associated with poorer nonverbal memory (β=-0.522 [95% CI, -0.849, -0.194]). CONCLUSIONS For middle-aged and older adults with long-duration type 1 diabetes, poorer cognition was associated with a recent episode of severe hypoglycemia as well as with the presence of micro- and/or macrovascular conditions. Given the increasing numbers of aging adults with type 1 diabetes, future longitudinal studies are needed to identify causality and to determine whether diabetes management techniques that reduce the onset or severity of vascular complications and hypoglycemia can also reduce the risk of cognitive dysfunction in this population.
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Affiliation(s)
- Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kristine E Lee
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States; Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
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17
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Njølstad I, Mathiesen EB, Schirmer H, Thelle DS. The Tromsø study 1974–2016: 40 years of cardiovascular research. SCAND CARDIOVASC J 2016; 50:276-281. [DOI: 10.1080/14017431.2016.1239837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B. Mathiesen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Dag Steinar Thelle
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Moon JH. Endocrine Risk Factors for Cognitive Impairment. Endocrinol Metab (Seoul) 2016; 31:185-92. [PMID: 27118278 PMCID: PMC4923401 DOI: 10.3803/enm.2016.31.2.185] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 12/28/2022] Open
Abstract
Cognitive impairment, including Alzheimer's disease and other kinds of dementia, is a major health problem in older adults worldwide. Although numerous investigators have attempted to develop effective treatment modalities or drugs, there is no reasonably efficacious strategy for preventing or recovering from cognitive impairment. Therefore, modifiable risk factors for cognitive impairment have received attention, and the growing literature of metabolic risk factors for cognitive impairment has expanded from epidemiology to molecular pathogenesis and therapeutic management. This review focuses on the epidemiological evidence for the association between cognitive impairment and several endocrine risk factors, including insulin resistance, dyslipidemia, thyroid dysfunction, vitamin D deficiency, and subclinical atherosclerosis. Researches suggesting possible mechanisms for this association are reviewed. The research investigating modifiable endocrine risk factors for cognitive impairment provides clues for understanding the pathogenesis of cognitive impairment and developing novel treatment modalities. However, so far, interventional studies investigating the beneficial effect of the "modification" of these "modifiable risk factors" on cognitive impairment have reported variable results. Therefore, well-designed, randomized prospective interventional studies are needed.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Rossetti HC, Weiner M, Hynan LS, Cullum CM, Khera A, Lacritz LH. Subclinical atherosclerosis and subsequent cognitive function. Atherosclerosis 2015; 241:36-41. [PMID: 25957568 DOI: 10.1016/j.atherosclerosis.2015.04.813] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the relationship between measures of subclinical atherosclerosis and subsequent cognitive function. METHOD Participants from the Dallas Heart Study (DHS), a population-based multiethnic study of cardiovascular disease pathogenesis, were re-examined 8 years later (DHS-2) with the Montreal Cognitive Assessment (MoCA); N = 1904, mean age = 42.9, range 8-65. Associations of baseline measures of subclinical atherosclerosis (coronary artery calcium, abdominal aortic plaque, and abdominal aortic wall thickness) with MoCA scores measured at follow-up were examined in the group as a whole and in relation to age and ApoE4 status. RESULTS A significant linear trend of successively lower MoCA scores with increasing numbers of atherosclerotic indicators was observed (F(3, 1150) = 5.918, p = .001). CAC was weakly correlated with MoCA scores (p = .047) and MoCA scores were significantly different between participants with and without CAC (M = 22.35 vs 23.69, p = 0.038). With the exception of a small association between abdominal AWT and MoCA in subjects over age 50, abdominal AWT and abdominal aortic plaque did not correlate with MoCA total score (p ≥ .052). Cognitive scores and atherosclerosis measures were not impacted by ApoE4 status (p ≥ .455). CONCLUSION In this ethnically diverse population-based sample, subclinical atherosclerosis was minimally associated with later cognitive function in middle-aged adults.
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Affiliation(s)
| | - Myron Weiner
- Department of Psychiatry, UT Southwestern Medical Center, USA
| | - Linda S Hynan
- Department of Psychiatry, UT Southwestern Medical Center, USA; Department of Clinical Science, UT Southwestern Medical Center, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, USA; Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, USA
| | - Amit Khera
- Internal Medicine, UT Southwestern Medical Center, USA
| | - Laura H Lacritz
- Department of Psychiatry, UT Southwestern Medical Center, USA; Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, USA
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