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Liu F, Yao Y, Zhu B, Yu Y, Ren R, Hu Y. The novel imaging methods in diagnosis and assessment of cerebrovascular diseases: an overview. Front Med (Lausanne) 2024; 11:1269742. [PMID: 38660416 PMCID: PMC11039813 DOI: 10.3389/fmed.2024.1269742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Cerebrovascular diseases, including ischemic strokes, hemorrhagic strokes, and vascular malformations, are major causes of morbidity and mortality worldwide. The advancements in neuroimaging techniques have revolutionized the field of cerebrovascular disease diagnosis and assessment. This comprehensive review aims to provide a detailed analysis of the novel imaging methods used in the diagnosis and assessment of cerebrovascular diseases. We discuss the applications of various imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and angiography, highlighting their strengths and limitations. Furthermore, we delve into the emerging imaging techniques, including perfusion imaging, diffusion tensor imaging (DTI), and molecular imaging, exploring their potential contributions to the field. Understanding these novel imaging methods is necessary for accurate diagnosis, effective treatment planning, and monitoring the progression of cerebrovascular diseases.
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Affiliation(s)
- Fei Liu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Yao
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bingcheng Zhu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Yu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Reng Ren
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yinghong Hu
- Neuroscience Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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Yang A, Zhuang H, Du L, Liu B, Lv K, Luan J, Hu P, Chen F, Wu K, Shu N, Shmuel A, Ma G, Wang Y. Evaluation of whole-brain oxygen metabolism in Alzheimer's disease using QSM and quantitative BOLD. Neuroimage 2023; 282:120381. [PMID: 37734476 DOI: 10.1016/j.neuroimage.2023.120381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the whole-brain pattern of oxygen extraction fraction (OEF), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) perturbation in Alzheimer's disease (AD) and investigate the relationship between regional cerebral oxygen metabolism and global cognition. METHODS Twenty-six AD patients and 25 age-matched healthy controls (HC) were prospectively recruited in this study. Mini-Mental State Examination (MMSE) was used to evaluate cognitive status. We applied the QQ-CCTV algorithm which combines quantitative susceptibility mapping and quantitative blood oxygen level-dependent models (QQ) for OEF calculation. CBF map was computed from arterial spin labeling and CMRO2 was generated based on Fick's principle. Whole-brain and regional OEF, CBF, and CMRO2 analyses were performed. The associations between these measures in substructures of deep brain gray matter and MMSE scores were assessed. RESULTS Whole brain voxel-wise analysis showed that CBF and CMRO2 values significantly decreased in AD predominantly in the bilateral angular gyrus, precuneus gyrus and parieto-temporal regions. Regional analysis showed that CBF value decreased in the bilateral caudal hippocampus and left rostral hippocampus and CMRO2 value decreased in left caudal and rostral hippocampus in AD patients. Considering all subjects in the AD and HC groups combined, the mean CBF and CMRO2 values in the bilateral hippocampus positively correlated with the MMSE score. CONCLUSION CMRO2 mapping with the QQ-CCTV method - which is readily available in MR systems for clinical practice - can be a potential biomarker for AD. In addition, CMRO2 in the hippocampus may be a useful tool for monitoring cognitive impairment.
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Affiliation(s)
- Aocai Yang
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Hangwei Zhuang
- Department of Biomedical Engineering, Cornell University, Ithaca, New York 14853, USA; Department of Radiology, Weill Cornell Medical College, New York, New York 10065, USA
| | - Lei Du
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, PR China
| | - Bing Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Kuan Lv
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, PR China
| | - Jixin Luan
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Pianpian Hu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, PR China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, Hainan, PR China
| | - Kai Wu
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangdong 510006, Guangzhou, PR China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, PR China
| | - Amir Shmuel
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada; Departments of Neurology and Neurosurgery, Physiology, and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Guolin Ma
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, PR China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China.
| | - Yi Wang
- Department of Biomedical Engineering, Cornell University, Ithaca, New York 14853, USA; Department of Radiology, Weill Cornell Medical College, New York, New York 10065, USA
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Henriksen OM, Gjedde A, Vang K, Law I, Aanerud J, Rostrup E. Regional and interindividual relationships between cerebral perfusion and oxygen metabolism. J Appl Physiol (1985) 2021; 130:1836-1847. [PMID: 33830816 DOI: 10.1152/japplphysiol.00939.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Quantitative measurements of resting cerebral blood flow (CBF) and metabolic rate of oxygen (CMRO2) show large between-subject and regional variability, but the relationships between CBF and CMRO2 measurements regionally and globally are not fully established. Here, we investigated the between-subject and regional associations between CBF and CMRO2 measures with independent and quantitative PET techniques. We included resting CBF and CMRO2 measurements from 50 healthy volunteers (aged 22-81 yr), and calculated the regional and global values of oxygen delivery (Do2) and oxygen extraction fraction (OEF). Linear mixed-model analysis showed that CBF and CMRO2 measurements were closely associated regionally, but no significant between-subject association could be demonstrated, even when adjusting for arterial Pco2 and hemoglobin concentration. The analysis also showed regional differences of OEF, reflecting variable relationship between Do2 and CMRO2, resulting in lower estimates of OEF in thalami, brainstem, and mesial temporal cortices and higher estimates of OEF in occipital cortex. In the present study, we demonstrated no between-subject association of quantitative measurements of CBF and CMRO2 in healthy subjects. Thus, quantitative measurements of CBF did not reflect the underlying between-subject variability of oxygen metabolism measures, mainly because of large interindividual OEF variability not accounted for by Pco2 and hemoglobin concentration.NEW & NOTEWORTHY Using quantitative PET-measurements in healthy human subjects, we confirmed a regional association of CBF and CMRO2, but did not find an association of these values across subjects. This suggests that subjects have an individual coupling between perfusion and metabolism and shows that absolute perfusion measurements does not serve as a surrogate measure of individual measures of oxygen metabolism. The analysis further showed smaller, but significant regional differences of oxygen extraction fraction at rest.
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Affiliation(s)
- Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Albert Gjedde
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,Translational Neuropsychiatry Unit, Aarhus University and University Hospital, Aarhus, Denmark.,Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Kim Vang
- Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | - Joel Aanerud
- Department of Nuclear Medicine and PET Centre, Aarhus University and University Hospital, Aarhus, Denmark
| | - Egill Rostrup
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark.,Mental Health Center Glostrup, University of Copenhagen, Copenhagen, Denmark
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4
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McFadden JJ, Matthews JC, Scott LA, Parker GJM, Lohézic M, Parkes LM. Optimization of quantitative susceptibility mapping for regional estimation of oxygen extraction fraction in the brain. Magn Reson Med 2021; 86:1314-1329. [PMID: 33780045 DOI: 10.1002/mrm.28789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to determine the degree to which oxygen extraction fraction (OEF) estimated using quantitative susceptibility mapping (QSM) depends on two critical acquisition parameters that have a significant impact on acquisition time: voxel size and final echo time. METHODS Four healthy volunteers were imaged using a range of isotropic voxel sizes and final echo times. The 0.7 mm data were downsampled at different stages of QSM processing by a factor of 2 (to 1.4 mm), 3 (2.1 mm), or 4 (2.8 mm) to determine the impact of voxel size on each analysis step. OEF was estimated from 11 veins of varying diameter. Inter- and intra-session repeatability were estimated for the optimal protocol by repeat scanning in 10 participants. RESULTS Final echo time was found to have no significant effect on OEF. The effect of voxel size was significant, with larger voxel sizes underestimating OEF, depending on the proximity of the vein to the superficial surface of the brain and on vein diameter. The last analysis step of estimating vein OEF values from susceptibility images had the largest dependency on voxel size. Inter-session coefficients of variation on OEF estimates of between 5.2% and 8.7% are reported, depending on the vein. CONCLUSION QSM acquisition times can be minimized by reducing the final echo time but an isotropic voxel size no larger than 1 mm is needed to accurately estimate OEF in most medium/large veins in the brain. Such acquisitions can be achieved in under 4 min.
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Affiliation(s)
- John J McFadden
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Julian C Matthews
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Lauren A Scott
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Geoff J M Parker
- Bioxydyn Limited, Manchester, United Kingdom.,Centre for Medical Image Computing, Department of Computer Science and Department of Neuroinflammation, University College London, London, United Kingdom
| | - Maélène Lohézic
- Applications & Workflow, GE Healthcare, Manchester, United Kingdom
| | - Laura M Parkes
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
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5
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Mitochondrial Dysfunction in Alzheimer's Disease: A Biomarker of the Future? Biomedicines 2021; 9:biomedicines9010063. [PMID: 33440662 PMCID: PMC7827030 DOI: 10.3390/biomedicines9010063] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia worldwide and is characterised pathologically by the accumulation of amyloid beta and tau protein aggregates. Currently, there are no approved disease modifying therapies for clearance of either of these proteins from the brain of people with AD. As well as abnormalities in protein aggregation, other pathological changes are seen in this condition. The function of mitochondria in both the nervous system and rest of the body is altered early in this disease, and both amyloid and tau have detrimental effects on mitochondrial function. In this review article, we describe how the function and structure of mitochondria change in AD. This review summarises current imaging techniques that use surrogate markers of mitochondrial function in both research and clinical practice, but also how mitochondrial functions such as ATP production, calcium homeostasis, mitophagy and reactive oxygen species production are affected in AD mitochondria. The evidence reviewed suggests that the measurement of mitochondrial function may be developed into a future biomarker for early AD. Further work with larger cohorts of patients is needed before mitochondrial functional biomarkers are ready for clinical use.
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Hirose D, Shimizu S, Hirao K, Ogawa Y, Sato T, Kaneko Y, Takenoshita N, Namioka N, Fukasawa R, Umahara T, Sakurai H, Watanabe R, Hanyu H. Neuroimaging Characteristics of Frailty Status in Patients with Alzheimer's Disease. J Alzheimers Dis 2020; 67:1201-1208. [PMID: 30689570 DOI: 10.3233/jad-180701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVE Although frailty is closely linked to dementia, particularly Alzheimer's disease (AD), underlying pathophysiology of frailty associated with AD remains uncertain. This study aimed to investigate differences in structural and functional brain imaging abnormalities between AD with and without frailty. METHODS A total of 191 outpatients with probable AD (men: 91; women: 100; age: 80.7±6.3 years) who underwent both magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) were enrolled in this study. Frailty was determined in accordance with the Obu study Health Promotion for the Elderly. We compared numbers of small infarctions in the subcortical gray and white matter and severity of white matter abnormalities (periventricular hyperintensity [PVH] and deep white matter hyperintensity [DWMH]) on MRI, and regional cerebral blood flow (rCBF) changes on SPECT between AD with and without frailty. RESULTS The prevalence of frailty was 43.4% in patients with AD. PVH and DWMH scores were significantly higher in AD with frailty compared to those without frailty. AD with frailty had a trend of decreased rCBF in the bilateral anterior cingulate gyrus, whereas those without frailty tend to have decreased rCBF in the left dominant parietal lobe and precuneus. CONCLUSION Our MRI and SPECT imaging studies suggest different underlying pathophysiology in the brain between AD with frailty and without frailty.
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Affiliation(s)
- Daisuke Hirose
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Soichiro Shimizu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kentaro Hirao
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Ogawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tomohiko Sato
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Yoshitsugu Kaneko
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Naoto Takenoshita
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Nayuta Namioka
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Raita Fukasawa
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takahiko Umahara
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hirofumi Sakurai
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Ryo Watanabe
- Kanagawa University of Human Services, Yokosuka City, Kanagawa Prefecture, Japan
| | - Haruo Hanyu
- Department of Geriatric Medicine, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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Eguchi A, Kimura N, Aso Y, Yabuuchi K, Ishibashi M, Hori D, Sasaki Y, Nakamichi A, Uesugi S, Jikumaru M, Sumi K, Shimomura T, Matsubara E. Relationship Between the Japanese Version of the Montreal Cognitive Assessment and PET Imaging in Subjects with Mild Cognitive Impairment. Curr Alzheimer Res 2019; 16:852-860. [PMID: 31385770 DOI: 10.2174/1567205016666190805155230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/28/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) test has high sensitivity and specificity for detecting mild cognitive impairment or early dementia. How the MoCA score relates to findings of positron emission tomography imaging, however, remains unclear. OBJECTIVE This prospective study examined the relationship between the Japanese version of the MoCA (MoCA-J) test and brain amyloid deposition or cerebral glucose metabolism among subjects with mild cognitive impairment. METHODS A total of 125 subjects with mild cognitive impairment underwent the MoCA-J test, and amyloid- and 18F-fluorodeoxyglucose- positron emission tomography. Linear correlation analysis and multiple linear regression analysis were conducted to investigate the relationship between the MoCA-J score and demographic characteristics, amyloid deposition, and cerebral glucose metabolism. Moreover, Statistical Parametric Mapping 8 was used for a voxel-wise regression analysis of the MoCA-J score and cerebral glucose metabolism. RESULTS The MoCA-J score significantly correlated with age, years of education, and the Mini-Mental State Examination score. After adjusting for age, sex, and education, the MoCA-J score significantly correlated negatively with amyloid retention (β= -0.174, p= 0.031) and positively with cerebral glucose metabolism (β= 0.183, p= 0.044). Statistical Parametric Mapping showed that Japanese version of MoCA score correlated with glucose metabolism in the bilateral frontal and parietal lobes, and the left precuneus. CONCLUSION The total MoCA-J score correlated with amyloid deposition and frontal and parietal glucose metabolism in subjects with mild cognitive impairment. Our findings support the usefulness of the MoCA-J test for screening subjects at high risk for Alzheimer's disease.
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Affiliation(s)
- Atsuko Eguchi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Noriyuki Kimura
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Yasuhiro Aso
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Kenichi Yabuuchi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Masato Ishibashi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Daiji Hori
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Yuuki Sasaki
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Atsuhito Nakamichi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Souhei Uesugi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Mika Jikumaru
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Kaori Sumi
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
| | - Tsuyoshi Shimomura
- Department of Neurosurgery, Oita University, Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Etsuro Matsubara
- Department of Neurology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan
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8
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BOLD signal physiology: Models and applications. Neuroimage 2019; 187:116-127. [DOI: 10.1016/j.neuroimage.2018.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 03/08/2018] [Indexed: 12/14/2022] Open
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9
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Clinical utility of FDG-PET for the differential diagnosis among the main forms of dementia. Eur J Nucl Med Mol Imaging 2018; 45:1509-1525. [PMID: 29736698 DOI: 10.1007/s00259-018-4035-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
AIM To assess the clinical utility of FDG-PET as a diagnostic aid for differentiating Alzheimer's disease (AD; both typical and atypical forms), dementia with Lewy bodies (DLB), frontotemporal lobar degeneration (FTLD), vascular dementia (VaD) and non-degenerative pseudodementia. METHODS A comprehensive literature search was conducted using the PICO model to extract evidence from relevant studies. An expert panel then voted on six different diagnostic scenarios using the Delphi method. RESULTS The level of empirical study evidence for the use of FDG-PET was considered good for the discrimination of DLB and AD; fair for discriminating FTLD from AD; poor for atypical AD; and lacking for discriminating DLB from FTLD, AD from VaD, and for pseudodementia. Delphi voting led to consensus in all scenarios within two iterations. Panellists supported the use of FDG-PET for all PICOs-including those where study evidence was poor or lacking-based on its negative predictive value and on the assistance it provides when typical patterns of hypometabolism for a given diagnosis are observed. CONCLUSION Although there is an overall lack of evidence on which to base strong recommendations, it was generally concluded that FDG-PET has a diagnostic role in all scenarios. Prospective studies targeting diagnostically uncertain patients for assessing the added value of FDG-PET would be highly desirable.
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10
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Lajoie I, Nugent S, Debacker C, Dyson K, Tancredi FB, Badhwar A, Belleville S, Deschaintre Y, Bellec P, Doyon J, Bocti C, Gauthier S, Arnold D, Kergoat MJ, Chertkow H, Monchi O, Hoge RD. Application of calibrated fMRI in Alzheimer's disease. NEUROIMAGE-CLINICAL 2017; 15:348-358. [PMID: 28560160 PMCID: PMC5443910 DOI: 10.1016/j.nicl.2017.05.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/26/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
Calibrated fMRI based on arterial spin-labeling (ASL) and blood oxygen-dependent contrast (BOLD), combined with periods of hypercapnia and hyperoxia, can provide information on cerebrovascular reactivity (CVR), resting blood flow (CBF), oxygen extraction fraction (OEF), and resting oxidative metabolism (CMRO2). Vascular and metabolic integrity are believed to be affected in Alzheimer's disease (AD), thus, the use of calibrated fMRI in AD may help understand the disease and monitor therapeutic responses in future clinical trials. In the present work, we applied a calibrated fMRI approach referred to as Quantitative O2 (QUO2) in a cohort of probable AD dementia and age-matched control participants. The resulting CBF, OEF and CMRO2 values fell within the range from previous studies using positron emission tomography (PET) with 15O labeling. Moreover, the typical parietotemporal pattern of hypoperfusion and hypometabolism in AD was observed, especially in the precuneus, a particularly vulnerable region. We detected no deficit in frontal CBF, nor in whole grey matter CVR, which supports the hypothesis that the effects observed were associated specifically with AD rather than generalized vascular disease. Some key pitfalls affecting both ASL and BOLD methods were encountered, such as prolonged arterial transit times (particularly in the occipital lobe), the presence of susceptibility artifacts obscuring medial temporal regions, and the challenges associated with the hypercapnic manipulation in AD patients and elderly participants. The present results are encouraging and demonstrate the promise of calibrated fMRI measurements as potential biomarkers in AD. Although CMRO2 can be imaged with 15O PET, the QUO2 method uses more widely available imaging infrastructure, avoids exposure to ionizing radiation, and integrates with other MRI-based measures of brain structure and function.
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Affiliation(s)
- Isabelle Lajoie
- Département de Pharmacologie et physiologie, Université de Montréal, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Montreal Neurological Institute, Montreal, QC, Canada.
| | - Scott Nugent
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Montreal Neurological Institute, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Clément Debacker
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Montreal Neurological Institute, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kenneth Dyson
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Montreal Neurological Institute, Montreal, QC, Canada; Department of Physiology, McGill University, Montreal, QC, Canada
| | - Felipe B Tancredi
- Departamento de Radiologia, Centro de Pesquisa em Imagem, Hospital Israelita Albert Einstein, São Palo, SP, Brazil
| | - AmanPreet Badhwar
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Department of Computer Science and Operations Research, Université de Montréal, Montreal, QC, Canada
| | - Sylvie Belleville
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Yan Deschaintre
- Département de Neurosciences, Université de Montréal, Montreal, QC, Canada; Service de neurologie, Département de Médecine, CHUM Notre-Dame, Montréal, QC, Canada
| | - Pierre Bellec
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Department of Computer Science and Operations Research, Université de Montréal, Montreal, QC, Canada
| | - Julien Doyon
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Département de Psychologie, Université de Montréal, Montreal, QC, Canada
| | - Christian Bocti
- Division de Neurologie, Faculté de Médecine et des Sciences de la Santé & Research Centre on Aging, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Serge Gauthier
- McGill Center for Studies in Aging, Douglas Mental Health Research Institute, Montreal, QC, Canada
| | - Douglas Arnold
- Montreal Neurological Institute, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Marie-Jeanne Kergoat
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Département de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Howard Chertkow
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Oury Monchi
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; McGill Center for Studies in Aging, Douglas Mental Health Research Institute, Montreal, QC, Canada; Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Richard D Hoge
- Département de Pharmacologie et physiologie, Université de Montréal, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada; Montreal Neurological Institute, Montreal, QC, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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11
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Increased cortical capillary transit time heterogeneity in Alzheimer's disease: a DSC-MRI perfusion study. Neurobiol Aging 2017; 50:107-118. [DOI: 10.1016/j.neurobiolaging.2016.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/17/2016] [Accepted: 11/11/2016] [Indexed: 01/18/2023]
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12
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Nagata K, Yamazaki T, Takano D, Maeda T, Fujimaki Y, Nakase T, Sato Y. Cerebral circulation in aging. Ageing Res Rev 2016; 30:49-60. [PMID: 27484894 DOI: 10.1016/j.arr.2016.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/20/2022]
Abstract
Cerebral circulation is known to be protected by the regulatory function against the hypoperfusion that will affect the cognitive function as a result of brain ischemia and energy failure. The regulatory function includes cerebrovascular autoregulation, chemical control, metabolic control, and neurogenic control, and those compensatory mechanisms can be influenced by hypertension, atherosclerosis, cardiac diseases, cerebrovascular diseases and aging. On the other hand, large and/or small infarction, intracranial hemorrhage, subarachnoid hemorrhage, atherosclerosis, amylod angiopathy are also more directly associated with cognitive decline not only in those with vascular cognitive impairment or vascular dementia but also those with Alzheimer's disease.
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Affiliation(s)
- Ken Nagata
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan.
| | - Takashi Yamazaki
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan
| | - Daiki Takano
- Department of Neurology, Clinical Research Institute, Yokohama General Hospital, Yokohama, Japan
| | - Tetsuya Maeda
- Department of Neurology and Gerontology, Iwate Medical University, Morioka, Japan
| | - Yumi Fujimaki
- Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Taizen Nakase
- Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan
| | - Yuichi Sato
- Department of Neurology, Noshiro Yamamoto Medical Association Hospital, Noshiro, Japan
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13
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Huang F, Hirano D, Shi Y, Taniguchi T. Comparison of cortical activation in an upper limb added-purpose task versus a single-purpose task: a near-infrared spectroscopy study. J Phys Ther Sci 2016; 27:3891-4. [PMID: 26834375 PMCID: PMC4713814 DOI: 10.1589/jpts.27.3891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare prefrontal activations during an
added-purpose task with those during a single-purpose task using functional near-infrared
spectroscopy. [Subjects] Six healthy right-handed adults were included in this study.
[Methods] The participants were instructed to complete both added-purpose and
single-purpose activities separately with each hand. The near-infrared spectroscopy probes
were placed on the scalp overlying the prefrontal cortex, according to the International
10–20 system (Fz). Changes in the oxygenated hemoglobin and deoxygenated hemoglobin
concentrations in the prefrontal cortex were measured during performance of the
activities. We then compared the number of activation channels with significant increase
in oxygenated hemoglobin, during added-purpose activity to single-purpose activity using
both hands separately. [Results] A greater number of widespread activations were observed
in the prefrontal cortex during the added-purpose task than during the single-purpose
task. These results were noted with both right and left hands. [Conclusion] According to
our findings, added-purpose activity can bring about more activation in the prefrontal
cortex, which may provide occupational therapists with effective guides in therapeutic
practice.
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Affiliation(s)
- Fubiao Huang
- Department of Occupational Therapy, China Rehabilitation Research Center, China; Faculty of Rehabilitation, Capital Medical University, China; Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Japan; Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Japan
| | - Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Japan; Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Japan
| | - Yun Shi
- Department of Occupational Therapy, New York University, USA
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Japan; Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Japan
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14
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Zhang H, Sachdev PS, Wen W, Crawford JD, Brodaty H, Baune BT, Kochan NA, Slavin MJ, Reppermund S, Kang K, Trollor JN. The relationship between inflammatory markers and voxel-based gray matter volumes in nondemented older adults. Neurobiol Aging 2015; 37:138-146. [PMID: 26559883 DOI: 10.1016/j.neurobiolaging.2015.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/24/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022]
Abstract
Ageing is characterized by chronically elevated inflammatory markers (IMs). Peripheral IM levels have been found in negative correlations with brain structural measures including global and lobar volumes and the hippocampus. This study investigated the relationship between 10 peripheral IMs and voxel-based gray matter (GM) volumes in nondemented older adults (n = 463). Two proinflammatory cytokines (tumor necrosis factor-α [TNF-α] and interleukin-1β) and 2 vascular IMs (vascular cellular adhesion molecule-1 and plasminogen activator inhibitor-1) were negatively correlated with regional GM volumes. TNF-α and interleukin-1β were both significantly correlated with GM volumes in the left occipitotemporal area, left superior occipital gyrus, and left inferior parietal lobule; TNF-α was also significantly correlated with the bilateral medial prefrontal cortices and approached significance for the correlations with the bilateral hippocampi. Significant GM correlations with vascular cellular adhesion molecule-1 were located in the bilateral anterior cingulate cortices, and with plasminogen activator inhibitor-1 in the cerebellum and right hippocampus. The neuroanatomical correlation patterns of 2 proinflammatory cytokines and 2 vascular IMs might be reflective of the effects of neurodegenerative and vascular pathological processes in the ageing brain.
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Affiliation(s)
- Haobo Zhang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, New South Wales, Australia; Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Bernard T Baune
- Department of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Melissa J Slavin
- Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Simone Reppermund
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristan Kang
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia.
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15
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Gauthier CJ, Lefort M, Mekary S, Desjardins-Crépeau L, Skimminge A, Iversen P, Madjar C, Desjardins M, Lesage F, Garde E, Frouin F, Bherer L, Hoge RD. Hearts and minds: linking vascular rigidity and aerobic fitness with cognitive aging. Neurobiol Aging 2014; 36:304-14. [PMID: 25308963 DOI: 10.1016/j.neurobiolaging.2014.08.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/18/2014] [Accepted: 08/15/2014] [Indexed: 12/20/2022]
Abstract
Human aging is accompanied by both vascular and cognitive changes. Although arteries throughout the body are known to become stiffer with age, this vessel hardening is believed to start at the level of the aorta and progress to other organs, including the brain. Progression of this vascular impairment may contribute to cognitive changes that arise with a similar time course during aging. Conversely, it has been proposed that regular exercise plays a protective role, attenuating the impact of age on vascular and metabolic physiology. Here, the impact of vascular degradation in the absence of disease was investigated within 2 groups of healthy younger and older adults. Age-related changes in executive function, elasticity of the aortic arch, cardiorespiratory fitness, and cerebrovascular reactivity were quantified, as well as the association between these parameters within the older group. In the cohort studied, older adults exhibited a decline in executive functions, measured as a slower performance in a modified Stroop task (1247.90 ± 204.50 vs. 898.20 ± 211.10 ms on the inhibition and/or switching component, respectively) than younger adults. Older participants also showed higher aortic pulse wave velocity (8.98 ± 3.56 vs. 3.95 ± 0.82 m/s, respectively) and lower VO₂ max (29.04 ± 6.92 vs. 42.32 ± 7.31 mL O2/kg/min, respectively) than younger adults. Within the older group, faster performance of the modified Stroop task was associated with preserved aortic elasticity (lower aortic pulse wave velocity; p = 0.046) and higher cardiorespiratory fitness (VO₂ max; p = 0.036). Furthermore, VO₂ max was found to be negatively associated with blood oxygenation level dependent cerebrovascular reactivity to CO₂ in frontal regions involved in the task (p = 0.038) but positively associated with cerebrovascular reactivity in periventricular watershed regions and within the postcentral gyrus. Overall, the results of this study support the hypothesis that cognitive status in aging is linked to vascular health, and that preservation of vessel elasticity may be one of the key mechanisms by which physical exercise helps to alleviate cognitive aging.
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Affiliation(s)
- Claudine Joëlle Gauthier
- Department of Physiology/Biomedical Engineering, Université de Montréal, Montreal, Canada; CRIUGM, Montreal, Canada; Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
| | - Muriel Lefort
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France
| | - Saïd Mekary
- CRIUGM, Montreal, Canada; Department of Kinesiology, Université de Montréal, Montreal, Canada
| | | | - Arnold Skimminge
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Pernille Iversen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Cécile Madjar
- CRIUGM, Montreal, Canada; Douglas Hospital/MNI, McGill University, Institut de Génie Biomédical, Montreal, Canada
| | - Michèle Desjardins
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France; Départment de Génie Électrique, École Polytechnique de Montréal, Montréal, Canada; Montreal Heart Institute, Montreal, Canada
| | - Frédéric Lesage
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France; Départment de Génie Électrique, École Polytechnique de Montréal, Montréal, Canada
| | - Ellen Garde
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Frédérique Frouin
- Sorbonne Universités UPMC Paris 06, CNRS, INSERM, LIB, Paris, France
| | - Louis Bherer
- CRIUGM, Montreal, Canada; Psychology Department, UQAM, Montreal, Canada; PERFORM, Concordia University, Montreal, Canada
| | - Richard D Hoge
- Department of Physiology/Biomedical Engineering, Université de Montréal, Montreal, Canada; CRIUGM, Montreal, Canada
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16
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Klohs J, Rudin M, Shimshek DR, Beckmann N. Imaging of cerebrovascular pathology in animal models of Alzheimer's disease. Front Aging Neurosci 2014; 6:32. [PMID: 24659966 PMCID: PMC3952109 DOI: 10.3389/fnagi.2014.00032] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/19/2014] [Indexed: 01/04/2023] Open
Abstract
In Alzheimer's disease (AD), vascular pathology may interact with neurodegeneration and thus aggravate cognitive decline. As the relationship between these two processes is poorly understood, research has been increasingly focused on understanding the link between cerebrovascular alterations and AD. This has at last been spurred by the engineering of transgenic animals, which display pathological features of AD and develop cerebral amyloid angiopathy to various degrees. Transgenic models are versatile for investigating the role of amyloid deposition and vascular dysfunction, and for evaluating novel therapeutic concepts. In addition, research has benefited from the development of novel imaging techniques, which are capable of characterizing vascular pathology in vivo. They provide vascular structural read-outs and have the ability to assess the functional consequences of vascular dysfunction as well as to visualize and monitor the molecular processes underlying these pathological alterations. This article focusses on recent in vivo small animal imaging studies addressing vascular aspects related to AD. With the technical advances of imaging modalities such as magnetic resonance, nuclear and microscopic imaging, molecular, functional and structural information related to vascular pathology can now be visualized in vivo in small rodents. Imaging vascular and parenchymal amyloid-β (Aβ) deposition as well as Aβ transport pathways have been shown to be useful to characterize their dynamics and to elucidate their role in the development of cerebral amyloid angiopathy and AD. Structural and functional imaging read-outs have been employed to describe the deleterious affects of Aβ on vessel morphology, hemodynamics and vascular integrity. More recent imaging studies have also addressed how inflammatory processes partake in the pathogenesis of the disease. Moreover, imaging can be pivotal in the search for novel therapies targeting the vasculature.
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Affiliation(s)
- Jan Klohs
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland ; Neuroscience Center Zurich, University of Zurich and ETH Zurich Zurich, Switzerland
| | - Markus Rudin
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich Zurich, Switzerland ; Neuroscience Center Zurich, University of Zurich and ETH Zurich Zurich, Switzerland ; Institute of Pharmacology and Toxicology, University of Zurich Zurich, Switzerland
| | - Derya R Shimshek
- Autoimmunity, Transplantation and Inflammation/Neuroinflammation Department, Novartis Institutes for BioMedical Research Basel, Switzerland
| | - Nicolau Beckmann
- Analytical Sciences and Imaging, Novartis Institutes for BioMedical Research Basel, Switzerland
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17
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Doepp F, Valdueza JM, Schreiber SJ. Transcranial and extracranial ultrasound assessment of cerebral hemodynamics in vascular and Alzheimer's dementia. Neurol Res 2013; 28:645-9. [PMID: 16945217 DOI: 10.1179/016164106x130380] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Increasing life expectancy of the population leads to a higher incidence of dementia. Exact differentiation between the most common types, vascular dementia (VD) and Alzheimer's dementia (AD), is crucial to the development and application of new treatment strategies. Both conditions are thought to differ greatly by their extent of microvascular affection. Transcranial and extracranial ultrasound permits analysis of cerebral hemodynamics and should help to differentiate between VD and AD. We compare multimodal ultrasound data between VD, AD and controls, and give an overview of the literature on this topic. METHODS Twenty VD and 20 AD patients were studied and compared with 12 age-matched controls. Transcranial color-coded ultrasound was performed to assess blood flow velocity (V(mean)) and pulsatility indices (PI) of the middle cerebral artery (MCA). Extracranial duplex and Doppler ultrasound techniques were used to assess the blood volume flow (BVF) in the anterior circulation (both internal carotid arteries [ICA]) and posterior circulation (both vertebral arteries [VA]), the global cerebral blood flow (CBF = BVF(ICA) + BVF(VA)), the global cerebral circulation time (CCT = time delay of echo-contrast bolus arrival between ICA and internal jugular vein) and global cerebral blood volume (CBV = CCT x CBF). RESULTS MCA V(mean) in VD (36 +/- 8 cm/s) and AD (43 +/- 13 cm/s) were significantly lower than in controls (59 +/- 13 cm/s) but did not differ significantly between VD and AD groups. PI (1.1 +/- 0.2; 1 +/- 0.2; 0.9 +/- 0.2) only differed significantly between VD group and controls. CBF and CCT in VD (570 +/- 61 ml/min; 8.8 +/- 2.6 s) and AD (578 +/- 77 ml/min; 8.2 +/- 1.4 s) were similar but differed significantly from controls (733 +/- 54 ml/min; 6.4 +/- 0.8 s). BVF in the anterior and posterior circulation of VD group (412 +/- 62 and 158 +/- 38 ml/min) and AD group (428 +/- 62 and 150 +/- 41 ml/min) were significantly lower than in controls (537 +/- 48 and 199 +/- 26 ml/min) but did not differ significantly between the patient groups. DISCUSSION Transcranial and extracranial ultrasound does not help to distinguish between VD and AD. However, our results add insight into the pathophysiology of dementia, arguing in favor of a common 'vascular' pathway in both conditions.
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Affiliation(s)
- Florian Doepp
- Department of Neurology, University Hospital Charité, Berlin, Germany.
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18
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Miklossy J. Cerebral hypoperfusion induces cortical watershed microinfarcts which may further aggravate cognitive decline in Alzheimer's disease. Neurol Res 2013; 25:605-10. [PMID: 14503014 DOI: 10.1179/016164103101202048] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increasing number of data, including the existence of common risk factors, indicate an association between cerebrovascular disease and Alzheimer's disease (AD). AD is known to be often associated with cerebral hypoperfusion. Recent histopathological evidence showed a significant association between watershed cortical microinfarcts and AD indicating that cerebral hypoperfusion induces not only white matter damage, known as leuko-araiosis, but cortical border zone infarcts as well, further aggravating the degenerative process and worsening dementia. In late stages of Alzheimer's disease--in cases with neuropathologically confirmed definite AD--the occurrence of watershed cortical microinfarcts was ten times higher than in aged matched control cases. Congophilic angiopathy and perturbed hemodynamic factors were found to be important factors in the genesis of watershed microinfarcts. To consider the vulnerability of the cerebral blood flow and the perturbed cortical vascular network in AD is important. Neuroleptic and sedative treatments frequently employed in AD may further accentuate cerebral hypoperfusion by decreasing blood pressure. Therefore, to treat and prevent arterial hypotension and maintain cerebral perfusion at an appropriate level in AD is essential.
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Affiliation(s)
- Judith Miklossy
- University Institute of Pathology, Division of Neuropathology, CHUV, Lausanne, Switzerland.
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19
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Tissue oxygen saturation and pulsatility index as markers for amnestic mild cognitive impairment: NIRS and TCD study. Clin Neurophysiol 2013; 124:851-6. [DOI: 10.1016/j.clinph.2012.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 11/11/2012] [Accepted: 11/19/2012] [Indexed: 02/02/2023]
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20
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Cognitive and Behavioral Neurology. Neurology 2012. [DOI: 10.1007/978-0-387-88555-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLDS. Vascular dementia: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I. Dement Neuropsychol 2011; 5:251-263. [PMID: 29213752 PMCID: PMC5619038 DOI: 10.1590/s1980-57642011dn05040003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the
second most common of all dementias. The present paper aims to define guidelines
on the basic principles for treating patients with suspected VaD (and vascular
cognitive impairment - no dementia) using an evidence-based, systematized
approach. The knowledge used to define these guidelines was retrieved from
searches of several databases (Medline, Scielo, Lilacs) containing scientific
articles, systematic reviews, meta-analyses, largely published within the last
15 years or earlier when pertinent. Information retrieved and selected for
relevance was used to analyze diagnostic criteria and to propose a diagnostic
system encompassing diagnostic criteria, anamnesis, as well as supplementary and
clinical exams (neuroimaging and laboratory). Wherever possible, instruments
were selected that had versions previously adapted and validated for use in
Brazil that take into account both schooling and age. This task led to proposed
protocols for supplementary exams based on degree of priority, for application
in clinical practice and research settings.
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Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired) - UFRJ, Coordinator of the Cognitive Neurology and Behavior Sector, INDC, CDA/IPUB, UFRJ, Rio de Janeiro RJ, Brazil
| | - Carla Tocquer
- Neurologist, Masters and PhD in Neuropsychology, Claude Bernard University, France
| | - Charles André
- Associate Professor of Neurology, Faculty of Medicine, UFRJ. Medical Director of SINAPSE Rehabilitation and Neurophysiology, Rio de Janeiro RJ, Brazil
| | - Denise Madeira Moreira
- Adjunct Professor of Radiology, School of Medicine, UFRJ. Head of Radiology Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | - Ivan Hideyo Okamoto
- Department of Neurology Neurosurgery, UNIFESP, Institute of Memory, UNIFESP, São Paulo SP, Brazil
| | - José Luiz de Sá Cavalcanti
- Adjunct Professor of Neurology, INDC, UFRJ. Cognitive Neurology and Behavior Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
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22
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Alterations in nicotinic α4β2 receptor binding in vascular dementia using 123I-5IA-85380 SPECT: Comparison with regional cerebral blood flow. Neurobiol Aging 2011; 32:293-301. [DOI: 10.1016/j.neurobiolaging.2009.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/07/2008] [Accepted: 02/05/2009] [Indexed: 11/21/2022]
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23
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Chen JJ, Rosas HD, Salat DH. Age-associated reductions in cerebral blood flow are independent from regional atrophy. Neuroimage 2010; 55:468-78. [PMID: 21167947 DOI: 10.1016/j.neuroimage.2010.12.032] [Citation(s) in RCA: 258] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 12/07/2010] [Accepted: 12/09/2010] [Indexed: 01/19/2023] Open
Abstract
Prior studies have demonstrated decreasing cerebral blood flow (CBF) in normal aging, but the full spatial pattern and potential mechanism of changes in CBF remain to be elucidated. Specifically, existing data have not been entirely consistent regarding the spatial distribution of such changes, potentially a result of neglecting the effect of age-related tissue atrophy in CBF measurements. In this work, we use pulsed arterial-spin labelling to quantify regional CBF in 86 cognitively and physically healthy adults, aged 23 to 88 years. Surface-based analyses were utilized to map regional decline in CBF and cortical thickness with advancing age, and to examine the spatial associations and dissociations between these metrics. Our results demonstrate regionally selective age-related reductions in cortical perfusion, involving the superior-frontal, orbito-frontal, superior-parietal, middle-inferior temporal, insular, precuneus, supramarginal, lateral-occipital and cingulate regions, while subcortical CBF was relatively preserved in aging. Regional effects of age on CBF differed from that of grey-matter atrophy. In addition, the pattern of CBF associations with age displays an interesting similarity with the default-mode network. These findings demonstrate the dissociation between regional CBF and structural alterations specific to normal aging, and augment our understanding of mechanisms of pathology in older adults.
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Affiliation(s)
- J Jean Chen
- MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.
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24
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Aslan S, Lu H. On the sensitivity of ASL MRI in detecting regional differences in cerebral blood flow. Magn Reson Imaging 2010; 28:928-35. [PMID: 20423754 DOI: 10.1016/j.mri.2010.03.037] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 03/09/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022]
Abstract
Arterial-spin-labeling (ASL) magnetic resonance imaging (MRI) provides a noninvasive tool to measure cerebral blood flow (CBF) and is increasingly used as a surrogate for baseline neural activity. However, the power of ASL MRI in detecting CBF differences between patient and control subjects is hampered by inter-subject variations in global CBF, which are associated with non-neural factors and may contribute to the noise in the across-group comparison. Here, we investigated the sensitivity of this technique and proposed a normalization strategy to better detect such a difference. A "model" situation was employed in which two visual stimuli (i.e. cross fixation and flashing checkerboard) were presented to two groups of subjects to mimic "control" and "patient" groups (N=7 for each group), respectively. It was found that absolute CBF (aCBF) in the occipital lobe in the checkerboard group was 26.0% greater compared to the fixation group, but the level of significance was modest (P=.03). In contrast, when normalizing the CBF with whole-brain CBF or CBF in a reference region [termed relative CBF (rCBF)], the statistical significance was improved considerably (P<.003). For voxel-based analysis, the rCBF indices correctly detected CBF differences in the occipital lobe in the across-group comparison, while aCBF failed to detect any significant cluster using the same statistical threshold. We also performed Monte Carlo simulation to confirm the experimental findings and found that the power improvement was most pronounced when signal-to-noise-ratio is moderate and the underlying CBF difference was small. The simulation also showed that, with the proposed normalization, a detection power of 80% can be achieved using a sample size of about 20. In summary, rCBF is a more sensitive index to detect small differences in CBF, rather than the much-sought-after aCBF, since it reduces data noise caused by inter-subject variations in global CBF.
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Affiliation(s)
- Sina Aslan
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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Schuff N, Matsumoto S, Kmiecik J, Studholme C, Du A, Ezekiel F, Miller BL, Kramer JH, Jagust WJ, Chui HC, Weiner MW. Cerebral blood flow in ischemic vascular dementia and Alzheimer's disease, measured by arterial spin-labeling magnetic resonance imaging. Alzheimers Dement 2010; 5:454-62. [PMID: 19896584 DOI: 10.1016/j.jalz.2009.04.1233] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 03/28/2009] [Accepted: 04/20/2009] [Indexed: 01/29/2023]
Abstract
BACKGROUND Our objectives were to compare the effects of subcortical ischemic vascular dementia (SIVD) and Alzheimer's disease (AD) on cerebral blood flow (CBF), and then to analyze the relationship between CBF and subcortical vascular disease, measured as volume of white-matter lesions (WMLs). METHODS Eight mildly demented patients with SIVD (mean +/- SD; aged 77 +/- 8 years; Mini-Mental State Examination score 26 +/- 3 years) and 14 patients with AD were compared with 18 cognitively normal elderly subjects. All subjects had CBF measured using arterial spin-labeling magnetic resonance imaging, and brain volumes were assessed using structural magnetic resonance imaging. RESULTS AD and SIVD showed marked CBF reductions in the frontal (P = 0.001) and parietal (P = 0.001) cortices. In SIVD, increased subcortical WMLs were associated with reduced CBF in the frontal cortex (P = 0.04), in addition to cortical atrophy (frontal, P = 0.05; parietal, P = 0.03). CONCLUSIONS Subcortical vascular disease is associated with reduced CBF in the cortex, irrespective of brain atrophy.
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Affiliation(s)
- Norbert Schuff
- Department of Veterans Affairs Medical Center, University of California at San Francisco, USA.
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Uh J, Lewis-Amezcua K, Martin-Cook K, Cheng Y, Weiner M, Diaz-Arrastia R, Devous M, Shen D, Lu H. Cerebral blood volume in Alzheimer's disease and correlation with tissue structural integrity. Neurobiol Aging 2009; 31:2038-46. [PMID: 19200623 DOI: 10.1016/j.neurobiolaging.2008.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 11/25/2008] [Accepted: 12/22/2008] [Indexed: 11/15/2022]
Abstract
A vascular component is increasingly recognized as important in Alzheimer's disease (AD). We measured cerebral blood volume (CBV) in patients with probable AD or Mild Cognitive Impairment (MCI) and in elderly non-demented subjects using a recently developed Vascular-Space-Occupancy (VASO) MRI technique. While both gray and white matters were examined, significant CBV deficit regions were primarily located in white matter, specifically in frontal and parietal lobes, in which CBV was reduced by 20% in the AD/MCI group. The regions with CBV deficit also showed reduced tissue structural integrity as indicated by increased apparent diffusion coefficients, whereas in regions without CBV deficits no such correlation was found. Subjects with lower CBV tended to have more white matter lesions in FLAIR MRI images and showed slower psychomotor speed. These data suggest that the vascular contribution in AD is primarily localized to frontal/parietal white matter and is associated with brain tissue integrity.
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Affiliation(s)
- Jinsoo Uh
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
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Chapter 2 Subcortical Ischemic Cerebrovascular Dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 84:21-33. [DOI: 10.1016/s0074-7742(09)00402-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Möller T, Born C, Reiser M, Möller HJ, Hampel H, Teipel S. Alzheimer-Krankheit und vaskuläre Demenz. DER NERVENARZT 2008; 80:54-61. [DOI: 10.1007/s00115-008-2556-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Many long-term care residents are diagnosed with dementia, but dementia appears in many forms. Alzheimer's disease, the most common, is typified by a slow onset and relentless progression to complete incapacitation. Vascular dementia usually appears somewhat abruptly, is associated
with vascular comorbidities, and has an unpredictable progression pattern. Lewy body dementia shares features of both Alzheimer's and Parkinson's disease; its hallmarks include fluctuating cognitive performance, visual hallucinations, and extrapyramidal motor symptoms. Frontotemporal dementias
are associated less with memory disorders and more with behavioral and language aberrations. Mixed dementia covers those patients who do not have an apparent singular cause of dementia. Pseudodementia is a dementia resulting from underlying causes and is reversible, unlike the aforementioned
dementias.
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Nagata K, Saito H, Ueno T, Sato M, Nakase T, Maeda T, Satoh Y, Komatsu H, Suzuki M, Kondoh Y. Clinical diagnosis of vascular dementia. J Neurol Sci 2007; 257:44-8. [PMID: 17445833 DOI: 10.1016/j.jns.2007.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vascular dementia (VaD) is a heterogeneous clinical entity based on various vascular pathophysiological processes underlying the subtypes of cerebrovascular disease (CVD). Several diagnostic criteria are currently being used for the clinical diagnosis of VaD, but they are mostly more than 10 years old and need to be renovated including the use of functional brain imaging methods such as single photon emission computerized tomography (SPECT). There is a limitation in the diagnosis based on the strict dichotomy between AD and VaD, and the concept of "AD with CVD" or "mixed dementia" should be included in the clinical diagnosis of VaD.
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Affiliation(s)
- Ken Nagata
- Department of Neurology, Research Institute for Brain and Blood Vessels, 6-10 Sesnshu-Kubota-Machi Akita 010-0874, Japan.
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Oosterman JM, Scherder EJA. Distinguishing between Vascular Dementia and Alzheimer's Disease by Means of the WAIS: A Meta-analysis. J Clin Exp Neuropsychol 2007; 28:1158-75. [PMID: 16840242 DOI: 10.1080/13803390500263543] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was intended to, meta-analytically, review whether the subtests of the Wechsler Adult Intelligence Scale are useful in differentiating between vascular dementia and Alzheimer's disease. We expected the Alzheimer's disease group to outperform the vascular dementia group on those subtests that require executive functions, whereas inferior performance of the Alzheimer's disease patients was expected on memory tests. Two steps in the analysis were undertaken in an attempt to clarify this issue. The first step consisted of including all studies examining Wechsler Adult Intelligence Scale subtest performance in vascular dementia and Alzheimer's disease patients. Secondly, a subcortical vascular dementia subgroup was distinguished and performance of this subgroup was compared to that of the Alzheimer's disease group.Overall, the analyses showed that both the vascular dementia and, more strongly, the subcortical vascular dementia group revealed decreased executive functions on several subtests compared to the Alzheimer's disease group. The Alzheimer's disease group showed inferior performance on a single semantic memory test only compared to both the vascular dementia and the subcortical vascular dementia groups. These results indicate that several subtests of the Wechsler Adult Intelligence Scale can differentiate between these two clinical groups, and that most of these tests reveal more impaired performance in the vascular dementia group.
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Affiliation(s)
- Joukje M Oosterman
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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32
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Marc G, Etcharry-Bouyx F, Dubas F. Demenze vascolari. Neurologia 2007. [DOI: 10.1016/s1634-7072(07)70557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Alves TCDTF, Busatto GF. Regional cerebral blood flow reductions, heart failure and Alzheimer's disease. Neurol Res 2006; 28:579-87. [PMID: 16945208 DOI: 10.1179/016164106x130416] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To discuss whether there are similarities between the functional brain abnormalities detectable in association with the diagnoses of heart failure (HF) and Alzheimer's disease (AD), focusing particularly on neuroimaging findings in vivo. METHODS Using an electronic database (Medline), we reviewed imaging studies that have evaluated resting cerebral blood flow (CBF), resting glucose metabolism or amyloid deposition in groups of subjects suffering AD or HF compared with healthy controls. RESULTS Single photon emission computed tomography (SPECT) investigations have reported global CBF reductions in HF groups compared with controls. In one recent SPECT study using modern voxel-based methods for image analysis, regional CBF deficits in the pre-cuneus and posterior cingulate gyrus were detected in a sample of HF sufferers relative to controls. The regional distribution of functional deficits in the latter study was similar to that found in many positron emission tomography (PET) investigations of glucose metabolism at early AD stages, as well as in recent PET investigations of amyloid deposition in AD. DISCUSSION Imaging studies have rarely investigated whether there are localized functional brain deficits in association with HF. Recent regional CBF SPECT data provide preliminary anatomic support to a view that AD-like brain changes may develop in HF patients, possibly as a consequence of chronic CBF reductions. Additional studies of larger HF samples are needed to confirm this possibility, preferably using PET measures that have afforded greater sensitivity and specificity to identify brain functional abnormalities associated with the diagnosis of AD, such as indices of glucose metabolism and amyloid deposition.
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Oguro H, Yamaguchi S, Abe S, Ishida Y, Bokura H, Kobayashi S. Differentiating Alzheimer's disease from subcortical vascular dementia with the FAB test. J Neurol 2006; 253:1490-4. [PMID: 17041740 DOI: 10.1007/s00415-006-0251-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 01/24/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The frontal assessment battery (FAB) test is a composite tool for assessing executive functions related to the frontal lobe. Neuropsychological and blood-flow studies indicate distinct patterns of deterioration of anterior and posterior cortical function in Alzheimer's disease (AD) and subcortical vascular dementia (VD) patients. We predict that the FAB score may be useful for discriminating VD from AD. OBJECTIVE To evaluate the clinical usefulness of the FAB test for differential diagnosis of AD and VD. METHODS We compared FAB scores in 25 patients with AD, 27 patients with VD, and 80 age-matched normal control subjects. The AD group was matched for age, education and MMSE score with the VD group. The subtest scores in FAB were also compared among the three groups. RESULTS The FAB scores were significantly decreased in both the AD and VD groups compared to the control group, and the reduction were greater in the VD group. Among the FAB subtests, mental flexibility (phonological verbal fluency) was the only subtest that significantly discriminated VD from the other two groups. CONCLUSIONS The FAB test can provide useful information for differentiating AD and VD at the bedside.
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Affiliation(s)
- Hiroaki Oguro
- Dept of Neurology, Hematology & Rheumatology, Faculty of Medicine, Shimane University, Izumo, Japan.
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Abstract
Biological aging of the brain is partly attributable to aging of the cerebrovascular circulation and the effects of these vascular changes on the brain. A variety of techniques ranging from simple, clinical scores to complex radiological techniques have been used in an attempt to understand, describe and quantify this process. Simultaneously attempts have been made to relate these changes to cognitive and physical changes and the risk of dementia and stroke associated with brain aging. The most frequently used clinical scores are the Framingham Stroke Risk Profile and the Hachinski Ischemic Score for vascular dementia. Radiological techniques to estimate cerebrovascular burden include many varieties of ultrasonographic, computerized tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine techniques. The radiological techniques evaluate the nature and extent of disease in the vessels supplying the brain and the pattern and extent of radiological evidence of damage to the brain both on static and dynamic imaging and are briefly outlined in this review. There are several studies using these techniques to study 'normal' aging populations, and the techniques used in the most widely known of these studies are briefly highlighted in this review.
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Affiliation(s)
- Sudha Seshadri
- Department of Neurology, School of Medicine, Boston University, Boston, USA.
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36
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Kerrouche N, Herholz K, Mielke R, Holthoff V, Baron JC. 18FDG PET in vascular dementia: differentiation from Alzheimer's disease using voxel-based multivariate analysis. J Cereb Blood Flow Metab 2006; 26:1213-21. [PMID: 16525414 DOI: 10.1038/sj.jcbfm.9600296] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The brain metabolic pattern of vascular dementia (VaD) remains poorly characterized. Univariate voxel-based analysis ignores the functional correlations among structures and may lack sensitivity and specificity. Here, we applied a novel voxel-based multivariate technique to a large ((18)F)2-fluoro-2-deoxy-D-glucose positron emission tomography data set. The sample consisted of 153 subjects, one-third each being probable subcortical VaD, probable Alzheimer disease (AD) (matched for Mini-Mental-State examination (MMSE) and age), and normal controls (NCs). We first applied principal component (PC) analysis and removed PCs significantly correlated to age. The remainders were used as feature vectors in a canonical variate analysis to generate canonical variates (CVs), that is, linear combinations of PC-scores. The first two CVs efficiently separated the groups. CV(1) separated VaD from AD with 100% accuracy, whereas CV(2) separated NC from demented subjects with 72% sensitivity and 96% specificity. Images depicting CV(1) and CV(2) showed that lower metabolism differentiating VaD from AD mainly concerned the deep gray nuclei, cerebellum, primary cortices, middle temporal gyrus, and anterior cingulate gyrus, whereas lower metabolism in AD versus VaD concerned mainly the hippocampal region and orbitofrontal, posterior cingulate, and posterior parietal cortices. The hypometabolic pattern common to VaD and AD mainly concerned the posterior parietal, precuneus, posterior cingulate, prefrontal, and anterior hippocampal regions, and linearly correlated with the MMSE. This study shows the potential of voxel-based multivariate methods to highlight independent functional networks in dementing diseases. By maximizing the separation between groups, this method extracted a metabolic pattern that efficiently differentiated VaD and AD.
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37
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Aliev G, Smith MA, Seyidova D, Neal ML, Lamb BT, Nunomura A, Gasimov EK, Vinters HV, Perry G, LaManna JC, Friedland RP. The role of oxidative stress in the pathophysiology of cerebrovascular lesions in Alzheimer's disease. Brain Pathol 2006; 12:21-35. [PMID: 11770899 PMCID: PMC8095987 DOI: 10.1111/j.1750-3639.2002.tb00419.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Alzheimer's disease (AD) and stroke are two leading causes of age-associated dementia. A rapidly growing body of evidence indicates that increased oxidative stress from reactive oxygen radicals is associated with the aging process and age-related degenerative disorders such as atherosclerosis, ischemia/reperfusion, arthritis, stroke, and neurodegenerative diseases. New evidence has also indicated that vascular lesions are a key factor in the development of AD. This idea is based on a positive correlation between AD and cardiovascular and cerebrovascular diseases such as arterio- and atherosclerosis and ischemia/reperfusion injury. In this review we consider recent evidence supporting the existence of an intimate relationship between oxidative stress and vascular lesions in the pathobiology of AD. We also consider the opportunities for therapeutic interventions based on the molecular pathways involved with these causal relationships.
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Affiliation(s)
| | | | | | | | - Bruce T. Lamb
- Genetics, Case Western Reserve University, Cleveland, Ohio
| | - Akihiko Nunomura
- Department of Psychiatry and Neurology, Asahikawa Medical College, Asahikawa, Japan
| | - Eldar K. Gasimov
- Department of Histology and Embryology, Baku Medical University, Baku Azerbaijan
| | - Harry V. Vinters
- Section of Neuropathology, Dept of Pathology and Lab Medicine, and Brain Research Institute, UCLA Medical Center, Los Angeles, Calif
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38
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Bateman GA, Levi CR, Schofield P, Wang Y, Lovett EC. Quantitative measurement of cerebral haemodynamics in early vascular dementia and Alzheimer's disease. J Clin Neurosci 2006; 13:563-8. [PMID: 16540327 DOI: 10.1016/j.jocn.2005.04.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Accepted: 04/07/2005] [Indexed: 11/19/2022]
Abstract
Alzheimer's disease (AD) and vascular dementia (VaD) both share significant vascular risk factors. The present study measures the haemodynamics of these diseases in absolute rather than relative terms. Twenty-four patients were classified as either early AD or VaD and were compared with 12 non-cognitively impaired subjects. Magnetic resonance imaging flow quantification was used to measure arterial inflow and arterial pulse volume. Mean vascular resistance and compliance were calculated. In AD, the arterial inflow was lower by 18%, resistance was higher by 23% and compliance of the arterial tree was lower by 20% compared with normal (p=0.01, 0.02 and 0.05, respectively). In VaD, the arterial pulse volume was higher by 24% and compliance was higher by 35% compared with normal (p=0.05 for both). Early VaD is characterized by normal blood flow, but increased pulsation. Reduced blood flow and an incompliant arterial tree characterize early AD.
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Affiliation(s)
- Grant A Bateman
- Department of Medical Imaging, John Hunter Hospital, Locked Bag 1, Newcastle Region Mail Center, New South Wales 2310, Australia.
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39
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Ebmeier KP, Donaghey C, Dougall NJ. Neuroimaging in dementia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2005; 67:43-72. [PMID: 16291019 DOI: 10.1016/s0074-7742(05)67002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- K P Ebmeier
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Morningside Park Edinburgh EH10 5HF, United Kingdom
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40
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Schreiber SJ, Doepp F, Spruth E, Kopp UA, Valdueza JM. Ultrasonographic measurement of cerebral blood flow, cerebral circulation time and cerebral blood volume in vascular and Alzheimer's dementia. J Neurol 2005; 252:1171-7. [PMID: 16151603 DOI: 10.1007/s00415-005-0826-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 01/14/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
Vascular dementia (VD) and Alzheimer's dementia (AD) are the most common differential diagnoses in patients with cognitive impairment. Although of different etiology, small vessel disease is postulated to be present in both conditions. We investigated global cerebral blood flow (CBF), global cerebral circulation time (CCT) and global cerebral blood volume (CBV) in VD and AD patients using a multimodal ultrasound (US) approach. 20 VD and 20 AD patients were included and compared with 12 age-matched controls. Duplex US of both internal carotid and vertebral arteries was performed to measure CBF. CCT was defined as the time delay of an echo-contrast bolus arrival between the internal carotid artery and internal jugular vein using extracranial Doppler. CBV was calculated as the product of CBF and CCT. CBF was significantly lower (VD: 570 +/- 61; AD: 578 +/- 77; controls: 733 +/- 54 ml/min) and CCT significantly longer (8.8 +/- 2.6; 8.2 +/- 1.4; 6.4 +/- 0.8 s) in both patient groups compared with controls (p < 0.003). No difference in CBF and CCT was found between the two patient groups. CBV was similar in all three groups (82 +/- 20; 79 +/- 19; 78 +/- 9 ml). The equally reduced CBF and prolonged CCT in VD and AD support the hypothesis, that small vessel disease is a relevant factor in both types of dementia. The presented multimodal US approach helps to assess the extent of changes in the global cerebral hemodynamics in patients with dementia but does not allow a differentiation between VD and AD.
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Affiliation(s)
- Stephan J Schreiber
- Dept. of Neurology, University Hospital Charité, Schumannstr. 20/21, 10117 Berlin, Germany.
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41
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Abstract
Dementia is a chronic brain syndrome with enormous impact on health care provision. Emission tomography (single photon emission computed tomography (SPECT) and positron emission tomography (PET)) provides a unique tool to investigate functional and neurochemical changes, both in those with established dementia and in those at risk of subsequent cognitive decline. Alzheimer's disease is characterized by bilateral temporoparietal hypoperfusion on SPECT and hypometabolism on PET, which may precede the onset of dementia as similar changes can be demonstrated in those with mild cognitive impairment and in those genetically at risk of developing Alzheimer's disease. In dementia with Lewy bodies medial parietal and occipital perfusion deficits are seen together with pre-synaptic and post-synaptic dopaminergic changes, most particularly a reduction in the striatal pre-synaptic dopamine transporter which can be visualized using appropriate ligands (e.g., (123)I-FP-CIT). Vascular dementia is associated with multiple, asymmetric, perfusion deficits in multi-infarct dementia. In contrast, subcortical vascular dementia is associated with reduced perfusion but preserved oxygen extraction fraction on PET. Fronto-temporal dementia is characterized by both hypometabolism and hypoperfusion in fronto-temporal lobes, though hypometabolism appears more extensive, affecting large areas of the cerebral hemispheres. Longitudinal studies of treatment response in Alzheimer's disease with cholinergic drugs have found changes in regional blood flow and nicotinic and muscarinic receptor function in those patients who respond to treatment. Currently, emission tomography is widely used for assisting with clinical differential diagnosis. Future developments will entail the development and application of more specific neurochemical ligands and those which bear a closer relationship to the underlying disease processes, including markers of tau, amyloid and synuclein pathology.
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Affiliation(s)
- Sanjeet Pakrasi
- Institute for Health and Ageing, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, NE4 6BE, UK.
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Du AT, Schuff N, Chao LL, Kornak J, Ezekiel F, Jagust WJ, Kramer JH, Reed BR, Miller BL, Norman D, Chui HC, Weiner MW. White matter lesions are associated with cortical atrophy more than entorhinal and hippocampal atrophy. Neurobiol Aging 2005; 26:553-9. [PMID: 15653183 DOI: 10.1016/j.neurobiolaging.2004.05.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 05/17/2004] [Accepted: 05/19/2004] [Indexed: 11/24/2022]
Abstract
The goal of this study was to examine the relationship between subcortical vascular disease and brain atrophy in patients with Alzheimer's disease (AD) and mixed dementia (i.e., AD and subcortical vascular disease together). MRI was performed on 77 cognitively normal (CN) subjects, 50 AD and 13 mixed dementia patients. Subcortical vascular disease was determined by white matter hyperintensities (WMH) volume and presence of subcortical lacunes. Brain atrophy was measured using total brain cortical gray matter (CGM), entorhinal cortex (ERC) and hippocampal volumes. CGM volume, but not ERC or hippocampal volume was inversely related to WMH volume in patients and controls. In contrast, no relationship was detected between CGM, ERC, or hippocampal volumes and subcortical lacunes. Furthermore, no interaction was found between WMH and diagnosis on cortical atrophy, implying that WMH affect cortical atrophy indifferently of group. These results suggest that subcortical vascular disease, manifested as WMH, may affect cortical atrophy more than ERC and hippocampal atrophy. Further, AD pathology and subcortical vascular disease may independently affect cortical atrophy.
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Affiliation(s)
- An-Tao Du
- Magnetic Resonance Unit (114M), Department of Veterans Affairs Medical Center, 4150, Clement Street, San Francisco, CA 94121, USA
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Tang BNT, Minoshima S, George J, Robert A, Swine C, Laloux P, Borght TV. Diagnosis of suspected Alzheimer's disease is improved by automated analysis of regional cerebral blood flow. Eur J Nucl Med Mol Imaging 2004; 31:1487-94. [PMID: 15232656 DOI: 10.1007/s00259-004-1597-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 05/11/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Accurate diagnosis of Alzheimer's disease (AD), the most common form of dementia, remains difficult. In order to assess whether fully automated stereotactic surface projection (3D-SSP) presentation contributes to the diagnosis of AD by single-photon emission computed tomography (SPECT), we investigated the diagnostic accuracy of transaxial display with and without 3D-SSP analysis as well as the correlation between cerebral perfusion in different cortical areas and the mini mental score (MMS). METHODS Seventy-two patients referred because of cognitive impairment were included in the study. According to the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer's disease and Related Disorders Association (ADRDA) criteria, 27 patients were diagnosed as having probable AD while 45 were classified as non-AD patients. 3D-SSP was used to quantify the regional cerebral blood flow (rCBF) acquired from SPECT imaging. RESULTS Compared with the transaxial section presentation alone, 3D-SSP presentation improved the area under the receiver operating curve (p<0.05) as well as intra-observer (k=0.73 vs 0.88) and inter-observer (k=0.50 vs 0.84) reproducibility. Upon normalisation of regional to thalamic activity, multiple regression analysis revealed a strong correlation between the MMS and rCBF in the right parietal cortex (p=0.002). CONCLUSION Addition of 3D-SSP to the transaxial section display of ECD-SPECT studies improves the reproducibility and the diagnostic performance in respect of AD in patients with cognitive impairment and provides a valid tool for assessment of the severity of cortical perfusion abnormalities in such patients.
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Affiliation(s)
- Bich-Ngoc-Thanh Tang
- Department of Nuclear Medicine, Mont-Godinne University Hospital, UCL-Université Catholique de Louvain, Yvoir, Belgium.
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Konkle ATM, Bielajew C. Tracing the Neuroanatomical Profiles of Reward Pathways with Markers of Neuronal Activation. Rev Neurosci 2004; 15:383-414. [PMID: 15656286 DOI: 10.1515/revneuro.2004.15.6.383] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Functional neuroanatomical tools have played an important role in proposing which structures underlie brain stimulation reward circuitry. This review focuses on studies employing metabolic markers of neuronal and glial activation, including 2-deoxyglucose, cytochrome oxidase, and glycogen phosphorylase, and a marker of cellular activation, the immediate early gene c-fos. The principles underlying each method, their application to the study of brain stimulation reward, and their strengths and limitations are described. The usefulness of this strategy in identifying candidate structures, and the degree of overlap in the patterns of activation arising from different markers is addressed in detail. How these data have contributed to an understanding of the organization of reward circuitry and directed our thinking towards an alternative framework of neuronal arrangement is discussed in the final section.
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Affiliation(s)
- Anne T M Konkle
- University of Ottawa, School of Psychology, Ottawa, Ontario, Canada
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45
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Schuff N, Capizzano AA, Du AT, Amend DL, O'Neill J, Norman D, Jagust WJ, Chui HC, Kramer JH, Reed BR, Miller BL, Yaffe K, Weiner MW. Different patterns of N-acetylaspartate loss in subcortical ischemic vascular dementia and AD. Neurology 2003; 61:358-64. [PMID: 12913198 PMCID: PMC1820863 DOI: 10.1212/01.wnl.0000078942.63360.22] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES 1) To determine the regional pattern of reduced N-acetylaspartate (NAA) in subcortical ischemic vascular dementia (SIVD); 2) to explore the relationship between NAA reduction and subcortical vascular disease; and 3) to test if MR spectroscopic imaging (MRSI) in combination with structural MRI improves differentiation between SIVD and Alzheimer disease (AD). METHODS Thirteen patients with SIVD (71 +/- 8 years old) and 43 patients with AD of comparable age and dementia severity were studied using MRSI and MRI. Patients were compared to 52 cognitively normal subjects with and without lacunes. RESULTS Compared to controls, patients with SIVD had lower NAA by 18% (p < 0.001) in frontal cortex and by 27% (p < 0.003) in parietal cortex, but no significant NAA reduction in white matter and medial temporal lobe. Compared to patients with AD, patients with SIVD had lower NAA by 13% (p < 0.02) in frontal cortex and by 20% (p < 0.002) in left parietal cortex. Cortical NAA decreased in SIVD with increasing white matter lesions (r = 0.54, p < 0.02) and number of lacunes (r = 0.59, p < 0.02). Thalamic lacunes were associated with greater NAA reduction in frontal cortex than were lacunes outside the thalamus (p < 0.02) across groups, after adjusting for cognitive impairments. Adding parietal NAA to MRI-derived hippocampal atrophy improved separation between SIVD and AD (p = 0.02) from 79 to 89%. CONCLUSIONS These results emphasize the importance of cortical dysfunction as a factor in SIVD and indicate a characteristic pattern of metabolite change that might serve as a basis for improved diagnosis.
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Affiliation(s)
- N Schuff
- Magnetic Resonance Unit, DVA Medical Center San Francisco, CA 94121, USA.
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Abstract
Measurement of local cerebral glucose metabolism (lCMRGlc) by positron emission tomography (PET) and 18F-2-fluoro-2-deoxy-D-glucose (FDG) has become a standard technique during the past 20 years and is now available at many university hospitals in all highly developed countries. Many studies have documented a close relation between lCMRGlc and localized cognitive functions, such as language and visuoconstructive abilities. Alzheimer's disease (AD) is characterized by regional impairment of cerebral glucose metabolism in neocortical association areas (posterior cingulate, temporoparietal and frontal multimodal association cortex), whereas primary visual and sensorimotor cortex, basal ganglia, and cerebellum are relatively well preserved. In a multicenter study comprising 10 PET centers (Network for Efficiency and Standardisation of Dementia Diagnosis, NEST-DD) that employed an automated voxel-based analysis of FDG PET images, the distinction between controls and AD patients was 93% sensitive and 93% specific, and even in very mild dementia (at MMSE 24 or higher) sensitivity was still 84% at 93% specificity. Significantly abnormal metabolism in mild cognitive deficit (MCI) indicates a high risk to develop dementia within the next two years. Reduced neocortical glucose metabolism can probably be detected with FDG PET in AD on average one year before onset of subjective cognitive impairment. In addition to glucose metabolism, specific tracers for dopamine synthesis (18F-F-DOPA) and for (11C-MP4A) are of interest for differentiation among dementia subtypes. Cortical acetylcholine esterase activity (AChE) activity is significantly lower in patients with AD or with dementia with Lewy bodies (DLB) than in age-matched normal controls. In LBD there is also impairment of dopamine synthesis, similar to Parkinson disease.
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Affiliation(s)
- Karl Herholz
- Neurologische Universitätsklinik, Max-Planck-Institut für neurologische Forschung, Köln, Germany.
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Van Heertum RL, Tikofsky RS. Positron emission tomography and single-photon emission computed tomography brain imaging in the evaluation of dementia. Semin Nucl Med 2003; 33:77-85. [PMID: 12605358 DOI: 10.1053/snuc.2003.127294] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The role of PET and SPECT brain imaging in the initial assessment and differential diagnosis of dementia is beginning to evolve rapidly. Numerous studies confirm the value of functional brain imaging, particularly with FDG-PET imaging, as a potentially cost-effective means of establishing an earlier diagnosis of Alzheimer's disease. Such an approach should allow for a more objective means of establishing which patients will benefit from treatment with cholinesterase inhibitors. In the future, neuroreceptor and plaque burden imaging studies should further enhance the sensitivity and specificity of dementia detection and patient management.
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Affiliation(s)
- Ronald L Van Heertum
- Department of Radiology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Yang DW, Kim BS, Park JK, Kim SY, Kim EN, Sohn HS. Analysis of cerebral blood flow of subcortical vascular dementia with single photon emission computed tomography: adaptation of statistical parametric mapping. J Neurol Sci 2002; 203-204:199-205. [PMID: 12417384 DOI: 10.1016/s0022-510x(02)00291-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Subcortical vascular dementia (VaD) is a relatively homogeneous subtype of VaD, but the mechanisms of cognitive dysfunction of subcortical VaD are not fully understood. This study investigates the changes of cerebral blood flow (CBF) in patients with subcortical VaD and the contribution of the white matter hyperintensity (WMHI) and clinical severity to CBF changes. METHODS 99mTc-ethyl cysteinate dimer single photon emission computed tomography (SPECT) was performed to measure the regional CBF and statistical parametric mapping SPM99 software was applied to automated and objective analysis of the SPECT image data. Twenty-three patients (12 male, 11 female) with mild to moderate dementia who met both the criteria of the DSM-IV and probable and possible NINDS-AIREN for VaD and had subcortical white matter changes and lacunar infarctions in brain MRI were evaluated against 17 normal control subjects (7 male, 10 female). The severity of the WMHI was measured by the semi-quantitative scale method proposed by Mäntyla. The Clinical Dementia Rating scale measured the severity of dementia. RESULTS SPM analysis of the SPECT image reveals significantly reduced regional CBF in the right thalamus, left caudate nucleus, cingulate, bilateral superior temporal, and left ventral subcallosal gyri in subcortical VaD patients compared to the normal controls (corrected P<0.001). Of four WMHIs, only the deep WMHI was associated with the small CBF reduction in the left superior temporal gyrus (uncorrected P<0.01). The reduction of the CBF according to the severity of dementia was noted in the anterior and posterior association areas (uncorrected P<0.01). CONCLUSIONS Our study suggests that cognitive dysfunction of subcortical VaD may be related to the reduction of the CBF in the brain areas mentioned, which are probably not associated with the severity of periventricular WMHI and dementia.
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Affiliation(s)
- Dong-Won Yang
- Department of Neurology, College of Medicine, The Catholic University of Korea, South Korea
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Tanaka M, Okamoto K, Hirai S. Cerebral blood flow and oxygen metabolism in vascular dementia evaluated by positron emission tomography: importance of frontal lobe hypoperfusion and hypometabolism. Ann N Y Acad Sci 2002; 977:135-40. [PMID: 12480743 DOI: 10.1111/j.1749-6632.2002.tb04808.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Makoto Tanaka
- Department of Neurology, Gunma University School of Medicine, 3-39-33 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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50
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Nagata K, Sato M, Satoh Y, Watahiki Y, Kondoh Y, Sugawara M, Box G, Wright D, Leung S, Yuya H, Shimosegawa E. Hemodynamic aspects of Alzheimer's disease. Ann N Y Acad Sci 2002; 977:391-402. [PMID: 12480778 DOI: 10.1111/j.1749-6632.2002.tb04843.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Neuroradiological functional imaging techniques demonstrate the patterns of hypoperfusion and hypometabolism that are thought to be useful in the differential diagnosis of Alzheimer's disease (AD) from other dementing disorders. Besides the distribution patterns of perfusion or energy metabolism, vascular transit time (VTT), vascular reactivity (VR), and oxygen extraction fraction (OEF), which can be measured with positron emission tomography (PET), provide hemodynamic aspects of brain pathophysiology. In order to evaluate the hemodynamic features of AD, PET studies were carried out in 20 patients with probable AD and 20 patients with vascular dementia (VaD). The PET findings were not included in their diagnostic process of AD. Using oxygen-15-labeled compounds, cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO(2)), OEF, cerebral blood volume, and VTT were measured quantitatively during resting state. To evaluate VR, CBF was also measured during CO(2) inhalation. There was a significant increase in OEF in and around the parietotemporal cortices, but both VTT and VR were well preserved in patients with AD. By contrast, VR was markedly depressed and VTT was mildly prolonged in patients with VaD. Thus, from the hemodynamic point of view, the preservation of vascular reserve may be a distinct difference between AD and VaD. Furthermore, this indicates a hemodynamic integrity of the vasculature in the level of arterioles in AD.
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Affiliation(s)
- Ken Nagata
- Department of Neurology, Research Institute for Brain and Blood Vessels, 6-10 Senshu-Kubota-Machi, Akita 010-0874, Japan.
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